Factors associated with weight gain after breast cancer: Results from a community-based survey of Australian women

Carolyn Ee, Adele Cave, Vaishnavi Vaddiparthi, Dhevaksha Naidoo, John Boyages, Carolyn Ee, Adele Cave, Vaishnavi Vaddiparthi, Dhevaksha Naidoo, John Boyages

Abstract

Purpose: Weight gain after breast cancer is common. The aim of this study was to determine factors associated with weight gain after breast cancer in Australian women.

Methods: A cross-sectional online survey was conducted between November 2017 and January 2018. Women living in Australia who self-identified as having breast cancer or ductal carcinoma in-situ were eligible. We created stepwise linear and logistic regression models to evaluate predictors for absolute and clinically significant (≥5%) weight gain respectively.

Results: Data from 276 women were analysed. Most were Caucasian and 92% had been diagnosed with Stage 0-III breast cancer. Absolute weight gain was associated with hot flushes, being in the menopausal transition at diagnosis, being less physically active than at diagnosis, lower eating self-efficacy when watching television or using a computer, and higher self-efficacy when anxious or nervous (F-ratio = 3.26, R2-adjusted = 0.16, p < .001). Clinically significant weight gain was associated with tamoxifen use (OR 2.7), being less physically active than at diagnosis (OR 3.1), and lower eating self-efficacy when watching television or using a computer (OR 0.82) (Chi-square 64.94, df = 16, p < .001). Weight gain was not associated with chemotherapy, radiotherapy, aromatase inhibitor use, number of lymph nodes removed, or body mass index at diagnosis.

Conclusions: Interventions to prevent weight gain after breast cancer, particularly aiming to maintain physical activity, should be targeted at women receiving tamoxifen. The role of eating self-efficacy, especially attentive eating, in managing weight after breast cancer should be explored.

Keywords: Breast cancer; Diet; Menopause; Physical activity; Tamoxifen; Weight gain.

Conflict of interest statement

Declaration of competing interest None.

Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.

References

    1. Vance V., Mourtzakis M., McCargar L., Hanning R. Weight gain in breast cancer survivors: prevalence, pattern and health consequences. Obes Rev. 2011;12(4):282–294.
    1. Ee C., Cave A.E., Naidoo D., Bilinski K., Boyages J. Weight before and after a diagnosis of breast cancer or ductal carcinoma in situ: a national Australian survey. BMC Cancer. 2020;20(1):113.
    1. Vagenas D., DiSipio T., Battistutta D., et al. Weight and weight change following breast cancer: evidence from a prospective, population-based, breast cancer cohort study. BMC Cancer. 2015;15:28.
    1. Pumpa K.L., Dalton J., Mara J.K., Zhang Y., Yip D. Identifying women at risk of weight gain after a breast cancer diagnosis: results from a cohort of Australian women. Health Promot J Aust. 2022;33(1):138–147.
    1. Ryan D.H., Yockey S.R. Weight loss and improvement in comorbidity: differences at 5%, 10%, 15%, and over. Current obesity reports. 2017;6(2):187–194.
    1. Saquib N., Flatt S.W., Natarajan L., et al. Weight gain and recovery of pre-cancer weight after breast cancer treatments: evidence from the women's healthy eating and living (WHEL) study. Breast Cancer Res Treat. 2007;105(2):177–186.
    1. Raghavendra A., Sinha A.K., Valle-Goffin J., Shen Y., Tripathy D., Barcenas C.H. Determinants of weight gain during adjuvant endocrine therapy and association of such weight gain with recurrence in long-term breast cancer survivors. Clin Breast Cancer. 2018;18(1):e7–e13.
    1. Koo H.-Y., Seo Y.-G., Cho M.-H., Kim M.-J., Choi H.-C. Weight change and associated factors in long-term breast cancer survivors. PLoS One. 2016;11(7) e0159098-e0159098.
    1. Imayama I., Alfano C., Neuhouser M., et al. Weight, inflammation, cancer-related symptoms and health-related quality of life among breast cancer survivors. Breast Cancer Res Treat. 2013;140(1):159–176.
    1. Ames G.E., Heckman M.G., Diehl N.N., Grothe K.B., Clark M.M. Further statistical and clinical validity for the weight efficacy lifestyle questionnaire-short form. Eat Behav. 2015;18:115–119.
    1. Russell A. 2006. Data Technical Report of the ALSWH: derived variables not included in datasets.
    1. IBM SPSS Statistics for Windows [computer program]. Version 26.0. IBM Corp; Armonk, NY: 2019. Released.
    1. Sedjo R.L., Byers T., Ganz P.A., et al. Weight gain prior to entry into a weight-loss intervention study among overweight and obese breast cancer survivors. J Cancer Surviv. 2014;8(3):410–418.
    1. Lei Y., Ho S.C., Kwok C., et al. Dietary pattern at 18-month post-diagnosis and outcomes of breast cancer among Chinese women with early-stage breast cancer. Cancer Manag Res. 2021;13:4553–4565.
    1. Gu K., Chen X., Zheng Y., et al. Weight change patterns among breast cancer survivors: results from the Shanghai breast cancer survival study. An International Journal of Studies of Cancer in Human Populations. 2010;21(4):621–629.
    1. Williamson D.F. Descriptive epidemiology of body weight and weight change in U.S. adults. Ann Intern Med. 1993;119(7 Pt 2):646–649.
    1. Sammel M.D., Grisso J.A., Freeman E.W., et al. Weight gain among women in the late reproductive years. Fam Pract. 2003;20(4):401–409.
    1. Howard-Anderson J., Ganz P.A., Bower J.E., Stanton A.L. Quality of life, fertility concerns, and behavioral health outcomes in younger breast cancer survivors: a systematic review. J Natl Cancer Inst. 2012;104(5):386–405.
    1. Reddy S.M., Sadim M., Helenowski I., Li J., Yi N., Kaklamani V. Clinical and genetic predictors of weight gain in patients diagnosed with breast cancer. J Clin Oncol. 2012;30(15)
    1. Gandhi A., Copson E., Eccles D., et al. Predictors of weight gain in a cohort of premenopausal early breast cancer patients receiving chemotherapy. Breast. 2019;45:1–6.
    1. Ekenga C.C., Wang X., Pérez M., Schootman M., Jeffe D.B. A prospective study of weight gain in women diagnosed with early-stage invasive breast cancer, ductal carcinoma in situ, and women without breast cancer. J Womens Health (Larchmt). 2020;29(4):524–533.
    1. Nyrop K.A., Williams G.R., Muss H.B., Shachar S.S. Weight gain during adjuvant endocrine treatment for early-stage breast cancer: what is the evidence? Breast Cancer Res Treat. 2016;158(2):203–217.
    1. Sternfeld B., Dugan S. Physical activity and health during the menopausal transition. Obstet Gynecol Clin N Am. 2011;38(3):537–566.
    1. Kravitz H.M., Kazlauskaite R., Joffe H. Sleep, health, and metabolism in midlife women and menopause: food for thought. Obstet Gynecol Clin N Am. 2018;45(4):679–694.
    1. Sestak I., Harvie M., Howell A., Forbes J.F., Dowsett M., Cuzick J. Weight change associated with anastrozole and tamoxifen treatment in postmenopausal women with or at high risk of developing breast cancer. Breast Cancer Res Treat. 2012;134(2):727–734.
    1. Baum M., Budzar A.U., Cuzick J., et al. Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer: first results of the ATAC randomised trial. Lancet. 2002;359(9324):2131–2139.
    1. Cuzick J., Forbes J., Edwards R., et al. First results from the international breast cancer intervention study (IBIS-I): a randomised prevention trial. Lancet. 2002;360(9336):817–824.
    1. Scalzo R.L., Foright R.M., Hull S.E., et al. Breast cancer endocrine therapy promotes weight gain with distinct adipose tissue effects in lean and obese female mice. Endocrinology. 2021;162(11)
    1. Caan B.J., Kwan M.L., Shu X.O., et al. Weight change and survival after breast cancer in the after breast cancer pooling project. Cancer Epidemiol Biomark Prev. 2012;21(8):1260–1271.
    1. Su H.I., Sammel M.D., Springer E., Freeman E.W., DeMichele A., Mao J.J. Weight gain is associated with increased risk of hot flashes in breast cancer survivors on aromatase inhibitors. Breast Cancer Res Treat. 2010;124(1):205–211.
    1. Thurston R.C., Sowers M.R., Sternfeld B., et al. Gains in body fat and vasomotor symptom reporting over the menopausal transition: the study of women's health across the nation. Am J Epidemiol. 2009;170(6):766–774.
    1. Kravitz H.M., Matthews K.A., Joffe H., et al. Trajectory analysis of sleep maintenance problems in midlife women before and after surgical menopause: the Study of Women's Health across the Nation (SWAN) Menopause. 2020;27(3):278–288.
    1. Tonorezos E.S., Jones L.W. Energy balance and metabolism after cancer treatment. Semin Oncol. 2013;40(6):745–756.
    1. Orban E., Jung A.Y., Möhl A., et al. Changes in alcohol consumption, body weight and physical activity among breast cancer survivors and population-based unaffected women in a prospective study. Cancer Epidemiol. 2021;70
    1. Rock C.L., Flatt S.W., Byers T.E., Colditz G.A., Demark-Wahnefried W., Ganz P.A. Results of the Exercise and Nutrition to Enhance Recovery and Good Health for You (ENERGY) Trial: a behavioral weight loss intervention in overweight or obese breast cancer survivors. J Clin Oncol. 2015;33
    1. Okumatsu K., Yamauchi H., Kotake R., Gosho M., Nakata Y. Association between endocrine therapy and weight gain after breast cancer diagnosis among Japanese patients: a retrospective cohort study. Med Sci. 2021;9(3)
    1. Hillemeier M.M., Weisman C.S., Chuang C., Downs D.S., McCall-Hosenfeld J., Camacho F. Transition to overweight or obesity among women of reproductive age. J Womens Health (Larchmt) 2011;20(5):703–710.
    1. Campbell K.L., Winters-Stone K.M., Wiskemann J., et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc. 2019;51(11):2375–2390.
    1. Liu M.G., Davis G.M., Kilbreath S.L., Yee J. Physical activity interventions using behaviour change theories for women with breast cancer: a systematic review and meta-analysis. J Cancer Surviv. 2022;16(5):1127–1148.
    1. Singh B., Zopf E.M., Howden E.J. Effect and feasibility of wearable physical activity trackers and pedometers for increasing physical activity and improving health outcomes in cancer survivors: a systematic review and meta-analysis. J Sport Health Sci. 2022;11(2):184–193.
    1. Lahart I.M., Metsios G.S., Nevill A.M., Carmichael A.R. Physical activity for women with breast cancer after adjuvant therapy. Cochrane Database Syst Rev. 2018;1(1):Cd011292.
    1. Ames G.E., Heckman M.G., Grothe K.B., Clark M.M. Eating self-efficacy: development of a short-form WEL. Eat Behav. 2012;13(4):375–378.
    1. Gilcharan Singh H.K., Chee W.S.S., Hamdy O., et al. Eating self-efficacy changes in individuals with type 2 diabetes following a structured lifestyle intervention based on the transcultural Diabetes Nutrition Algorithm (tDNA): a secondary analysis of a randomized controlled trial. PLoS One. 2020;15(11)
    1. Nezami B.T., Lang W., Jakicic J.M., et al. The effect of self-efficacy on behavior and weight in a behavioral weight-loss intervention. Health Psychol. 2016;35(7):714–722.
    1. Martin P.D., Dutton G.R., Brantley P.J. Self-efficacy as a predictor of weight change in African-American women. Obes Res. 2004;12(4):646–651.
    1. Hays L.M., Finch E.A., Saha C., Marrero D.G., Ackermann R.T. Effect of self-efficacy on weight loss: a psychosocial analysis of a community-based adaptation of the diabetes prevention program lifestyle intervention. Diabetes Spectr. 2014;27(4):270–275.
    1. Linde J.A., Rothman A.J., Baldwin A.S., Jeffery R.W. The impact of self-efficacy on behavior change and weight change among overweight participants in a weight loss trial. Health Psychol. 2006;25
    1. Martin P.D., Dutton G.R., Brantley P.J. Self-efficacy as a predictor of weight change in african-American women. Obes Res. 2004;12(4):646–651.
    1. Chen X., Lu W., Zheng W., et al. Obesity and weight change in relation to breast cancer survival. Breast Cancer Res Treat. 2010;122(3):823–833.
    1. Rock C.L., Flatt S.W., Newman V., et al. Factors associated with weight gain in women after diagnosis of breast cancer. Women's Healthy Eating and Living Study Group. J Am Diet Assoc. 1999;99(10):1212–1221.
    1. Robinson E., Aveyard P., Daley A., et al. Eating attentively: a systematic review and meta-analysis of the effect of food intake memory and awareness on eating. AJCN (Am J Clin Nutr) 2013;97(4):728–742.
    1. Duif I., Wegman J., Mars M.M., de Graaf C., Smeets P.A.M., Aarts E. Effects of distraction on taste-related neural processing: a cross-sectional fMRI study. AJCN (Am J Clin Nutr) 2020;111(5):950–961.
    1. Morris J., Vi C.T., Obrist M., Forster S., Yeomans M.R. Ingested but not perceived: response to satiety cues disrupted by perceptual load. Appetite. 2020;155
    1. Cruz-Jentoft A.J., Bahat G., Bauer J., et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(4):601.
    1. Silveira E.A., da Silva Filho R.R., Spexoto M.C.B., Haghighatdoost F., Sarrafzadegan N., de Oliveira C. The role of sarcopenic obesity in cancer and cardiovascular disease: a synthesis of the evidence on pathophysiological aspects and clinical implications. Int J Mol Sci. 2021;22(9)
    1. Morlino D., Marra M., Cioffi I., et al. Prevalence of sarcopenia in women with breast cancer. Nutrients. 2022;14(9)
    1. Zhang X.M., Dou Q.L., Zeng Y., Yang Y., Cheng A.S.K., Zhang W.W. Sarcopenia as a predictor of mortality in women with breast cancer: a meta-analysis and systematic review. BMC Cancer. 2020;20(1):172.
    1. Liu L.-N., Lin Y.-C., Miaskowski C., Chen S.-C., Chen M.-L. Association between changes in body fat and disease progression after breast cancer surgery is moderated by menopausal status. BMC Cancer. 2017;17(1)
    1. Pang Y., Wei Y., Kartsonaki C. Breast Cancer; 2022. Associations of adiposity and weight change with recurrence and survival in breast cancer patients: a systematic review and meta-analysis.
    1. Park J., Morley T.S., Kim M., Clegg D.J., Scherer P.E. Obesity and cancer--mechanisms underlying tumour progression and recurrence. Nat Rev Endocrinol. 2014;10(8):455–465.

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