- Obesity has many adverse effects in patients with breast and other cancers.
- In this analysis, breast cancer patients randomized to a behavioral weight-loss intervention lost an average of 4.7% of their baseline body weight.
- Meanwhile, a control group who received health education only gained 1% of their baseline body weight.
A telephone-based intervention resulted in significant weight loss for breast cancer patients with overweight or obesity in a secondary analysis of the phase III Breast Cancer Weight Loss (BWEL) trial.
At 1 year, patients randomized to the behavioral weight-loss intervention lost an average of 4.7% of their baseline body weight compared with a gain of 1% of body weight in a control group (P<0.001), reported Jennifer A. Ligibel, MD, of the Dana-Farber Cancer Institute in Boston, and colleagues in JAMA Oncology.
About 47% of patients in the intervention group lost 5% of their baseline body weight compared with 14.3% in the control group, while 22.5% and 5% of the two groups lost 10% of their baseline body weight, respectively. In contrast, 21.9% of control participants gained more than 5% of baseline body weight compared with just 8.2% in the weight-loss intervention group.
"Given the many adverse effects of obesity in patients with breast and other cancers, the BWEL trial provides a path to reduce toxic effects, reduce the risk of comorbidities such as diabetes and cardiovascular disease, and improve quality of life in the growing population of patients with cancer and obesity," the authors concluded. "Further, these findings suggest that the BWEL trial is poised to test the impact of lifestyle-based weight loss on disease outcomes in early breast cancer, potentially helping to mitigate the poor breast cancer outcomes experienced by women with obesity."
The weight gain observed in the control group highlights "the significant challenges that patients with breast cancer experience in avoiding weight gain and the need for scalable [weight-loss interventions] that can be applied across clinical settings," they noted.
However, in an editorial accompanying the study, Anne McTiernan, MD, PhD, of the Fred Hutchinson Cancer Center in Seattle, pointed out that "it is not clear if the amount [of weight loss] achieved will be sufficient to produce meaningful improvement in prognosis."
"If the BWEL trial shows beneficial effects on its primary endpoint [disease-free survival], the clinical impact could be significant," she added.
This study along with other randomized trials of behavioral weight-loss interventions "are making major contributions to help improve the clinical care of women with breast cancer," McTiernan concluded. "Trials of weight loss treatments that produce greater degrees of weight loss are also needed in patients with breast cancer, both to determine risk-benefit ratios and to provide treatment options for this population."
The BWEL trial involved 3,180 women with stage II-III HER2-negative breast cancer and a body mass index (BMI) of ≥27, who were enrolled from 637 cancer treatment centers in the U.S. and Canada between August 2016 and February 2021.
Mean age at baseline was 53.4 years, and mean BMI was 34.4; 80.3% were white, 12.8% were Black, and 7.3% were Hispanic or Latino.
Participants in the intervention group received a 2-year, telephone-based lifestyle intervention that promoted weight loss through caloric restriction, increased physical activity, and health education. The control group received health education alone.
Overall, 81.2% of participants had received neoadjuvant or adjuvant chemotherapy prior to the start of the trial, 88.1% had undergone radiation therapy, and 94.3% with hormone receptor (HR)-positive cancers received endocrine therapy.
While the weight-loss intervention resulted in less weight loss in premenopausal, Black, and Hispanic or Latino participants, there were no significant differences in its effectiveness according to HR status, patient factors (education level, baseline BMI category, income level, smoking status), or treatment factors (receipt of chemotherapy or hormonal therapy).
Disclosures
The study was supported by the National Cancer Institute.
Ligibel had no disclosures.
Co-authors reported relationships with the National Cancer Institute, Pfizer, Bristol Myers Squibb, Sanofi, Gilead, Seattle Genetics, Lilly, AstraZeneca, Novartis, Genentech, the Merck Foundation, Guardant Health, Merck, GSK, AbbVie, Foundation Medicine, Daiichi Sankyo/AstraZeneca, Weight Watchers, the American Society of Clinical Oncology, and Wolters Kluwer.
McTiernan reported grants from the Breast Cancer Research Foundation.
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.