Changes in weight, physical and psychosocial patient-reported outcomes among obese women receiving treatment for early-stage breast cancer: A nationwide clinical study

Abstract

Background: Evidence on how weight loss correlates to health-related quality-of-life (HRQOL) among obese breast cancer (BC) patients is limited. We aimed to evaluate associations between weight changes and HRQOL.

Methods: We included 993 obese women with stage I-II-III BC from CANTO, a multicenter, prospective cohort collecting longitudinal, objectively-assessed anthropometric measures and HRQOL data (NCT01993498). Associations between weight changes (±5% between diagnosis and post-treatment [shortly after completion of surgery, adjuvant chemo- or radiation-therapy]) and patient-reported HRQOL (EORTC QLQ-C30/B23) were comprehensively evaluated. Changes in HRQOL and odds of severely impaired HRQOL were assessed using multivariable generalized estimating equations and logistic regression, respectively.

Results: 14.1% women gained weight, 67.3% remained stable and 18.6% lost weight. Significant decreases in functional status and exacerbation of symptoms were observed overall post-treatment. Compared to gaining weight or remaining stable, obese women who lost weight experienced less of a decline in HRQOL, reporting better physical function (mean change [95%CI] for gain, stability and loss: -12.9 [-16.5,-9.3], -6.9 [-8.2,-5.5] and -6.2 [-8.7,-3.7]; p_{interaction[weight-change-by-time]} = 0.006), less dyspnea (+18.9 [+12.3,+25.6], +9.2 [+6.5,+11.9] and +3.2 [-1.0,+7.3]; p_interaction = 0.0003), and fewer breast symptoms (+22.1 [+16.8,+27.3], +18.0 [+15.7,+20.3] and +13.4 [+9.0,+17.2]; p_interaction = 0.044). Weight loss was also significantly associated with reduced odds of severe pain compared with weight gain (OR [95%CI] = 0.51 [0.31-0.86], p = 0.011) or stability (OR [95%CI] = 0.62 [0.41-0.95], p = 0.029). No associations between weight loss and worsening of other physical or psychosocial parameters were found.

Conclusions: This large contemporary study suggests that weight loss among obese BC patients during early survivorship was associated with better patient-reported outcomes, without evidence of worsened functionality or symptomatology in any domain of HRQOL.

Keywords: Breast cancer; Health-related quality-of-life; Obesity; Patient-reported outcomes; Survivorship; Weight change; Weight loss.

Fig. 1

CONSORT diagram of patient population. ∗Note: total accrual in CANTO 12012 patients. We accessed information from 5801 women who were enrolled from March 2012 to January 2015.

Fig. 2

Prevalence (%) of patients reporting poor function or severe symptoms at baseline and post-treatment in the whole cohort (2A). Prevalence (%) of patients reporting poor function or severe symptoms post-treatment by category of weight change (2B). Poor function is defined by a score <60, severe symptoms by a score ≥40 on the respective EORTC QLQ-C30 and QLQ-B23 scales. Prevalence of poor sexual function is not displayed because of scaling of the y-axis (prevalence > 80% in all subgroups). Adjusted odds ratios (aOR) and respective 95% Confidence Intervals (CI) were obtained from multivariable logistic regression models and are reported for selected domains. All models were adjusted for time, age, menopausal status, Body Mass Index, comorbidities, marital status, education, smoking status, physical activity, breast and axillary surgery, receipt of chemotherapy, radiation therapy, endocrine therapy, anti-HER2 therapy, anxiety, and depression.