Skip to main content

Advertisement

Log in

Weight changes in postmenopausal breast cancer survivors over 2 years of endocrine therapy: a retrospective chart review

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Obesity and weight gain after breast cancer (BC) diagnosis can affect cancer outcomes. This study explores the question of weight change during the first 2 years of endocrine treatment (ET) to identify the independent effects of BC diagnosis and treatment on post-diagnosis weight trajectories in early-stage postmenopausal BC survivors.

Methods

The study design is a retrospective chart review. Chi square tests and ANOVA were used to compare patients who gained >2 kg, lost >2 kg, or had stable weight. Log-binomial regression models were used to evaluate associations between patient characteristics and weight trajectories.

Results

The final sample is N = 300, with mean age at BC diagnosis of 65 years and 76% white. After 2 years of ET, 39% of study participants had gained >2 kg, 27% had lost >2 kg, and 34% had stable weight. Relative risks (RR) for weight gain were as follows: age at diagnosis = 0.98 (0.96, 0.99), being married = 1.48 (1.04, 2.12), weight change between BC diagnosis and start of ET = 0.98 (0.97, 0.99), Stage II = 1.42 (1.01, 2.01) or Stage III = 1.99 (1.41, 2.82), PR negative = 0.70 (0.51, 0.96), HER2 positive = 1.51 (1.07, 2.13), mastectomy = 1.49 (1.12, 1.98), axillary node dissection = 1.67 (1.27, 2.20), adjuvant chemotherapy = 1.49 (1.02, 2.19), and neoadjuvant chemotherapy = 2.29 (1.67, 3.14). Type of ET (tamoxifen or aromatase inhibitor) was not significant.

Conclusions

In our sample of postmenopausal early-stage BC survivors, a majority had stable or lost weight during the first 2 years of ET. Higher disease complexity and associated treatment posed higher RR for weight gain.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Playdon MC, Bracken MB, Sanft TB, Ligibel JA, Harrigan M, Irwin ML (2015) Weight gain after breast cancer diagnosis and all-cause mortality: systematic review and meta-analysis. J Natl Cancer Inst 107(12):275

    Article  Google Scholar 

  2. Ligibel JA, Alfano CM, Courneya KS et al (2014) American Society of Clinical Oncology position statement on obesity and cancer. J Clin Oncol 32(31):3568–3574

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ligibel JA, Alfano CM, Hershman D et al (2015) Recommendations for obesity clinical trials in cancer survivors: American Society of Clinical Oncology Statement. J Clin Oncol 33(33):3961–3967

    Article  PubMed  Google Scholar 

  4. Denlinger CS, Ligibel JA, Are M et al (2014) Survivorship: nutrition and weight management, Version 2.2014. Clinical practice guidelines in oncology. J Natl Compr Canc Netw 12(10):1396–1406

    PubMed  PubMed Central  Google Scholar 

  5. Anderson AS, Key TJ, Norat T et al (2015) European code against cancer 4th edition: obesity, body fatness and cancer. Cancer Epidemiol 39(Suppl 1):S34–S45

    Article  PubMed  Google Scholar 

  6. Alfano CM, Bluethmann SM, Tesauro G et al (2016) NCI Funding trends and priorities in physical activity and energy balance research among cancer survivors. J Natl Cancer Inst. doi:10.1093/jnci/djv285

    PubMed  Google Scholar 

  7. Ballard-Barbash R, Siddiqi SM, Berrigan DA, Ross SA, Nebeling LC, Dowling EC (2013) Trends in research on energy balance supported by the National Cancer Institute. Am J Prev Med 44(4):416–423

    Article  PubMed  PubMed Central  Google Scholar 

  8. Alfano CM, Molfino A, Muscaritoli M (2013) Interventions to promote energy balance and cancer survivorship: priorities for research and care. Cancer 119(Suppl 11):2143–2150

    Article  PubMed  PubMed Central  Google Scholar 

  9. Rock CL, Doyle C, Demark-Wahnefried W et al (2012) Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 62(4):243–274

    Article  PubMed  Google Scholar 

  10. Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA et al (2010) American college of sports medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 42(7):1409–1426

    Article  PubMed  Google Scholar 

  11. Kushi LH, Doyle C, McCullough M et al (2012) American Cancer Society guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin 62(1):30–67

    Article  PubMed  Google Scholar 

  12. Demark-Wahnefried W, Peterson B, McBride C, Lipkus I, Clipp E (2000) Current health behaviors and readiness to pursue life-style changes among men and women diagnosed with early stage prostate and breast carcinomas. Cancer 88(3):674–684

    Article  CAS  PubMed  Google Scholar 

  13. Harvie M (2010) The importance of controlling body weight after a diagnosis of breast cancer: the role of diet and exercise in breast cancer patient management. In: Saxton J, Daley A (eds) Exercise and cancer survivorship: impact on health outcomes and quality of life. Springer, New York

    Google Scholar 

  14. Key TJ, Appleby PN, Reeves GK, Roddam A, Dorgan JF et al (2003) Body mass index, serum sex hormones, and breast cancer risk in postmenopausal women. N Natl Cancer Inst 95(16):1218–1226

    Article  CAS  Google Scholar 

  15. Cheraghi Z, Poorolajal J, Hashem T, Esmailnasab N, Doosti Irani A (2012) Effect of body mass index on breast cancer during premenopausal and postmenopausal periods: a meta-analysis. PLoS ONE 7(12):e51446

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Keum N, Greenwood DC, Lee DH et al (2015) Adult weight gain and adiposity-related cancers: a dose-response meta-analysis of prospective observational studies. J Natl Cancer Inst. doi:10.1093/jnci/dju428

    Google Scholar 

  17. La Vecchia C, Giordano SH, Hortobagyi GN, Chabner B (2011) Overweight, obesity, diabetes, and risk of breast cancer: interlocking pieces of the puzzle. Oncologist 16(6):726–729

    Article  PubMed  PubMed Central  Google Scholar 

  18. Xia X, Chen W, Li J et al (2014) Body mass index and risk of breast cancer: a nonlinear dose-response meta-analysis of prospective studies. Sci Rep 4:7480

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Coughlin SS, Smith SA (2015) The insulin-like growth factor axis, adipokines, physical activity, and obesity in relation to breast cancer incidence and recurrence. Cancer Clin Oncol 4(2):24–31

    PubMed  PubMed Central  Google Scholar 

  20. Petrelli JM, Calle EE, Rodriguez C, Thun MJ (2002) Body mass index, height, and postmenopausal breast cancer mortality in a prospective cohort of US women. Cancer Causes Control 13(4):325–332

    Article  PubMed  Google Scholar 

  21. Nechuta S, Chen WY, Cai H et al (2016) A pooled analysis of post-diagnosis lifestyle factors in association with late estrogen-receptor-positive breast cancer prognosis. Int J Cancer 138(9):2088–2097

    Article  CAS  PubMed  Google Scholar 

  22. Bradshaw PT, Ibrahim JG, Stevens J, Cleveland RJ, Abrahamson PE et al (2012) Postdiagnosis change in bodyweight and survival after breast cancer diagnosis. Epidemiology 23(2):320–327

    Article  PubMed  PubMed Central  Google Scholar 

  23. Niraula S, Ocana A, Ennis M, Goodwin PJ (2012) Body size and breast cancer prognosis in relation to hormone receptor and menopausal status: a meta-analysis. Breast Cancer Res Treat 134(2):769–781

    Article  CAS  PubMed  Google Scholar 

  24. Dixon JK, Moritz DA, Baker FL (1978) Breast cancer and weight gain: an unexpected finding. Oncol Nurs Forum 5(3):5–7

    CAS  PubMed  Google Scholar 

  25. Levine EG, Raczynski JM, Carpenter JT (1991) Weight gain with breast cancer adjuvant treatment. Cancer 67(7):1954–1959

    Article  CAS  PubMed  Google Scholar 

  26. Demark-Wahnefried W, Winer EP, Rimer BK (1993) Why women gain weight with adjuvant chemotherapy for breast cancer. J Clin Oncol 11(7):1418–1429

    Article  CAS  PubMed  Google Scholar 

  27. Anderson WF, Pfeiffer RM, Dores GM, Sherman ME (2006) Comparison of age distribution patterns for different histopathologic types of breast carcinoma. Cancer Epidemiol Biomark Prev 15(10):1899–1905

    Article  Google Scholar 

  28. Benz CC (2008) Impact of aging on the biology of aging. Crit Rev Oncol Hematol 66(1):65–74

    Article  PubMed  Google Scholar 

  29. Howlader N, Altekruse SF, Li CI et al (2014) US incidence of breast cancer subtypes defined by joint hormone receptor and HER2 status. J Natl Cancer Inst. doi:10.1093/jnci/dju055

    PubMed  PubMed Central  Google Scholar 

  30. Clark GM, Osborne CK, McGuire WL (1984) Correlations between estrogen receptor, progesterone receptor, and patient characteristics in human breast cancer. J Clin Oncol 2:1102–1109

    Article  CAS  PubMed  Google Scholar 

  31. Jenkins EO, Deal AM, Anders CK et al (2014) Age-specific changes in intrinsic breast cancer subtypes: a focus on older women. Oncologist 19(10):1076–1083

    Article  PubMed  PubMed Central  Google Scholar 

  32. Kohler BA, Sherman RL, Howlader N et al (2015) Annual report to the nation on the status of cancer, 1975-2011, featuring incidence of breast cancer subtypes by race/ethnicity, poverty, and state. J Natl Cancer Inst 107(6):djv048

    Article  PubMed  PubMed Central  Google Scholar 

  33. Dunnwald LK, Rossing MA, Li CI (2007) Hormone receptor status, tumor characteristics, and prognosis: a prospective cohort of breast cancer patients. Breast Cancer Res 9(1):R6

    Article  PubMed  PubMed Central  Google Scholar 

  34. Eppenberger-Castori S, Moore DH Jr, Thor AD et al (2002) Age-associated biomarker profiles of human breast cancer. Int J Biochem Cell Biol 34(11):1318–1330

    Article  CAS  PubMed  Google Scholar 

  35. Taylor WC, Muss HB (2010) Recent advances: adjuvant therapy for older women with breast cancer. Cancer J 16(4):289–293

    Article  PubMed  Google Scholar 

  36. Schiavon G, Smith IE (2014) Status of adjuvant endocrine therapy for breast cancer. Breast Cancer Res 16(2):206

    Article  PubMed  PubMed Central  Google Scholar 

  37. Dowsett M, Cuzick J, Ingle J et al (2010) Meta-analysis of breast cancer outcomes in adjuvant trials of aromatase inhibitors versus tamoxifen. J Clin Oncol 28(3):509–518

    Article  CAS  PubMed  Google Scholar 

  38. Goss PE, Ingle JN, Pritchard KI, et al (2016) Extending aromatase-inhibitor adjuvant therapy to 10 years. N Engl J Med 375(3):209–219

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Sestak I, Cuzick J, Sapunar F et al (2008) Risk factors for joint symptoms in patients enrolled in the ATAC trial: a retrospective, exploratory analysis. Lancet Oncol 9(9):866–872

    Article  PubMed  Google Scholar 

  40. Mao JJ, Chung A, Benton A et al (2013) Online discussion of drug side effects and discontinuation among breast cancer survivors. Pharmacoepidemiol Drug Saf 22(3):256–262

    Article  PubMed  PubMed Central  Google Scholar 

  41. Aiello Bowles EJ, Boudreau DM, Chubak J et al (2012) Patient-reported discontinuation of endocrine therapy and related adverse effects among women with early-stage breast cancer. J Oncol Pract 8(6):49–57

    Article  Google Scholar 

  42. Malinovszky KM, Cameron D, Douglas S et al (2004) Breast cancer patients’ experiences on endocrine therapy: monitoring with a checklist for patients on endocrine therapy (C-PET). Breast 13(5):363–368

    Article  CAS  PubMed  Google Scholar 

  43. Kadakia KC, Snyder CF, Kidwell KM et al (2016) Patient-reported outcomes and early discontinuation in aromatase inhibitor-treated postmenopausal women with early stage breast cancer. Oncologist 21(5):539–546

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Sestak I, Distler W, Forbes JF, Dowsett M, Howell A, Cuzick J (2010) Effect of body mass index on recurrences in tamoxifen and anastrozole treated women: an exploratory analysis from the ATAC trial. J Clin Oncol 28(21):3411–3415

    Article  CAS  PubMed  Google Scholar 

  45. Wolters R, Schwentner L, Regierer A, Wischnewsky M, Kreienberg R, Wöckel A (2012) Endocrine therapy in obese patients with primary breast cancer: another piece of evidence in an unfinished puzzle. Breast Cancer Res Treat 131(3):925–931

    Article  CAS  PubMed  Google Scholar 

  46. Gnant M, Pfeiler G, Stoger H et al (2013) The predictive impact of body mass index on the efficacy of extended adjuvant endocrine treatment with anastrozole in postmenopausal patients with breast cancer: an analysis of the randomised ABCSG-6a trial. Br J Cancer 109(3):589–596

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Pfeiler G, Stoger H, Dubsky P et al (2013) Efficacy of tamoxifen ± aminoglutethimide in normal weight and overweight postmenopausal patients with hormone receptor-positive breast cancer: an analysis of 1509 patients of the ABCSG-06 trial. Br J Cancer 108(7):1408–1414

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Ioannides SJ, Barlow PL, Elwood JM, Porter D (2014) Effect of obesity on aromatase inhibitor efficacy in postmenopausal, hormone receptor-positive breast cancer: a systematic review. Breast Cancer Res Treat 147(2):237–248

    Article  CAS  PubMed  Google Scholar 

  49. Caan BJ, Emond JA, Su HI et al (2012) Effect of postdiagnosis weight change on hot flash status among early-stage breast cancer survivors. J Clin Oncol 30(13):1492–1497

    Article  PubMed  PubMed Central  Google Scholar 

  50. Su H, Sammel MD, Springer E, Freeman EW, DeMichele A, Mao JJ (2010) Weight gain is associated with increased risk of hot flashes in breast cancer survivors on aromatase inhibitors. Breast Cancer Res Treat 124(1):205–211

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Young A, Weltzien E, Kwan M, Castillo A, Caan B, Kroenke CH (2014) Pre- to post-diagnosis weight change and associations with physical functional limitations in breast cancer survivors. J Cancer Surviv 8(4):539–547

    Article  PubMed  PubMed Central  Google Scholar 

  52. Voskuil DW, van Nes JG, Junggeburt JM, van de Velde CJ, van Leeuwen FE, de Haes JC (2010) Maintenance of physical activity and body weight in relation to subsequent quality of life in postmenopausal breast cancer patients. Ann Oncol 21(10):2094–2101

    Article  CAS  PubMed  Google Scholar 

  53. Nyrop KA, Williams GR, Muss HB, Shachar SS (2016) Weight gain during adjuvant endocrine treatment for early-stage breast cancer: what is the evidence? Breast Cancer Res Treat 158(2):203–217

    Article  CAS  PubMed  Google Scholar 

  54. Gallicchio L, MacDonald R, Wood B, Rushovich E, Helzlsouer KJ (2012) Menopausal-type symptoms among breast cancer patients on aromatase inhibitor therapy. Climacteric 15(4):339–349

    Article  CAS  PubMed  Google Scholar 

  55. Heideman WH, Russell NS, Gundy C, Rookus MA, Voskuil DW (2009) The frequency, magnitude and timing of post-diagnosis body weight gain in Dutch breast cancer survivors. Eur J Cancer 45:119–126

    Article  CAS  PubMed  Google Scholar 

  56. van de Velde CJ, Rea D, Seynaeve C et al (2011) Adjuvant tamoxifen and exemestane in early breast cancer (TEAM): a randomised phase 3 trial. Lancet 377(9762):321–331

    Article  PubMed  Google Scholar 

  57. Fallowfield LJ, Kilburn LS, Langridge C et al (2012) Long-term assessment of quality of life in the intergroup exemestane study: 5 years post-randomisation. Br J Cancer 106(6):1062–1067

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Sestak I, Harvie M, Howell A, Forbes JF, Dowsett M, Cuzick J (2012) Weight change associated with anastrozole and tamoxifen treatment in postmenopausal women with or at high risk of developing breast cancer. Breast Cancer Res Treat 134(2):727–734

    Article  CAS  PubMed  Google Scholar 

  59. Vassar M, Holzmann M (2013) The retrospective chart review: important methodological considerations. J Edu Eval Health Prof 10:12

    Article  Google Scholar 

  60. Goodwin PJ, Ennis M, Pritchard KI, McCready D, Koo J et al (1999) Adjuvant treatment and onset of menopause predict weight gain after breast cancer diagnosis. J Clin Oncol 17(1):120–129

    Article  CAS  PubMed  Google Scholar 

  61. Hoskin PJ, Ashley S, Yarnold JR (1992) Weight gain after primary surgery for breast cancer—effect of tamoxifen. Breast Cancer Res Treat 22(2):129–132

    Article  CAS  PubMed  Google Scholar 

  62. Kritchevsky SB, Wilcosky TC, Morris DL, Truong KN, Tyroler HA (1991) Changes in plasma lipid and lipoprotein cholesterol and weight prior to the diagnosis of cancer. Cancer Res 51(12):3198–3203

    CAS  PubMed  Google Scholar 

  63. McTiernan A, Sorensen B, Irwin ML et al (2007) Exercise effect on weight and body fat in men and women. Obesity (Silver Spring, Md.) 15(6):1496–1512

    Article  Google Scholar 

  64. Myers CA, Slack T, Martin CK, Broyles ST, Heymsfield SB (2016) Change in obesity prevalence across the united states is influenced by recreational and healthcare contexts, food environments, and hispanic populations. PLoS ONE 11(2):e0148394

    Article  PubMed  PubMed Central  Google Scholar 

  65. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009(42):377–381

    Article  Google Scholar 

  66. Warner ET, Tamimi RM, Hughes ME et al (2015) Racial and ethnic differences in breast cancer survival: mediating effect of tumor characteristics and sociodemographic and treatment factors. J Clin Oncol 33(20):2254–2261

    Article  PubMed  PubMed Central  Google Scholar 

  67. Hou N, Huo D (2013) A trend analysis of breast cancer incidence rates in the United States from 2000 to 2009 shows a recent increase. Breast Cancer Res Treat 138(2):633–641

    Article  PubMed  Google Scholar 

  68. Nyrop KA, Callahan LF, Rini C et al (2016) Aromatase inhibitor associated arthralgia: the importance of oncology provider-patient communication about side effects and potential management through physical activity. Support Care Cancer 24(6):2643–2650

    Article  PubMed  Google Scholar 

  69. Nyrop KA, Deal AM, Williams GR, Guerard EJ, Pergolotti M, Muss HB (2016) Physical activity communication between oncology providers and patients with early-stage breast, colon, or prostate cancer. Cancer 122(3):470–476

    Article  PubMed  Google Scholar 

  70. Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM (2005) Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol 23(24):5814–5830

    Article  PubMed  PubMed Central  Google Scholar 

  71. Rabin C (2009) Promoting lifestyle change among cancer survivors: when is the teachable moment? Am J Lifestyle Med 3:369

    Article  Google Scholar 

  72. Anderson AS, Mackison D, Boath C, Steele R (2013) Promoting changes in diet and physical activity in breast and colorectal cancer screening settings: an unexplored opportunity for endorsing healthy behaviors. Cancer Prev Res (Phila) 6(3):165–172

    Article  Google Scholar 

  73. Humpel N, Magee C, Jones SC (2007) The impact of a cancer diagnosis on the health behaviors of cancer survivors and their family and friends. Support Care Cancer 15(6):621–630

    Article  PubMed  Google Scholar 

  74. Wolin KY, Schwartz AL, Matthews CE, Courneya KS, Schmitz KH (2012) Implementing the exercise guidelines for cancer survivors. J Support Oncol 10(5):171–177

    Article  PubMed  PubMed Central  Google Scholar 

  75. Santa Mina D, Alibhai SM, Matthew AG et al (2012) Exercise in clinical cancer care: a call to action and program development description. Curr Oncol 19(3):e136–e144

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Ruiz-Casado A, Lucia A (2014) The time has come for oncologists to recommend physical activity to cancer survivors. Arch Exerc Health Dis 4(1):214–215

    Google Scholar 

Download references

Acknowledgements

This study was supported by the Breast Cancer Research Foundation of New York and the UNC Lineberger Comprehensive Cancer Center/University Cancer Research Fund. Dr. Shachar’s fellowship at UNC was supported by the Friends of Rambam Medical Center and The J&G Zukier Medical Fund Donation, Haifa, Israel.

Funding

This study was funded in part by the Breast Cancer Research Foundation of New York, and UNC Lineberger Comprehensive Cancer Center/University Cancer Research Fund.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kirsten A. Nyrop.

Ethics declarations

Conflict of interest

The authors declare they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

This study did not entail direct contact with humans and therefore did not entail obtaining informed consent.

Additional information

The abstract for this study was accepted for publication, 2016 ASCO Annual Meeting.

Appendix

Appendix

See Fig. 3.

Fig. 3
figure 3

Flow diagram

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nyrop, K.A., Deal, A.M., Lee, J.T. et al. Weight changes in postmenopausal breast cancer survivors over 2 years of endocrine therapy: a retrospective chart review. Breast Cancer Res Treat 162, 375–388 (2017). https://doi.org/10.1007/s10549-017-4106-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-017-4106-y

Keywords

Navigation