Tato stránka byla automaticky přeložena a přesnost překladu není zaručena. Podívejte se prosím na anglická verze pro zdrojový text.

POWER-remote Weight Loss Program in Early Stage Breast Cancer

A Randomized Study Evaluating the Effect of a Remote-Based Weight Loss Program (POWER-remote) on Biomarkers in Women With Early Stage Breast Cancer

This research is being done to assess the effectiveness of a weight loss program in women with early stage breast cancer whose body mass index (BMI) is in the overweight or obese range (>25). Weight loss is beneficial in improving cardiovascular risk factors and overall health, but may also decrease the chance of breast cancer coming back. A weight loss counseling program was studied in a general population and was found to be effective to help reduce weight over a 2 year period.

The main goal of this study is to determine if women with a recent diagnosis of early breast cancer will also lose weight with this program. To better understand the effect that weight loss has on women with breast cancer, we will compare the patterns in blood and breast tissue samples (tissue biopsies will be optional), and questionnaires evaluating different aspects of one's well-being, before and after a dietary intervention or no intervention.

Přehled studie

Postavení

Dokončeno

Podmínky

Intervence / Léčba

Detailní popis

The prevalence of obesity has increased rapidly in recent years. Epidemiological studies since the 1970's have strongly suggested that excess body weight gain may be a major risk factor for many cancers including breast cancer. In addition, once diagnosed with breast cancer, women who are overweight or obese experience worse outcomes despite standard local and adjuvant therapy. Furthermore, most women gain weight following a diagnosis of breast cancer, and this weight gain may increase risk of recurrence by 40-50% and breast cancer-related mortality by 53-60%.

A great deal of effort has been made for many years to explain the relationship between obesity and breast cancer. Molecularly, the relationship involves dynamic and complex interactions between a milieu of hormones, cytokines, adipokines, affecting cell signaling and potentially epigenetic pathways. Recently, studies in postmenopausal women have shown that weight loss modulates these cytokines and adipokines favorably. Inflammation associated with obesity can also be characterized pathologically when macrophages surround necrotic adipocytes in what are called crown-like structures (CLS). Furthermore, increased central obesity as measured by waist-to-hip ratios, may be associated with hypermethylation of certain breast cancer genes, and physical activity can reduce methylation of certain breast cancer-associated genes.

The Women's Intervention Nutrition Study (WINS) demonstrated that women with early-stage breast cancer receiving conventional cancer management randomized to a dietary intervention group had lower risk of relapse compared to those in a control group in those who lost weight. While women with a diagnosis of breast cancer are therefore recommended to maintain ideal body weight, limited progress has been made in developing feasible weight loss programs. However, collaborators from the Welch Center for Prevention, Epidemiology, and Clinical Research at the Johns Hopkins University have recently reported impressive and sustained weight loss in randomized controlled trials designated Practice-based Opportunities for Weight Reduction (POWER) in obese women with at least one cardiovascular risk factor using a remote-support weight loss intervention.

The overall goal of this study is to determine the effectiveness of the remote-support weight loss intervention of the POWER study, designated POWER-remote, in women with early breast cancer who are overweight or obese, and to assess the effects of weight loss of ≥5% body weight at 6 months and on biomarkers associated with obesity, inflammation, and breast cancer. The data will be used to implement a clinical intervention available to all overweight and obese women with breast cancer, and to design definitive studies assessing the impact of weight loss and biomarker modulation on risk of recurrent disease or development of new primary breast cancers.

Typ studie

Intervenční

Zápis (Aktuální)

96

Fáze

  • Nelze použít

Kontakty a umístění

Tato část poskytuje kontaktní údaje pro ty, kteří studii provádějí, a informace o tom, kde se tato studie provádí.

Studijní místa

    • Maryland
      • Baltimore, Maryland, Spojené státy, 21287-0013
        • Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

Kritéria účasti

Výzkumníci hledají lidi, kteří odpovídají určitému popisu, kterému se říká kritéria způsobilosti. Některé příklady těchto kritérií jsou celkový zdravotní stav osoby nebo předchozí léčba.

Kritéria způsobilosti

Věk způsobilý ke studiu

18 let a starší (Dospělý, Starší dospělý)

Přijímá zdravé dobrovolníky

Ne

Pohlaví způsobilá ke studiu

Ženský

Popis

Inclusion Criteria:

  • Women
  • 18 years or older
  • Ductal carcinoma in situ (DCIS) or stage I-III invasive breast cancer
  • Eastern Cooperative Oncology Group (ECOG) performance status 0-2
  • Current BMI ≥ 25 kg/m2 and weight ≤ 400 lbs, and willing to lose >5% of their body weight. NOTE: Participants may not have documented weight loss greater than 5% of body weight from time of diagnosis. Exceptions that are felt to be due to surgical or other procedures (e.g., mastectomies or reconstruction) may be allowed with prior approval of the Protocol Chair/designee.
  • Patients must have completed local therapy (i.e. surgery and radiation therapy), and any preoperative or adjuvant chemotherapy within >3 and <60 months of registration. NOTE: Concurrent anti-HER2 therapy is permitted. Concurrent endocrine breast cancer therapy is permitted; patients may enroll >3 months after initiation of hormone therapy if expected to continue the same hormone agent for at least the first 6 months of the study. Concurrent enrollment in other interventional or drug clinical trials is at the discretion of the Protocol Chair.
  • Willingness to change diet, physical activity and weight.
  • To ensure compliance with the POWER-remote and PatientViewpoint programs, patients must meet the following: prior experience with web forms and feels able to use the POWER-remote web program and PatientViewpoint; has or is able to download Internet Explorer 8+, Firefox 3.0+, Safari 4.0+, Chrome 4.0+, and Adobe Flash Player 10; familiarity with and access to internet at least 4 days per week; use of an email program or willing and able to establish one for this study; and, able to read and write the English language without assistance.
  • Patient is aware of her diagnosis, understands the study regimen, its requirements, risks, and discomforts, and is able and willing to sign an informed consent form.

Exclusion Criteria:

  • History of another prior cancer within the last 5 years, with the exception of another breast cancer, adequately treated cone-biopsied in situ carcinoma of the cervix uteri, and basal or squamous cell carcinoma of the skin
  • Medical condition likely to hinder accurate measurement of weight, including any condition: for which weight loss is contraindicated, which would likely cause weight loss, or which would affect adipokine and inflammatory markers (e.g., end stage renal disease (ESRD) on dialysis, cirrhosis, autoimmune disease, adrenal disease, and history of bariatric surgery).
  • The use of the following medications are excluded: insulin or sulfonylureas; patients with thyroid disease who are not on stable doses of thyroid medication for at least the past 6 months; medications that cause weight loss (e.g., topiramate, bupropion, exenatide, lorcaserin, phentermine or orlistat) within the past 3 months; medications that are likely to cause weight gain or prevent weight loss (e.g., corticosteroids, lithium, olanzapine, risperidone, clozapine, oral contraceptive pills, hormone replacement therapy) within the past 3 months; medications that may affect adipokine or inflammatory markers (e.g., sulfonylureas, glitazones, insulin, steroids, ACE inhibitors, beta blockers and statins) unless started ≥3 months prior to enrollment, or chronic NSAIDS (defined as use of ≥3 times a week) for ≥1 month.
  • Pregnant or nursing within past 6 months, or plans to become pregnant in the next year
  • Currently enrolled or planning to enroll in a weight loss program (e.g., Innergy, Weight Watchers, Jenny Craig, Nutrisystem, and Medifast).

Studijní plán

Tato část poskytuje podrobnosti o studijním plánu, včetně toho, jak je studie navržena a co studie měří.

Jak je studie koncipována?

Detaily designu

  • Primární účel: Léčba
  • Přidělení: Randomizované
  • Intervenční model: Paralelní přiřazení
  • Maskování: Žádné (otevřený štítek)

Zbraně a zásahy

Skupina účastníků / Arm
Intervence / Léčba
Experimentální: POWER-remote
Participants will start a weight loss program called POWER-remote for Breast Cancer Survivors. This program involves two main components: an online portion accessed on a computer through the internet and a telephone portion to help monitor progress.
Web-based weight loss program.
Aktivní komparátor: Self-directed
Participants will receive a pamphlet entitled "Aim for a Healthy Weight", to help guide weight loss goals without access to the web-based POWER-remote system and coach support.
Pamphlet entitled "Aim for a Healthy Weight" will be given.

Co je měření studie?

Primární výstupní opatření

Měření výsledku
Popis opatření
Časové okno
Change in body weight
Časové okno: After 12 months
To compare the proportion of women with early stage breast cancer, who have completed all local therapy and adjuvant chemotherapy, who lose ≥5% of their baseline body weight after 6 and 12 months between a control arm (self-directed weight loss) and an experimental arm (POWER-remote)
After 12 months

Sekundární výstupní opatření

Měření výsledku
Popis opatření
Časové okno
Change in biomarkers
Časové okno: After 12 months
To evaluate the effects of weight loss and POWER-remote on serum biomarkers (including fasting glucose, fasting lipids, fasting insulin, insulin like growth factor (IGF), high-sensitivity C-reactive protein (hsCRP), interleukin 1 and 6 (IL-1 and IL-6), tumor necrosis factor- alpha (TNF-α), leptin, adiponectin, and estradiol) at baseline and 6 months
After 12 months
Change in PROs (Patient Reported Outcomes)
Časové okno: After 12 months
To evaluate the effects of weight loss and POWER-remote on PROs, with a specific interest in comparing the change in Physical Function at 6 months from baseline as a function of weight los
After 12 months

Spolupracovníci a vyšetřovatelé

Zde najdete lidi a organizace zapojené do této studie.

Sponzor

Spolupracovníci

Vyšetřovatelé

  • Studijní židle: Vered Stearns, M.D., Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

Termíny studijních záznamů

Tato data sledují průběh záznamů studie a předkládání souhrnných výsledků na ClinicalTrials.gov. Záznamy ze studií a hlášené výsledky jsou před zveřejněním na veřejné webové stránce přezkoumány Národní lékařskou knihovnou (NLM), aby se ujistily, že splňují specifické standardy kontroly kvality.

Hlavní termíny studia

Začátek studia

1. července 2013

Primární dokončení (Aktuální)

1. prosince 2016

Dokončení studie (Aktuální)

1. prosince 2016

Termíny zápisu do studia

První předloženo

3. června 2013

První předloženo, které splnilo kritéria kontroly kvality

5. června 2013

První zveřejněno (Odhad)

6. června 2013

Aktualizace studijních záznamů

Poslední zveřejněná aktualizace (Aktuální)

5. února 2018

Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality

31. ledna 2018

Naposledy ověřeno

1. ledna 2018

Více informací

Termíny související s touto studií

Další identifikační čísla studie

  • J12128 (Jiný identifikátor: SKCCC at Johns Hopkins)

Plán pro data jednotlivých účastníků (IPD)

Plánujete sdílet data jednotlivých účastníků (IPD)?

NE

Popis plánu IPD

All participant data is deidentified and will be grouped together when presenting results.

Tyto informace byly beze změn načteny přímo z webu clinicaltrials.gov. Máte-li jakékoli požadavky na změnu, odstranění nebo aktualizaci podrobností studie, kontaktujte prosím register@clinicaltrials.gov. Jakmile bude změna implementována na clinicaltrials.gov, bude automaticky aktualizována i na našem webu .