Lack of financial comfort linked to weight gain among young breast cancer survivors
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Key findings:
- Weight gain appeared common among young breast cancer survivors at 3 years after diagnosis.
- Less financial comfort, but not treatment-associated menopause, had a significant association with weight gain.
- Clinicians should consider “interventions that are accessible to people who may have more financial constraints.”
One-third of a cohort of young breast cancer survivors experienced significant weight gain at 3 years after diagnosis, according to study results.
Findings of the study, published in Cancer, showed weight gain had no significant association with treatment type or treatment-associated menopause — but less financial comfort did.
Rationale and methods
This study is a part of a larger ongoing research effort at Dana-Farber Cancer Institute that focuses on young women with breast cancer, Jennifer A. Ligibel, MD, associate professor at Harvard Medical School and director of Leonard P. Zakim Center for Integrative Therapies and Healthy Living and of Center for Faculty Well-Being at Dana-Farber, told Healio.
“We were very interested in recognizing the connection between weight, cancer risk and outcomes,” Ligibel said. “Previously published large cohort studies of long-term follow-up in women have showed that excess weight is a risk factor for developing breast cancer and for breast cancer recurrence. Prior studies have suggested that many treatments can contribute to weight gain, especially among young women who often have either temporary or permanent menopause as a result of treatment.”
Weight gain also may be linked to poor cancer outcomes and long-term high risk for chronic conditions, including heart disease and diabetes, Ligibel added.
“We also know that weight gain in young women is sometimes associated with poor quality of life and body image. So, it is an important factor for many reasons,” she said.
Ligibel, first author Tal Sella, MD, and colleagues pooled data on 956 women (median age at diagnosis, 37 years) diagnosed with stage zero to stage III breast cancer between 2006 and 2016 included in Young Women’s Breast Cancer Study led by Ann H. Partridge, MD, MPH, founder and director of Program for Young Women with Breast Cancer and director of Adult Survivorship Program at Dana-Farber. Researchers mailed study participants a baseline survey and subsequent semiannual surveys for the first 3 years after diagnosis, and then annual surveys.
Researchers collected patient-reported weight at diagnosis and 1 and 3 years after diagnosis. They obtained data on tumors and treatment from medical records and patient surveys. Researchers used multinomial logistic regression to identify factors associated with weight gain of 5% or more or weight loss of 5% or more compared with stable weight at 1 year and 3 years after diagnosis.
Key findings
Results showed mean weight increased from 66.5 kg at baseline to 67.3 kg at 1 year after diagnosis and 67.7 kg at 3 years (P .001 for both).
“Women gained a modest amount of weight, but weight gain was not as significant as it had been reported in previous studies and that is important to recognize,” Ligibel said.
The percentage of those who experienced weight gain of 5% or more increased from 24.8% at 1 year to 33.9% at 3 years.
Factors significantly associated with weight gain at 1 year after diagnosis included less self-perceived financial comfort, Black race and stage III disease. However, only less self-perceived financial comfort remained a significant factor for weight gain at 3 years after diagnosis.
Conversely, researchers found baseline overweight or obesity had a significant association with weight loss at 1 and 3 years, whereas chemotherapy, endocrine therapy and treatment-associated menopause had no association with weight change.
Ligibel and colleagues paid close attention to patients’ menopausal status, which had not been carefully considered in previous studies, she said.
“In prior studies, there was a connection between menopause and ‘shutting down’ the ovaries and other things that led to cessation of menses and the risk for gaining weight,” Ligibel said. “But we did not find that the type of antiestrogen treatment or treatment-related menopause were associated with weight change, which was surprising. However, we did find that the most significant predictor of weight gain was the financial status of the patient. Individuals who felt that they were not financially comfortable were more likely to gain weight.
“It is known that there is a strong relationship between socioeconomic status and obesity, but it was surprising to see this come through so strongly in this study, where at both short- and long-term time points, financial comfort appeared to be the strongest predictor of weight gain,” Ligibel added.
Implications
The findings better explain the vulnerability of patient populations who experience weight gain, Ligibel said.
“Knowing this should help us be more aware of this patient population that we need to pay special attention to,” she said. “In addition, as we develop interventions, we need to think about how these interventions are accessible to people who may have more financial constraints. For example, exercise programs are not something that most third-party insurers cover as a part of cancer care. We need to be able to support a healthy lifestyle in our patients.”
Ligibel and colleagues are now conducting a large randomized trial examining the impact of a weight loss program on recurrence among women with early breast cancer.
“The Breast Cancer Weight Loss [BWEL] study has enrolled almost 3,200 women from across the U.S. and Canada and looks at the impact of a diet and exercise-based weight management program on cancer recurrence in these patients,” Ligibel said. “The current study made us recognize the importance of looking at young women with breast cancer as a subset of that total study population. We have applied for ancillary projects that are trying to study that young cancer population in more detail.”
Partridge received additional grants recently to further develop interventions for these young women, Ligibel said.
“The goals of this work are to help to develop interventions that help support young breast cancer survivors both physically and psychologically,” Ligibel said.
In an accompanying editorial, Elizabeth J. Cathcart-Rake, MD, and Amye J. Tevaarwerk, MD, both oncologists at Mayo Clinic in Rochester, Minnesota, and Tara Sanft, MD, oncologist and director of the survivorship clinic at Yale Cancer Center and Smilow Cancer Hospital said, commended Ligibel and colleagues on the design of the study, which allowed for inclusion of traditionally underrepresented survivors.
“Their study survey went beyond the traditional questions about weight to examine some social determinants of health, eg, economic and/or social circumstances that influence individual and group differences in health status,” they wrote. “[The researchers] also incorporated the unique patient-reported outcome variable of financial comfort. This captures economic stability in a more pragmatic way than demographic data alone.”
A next step will be to translate the findings into meaningful action, the editorial authors noted.
“Policy and regulatory changes that target modifiable determinants of health with practical, sustainable interventions likely are needed and ultimately may improve breast cancer outcomes,” they wrote.
References:
- Cathcart-Rake EJ, et al. Cancer. 2022;doi:10.1002/cncr.34343.
- Sella T, et al. Cancer. 2022;doi:10.1002/cncr.34342.
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