Telephone-based intervention helps women with breast cancer lose weight
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Key takeaways:
- Women assigned the intervention lost an average 4.8% of baseline body weight at 6 months.
- The amount of weight loss varied based on factors such as menopausal status and race/ethnicity.
Women with breast cancer whose BMI fell in the overweight or obese ranges achieved meaningful weight loss via a telephone-based intervention, according to phase 3 study results.
Findings of the Breast Cancer Weight Loss (BWEL) trial, presented during a press conference ahead of ASCO Annual Meeting, also showed the amount of weight loss varied depending on menopausal status and race/ethnicity.
Rationale and methods
“We have known for a long time that women with obesity have poor outcomes in early breast cancer,” Jennifer A. Ligibel, MD, FASCO, associate professor of medicine at Dana-Farber Cancer Institute, told Healio. “Additionally, more and more of the global population has obesity, with average body weight increasing across the world, and it is beginning to contribute in a major way to breast cancer-associated mortality. We recognized these patients are at risk for poor outcomes based on their excess adiposity, so we wanted to see if we could help improve their outcomes by helping them lose weight.”
The study included 3,181 women (mean age, 53.4 years; average BMI, 34.5 kg/m²; 57% postmenopausal; 80.3% white) who received care at 600 sites across the U.S. and Canada between August 2016 and February 2021 for stage II or stage III hormone receptor-positive, HER2-negative or triple-negative breast cancer within the previous 14 months.
Eligibility criteria included completion of chemotherapy and radiation therapy and a BMI of at least 27 kg/m².
“This BMI is on the upper end of the overweight range, recognizing that many women will gain weight in the years after breast cancer diagnosis,” Ligibel said. “We enrolled women in both the obese range and women likely to end up in this range in the years after their diagnosis.”
Ligibel and colleagues sought to assess the impact of a 2-year telephone-based weight loss intervention on cancer recurrence and survival among these women. They randomly assigned women to the intervention plus health education or health education alone.
“The weight loss program was delivered by phone by weight loss counselors at the Dana-Farber Cancer Institute and focused on lowering calories and increasing physical activity,” Ligibel said. “Telephone calls were supplemented with a workbook and a variety of tools that patients could use to help foster weight loss, such as an activity monitor, wireless scale and meal replacement shakes.”
The health education program included nontailored diet and exercise materials, a quarterly newsletter, twice-yearly webinars and a subscription to a health magazine of choice, according to Ligibel.
“Notably, women who were interested in a weight-loss medication or undergoing bariatric surgery within 2 years were not eligible for this study as this was a lifestyle weight-loss program,” Ligibel said.
Invasive DFS served as the primary outcome, with a key secondary outcome of weight change.
Findings
Women assigned the intervention group lost an average 4.8% of baseline body weight at 6 months compared with 0.3% weight gain among those assigned health education alone.
“At 1 year, women assigned the weight loss intervention maintained the weight loss at 6 months, whereas patients randomized to the [health education alone] group gained additional weight and ended with a 0.9% weight gain at 1 year,” Ligibel said. “[This] equated to a 5.65%, or approximately 12-pound, weight differential between the two arms, [which was] clinically significant given that a 3% weight loss is sufficient to improve diabetes and other chronic diseases.”
Results of analyses that examined weight loss in patient subsets showed significant interactions between menopausal status and race/ethnicity and patterns of weight change.
“Premenopausal women in the weight loss intervention group lost less weight, whereas those assigned to the [health education alone] group gained more weight compared with postmenopausal women,” Ligibel said.
In addition, white women lost a higher percentage of body weight at 6 months (6.05%) than Hispanic women (4.13%) and Black women (3.74%; P for interaction = .019).
“We were really interested to see how the weight loss program worked across different patient groups because prior studies that compared young vs. older-aged women or white vs. Black women with breast cancer were not successful in reducing weight among young or Black women,” Ligibel said. “We found that there were, in fact, differences. For example, Black women in the health education-alone group gained more weight than any other group of patients and experienced less weight loss than other women in the intervention group. The same appeared true for younger women, but the intervention did reduce weight across all groups.”
Further analyses revealed greater weight loss among women with hormone receptor-positive vs. -negative disease, according to Ligibel.
“We will continue to dig through that data, but this offers a lot of hope to women who are on aromatase inhibitors and are struggling to lose weight,” Ligibel said. “With a structured diet and exercise program, weight loss is attainable.”
Implications
The BWEL trial will eventually reveal whether losing weight improves outcomes for these patients, Ligibel told Healio.
“We do not yet have the results of the long-term analysis, but the current analysis was necessary for us to show that this weight loss program actually worked,” she said.
Ligibel noted that not all patients in the trial were enrolled from large cancer centers or had already had access to this type of program.
“Many women were enrolled from community-based practices and rural areas, as well as inner cities,” she said. “The weight loss intervention worked across all of these different groups of patients, and it is important to note that the intervention was completely distance-based. We never met these women in real life. They worked with our coaches through the phone and the web, so the intervention can be applied to patients anywhere.”
Ligibel said she hopes further research shows the weight loss intervention can reduce the risk for overall cancer recurrence and extend survival.
“We are still a ways out from those findings, but we will continue to follow patients over time to examine whether losing weight really does reduce the risk for death from breast cancer, which is the most important piece of this study that we are working toward,” she said. “There is a lot more that we hope to learn from this study during the coming years.”
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Ligibel JA, et al. Abstract 12001. Scheduled for presentation at: ASCO Annual Meeting; June 2-6, 2023; Chicago.
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