Weight Gain in Women Diagnosed with Breast Cancer

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Abstract

This review of the literature indicates that weight gain is a common observation among women after the diagnosis of breast cancer. Gains in weight range from 0 to 50 lb and are influenced by menopausal status; nodal status; and the type, duration, and intensity of treatment. Weight gain appears to be greater among premenopausal women; among those who are node positive; and among those receiving higher dose, longer duration, and multiagent regimens. Psychosocial research suggests that weight gain has a profoundly negative impact on quality of life in patients with breast cancer. Recent findings also suggest that weight gain during therapy may increase the risk of recurrence and decrease survival. Although weight gain in patients with breast cancer is clinically well appreciated, little research has been conducted to investigate the underlying mechanisms of energy imbalance. Changes in rates of metabolism, physical activity, and dietary intake are all plausible mechanisms and call for more research. Further study will provide valuable insight into the problem of weight gain and encourage effective interventions to improve the quality and quantity of life for the woman with breast cancer. Until more is known, however, dietetics practitioners will have to monitor and work individually with patients with breast cancer and use empirical approaches to achieve the important goal of weight management.

Section snippets

Magnitude AND Prevalence OF Weight Gain After the Diagnosis Of Breast Cancer

Although weight gain is a common occurrence in patients whith breast cancer, its reported prevalence and magnitude appear highly dependent on the type of treatment received. Gains are well documented in research focused on systemic therapy, that is, hormonal therapy and chemotherapy (13). In contrast, there are few accounts of weight gain in women who receive only localized treatment, that is, surgery alone or surgery plus radiation (13). In one of the few studies that compared weight gain in

Other Factors Related to Weight Gain

The menopausal status of patients with breast cancer appears to be a factor influencing the degree of weight gain. A North Central Cancer Treatment Group study compared weight gain in 255 postmenopausal and 321 premenopausal patients receiving a variety of therapies and found lesser gains in older patients (7.9 lb) than in younger patients (13 lb) (6). Eighty percent of postmenopausal women had weight gains greater than 5 lb compared with 90% of premenopausal women. Twenty percent of all

Adverse Consequences of Weight Gain in Women Diagnosed with Breast Cancer

In a study of 87 patients with early-stage disease, Knobf et al (3) found that a majority of those who gained more than 10 lb reported their weight gain as distressing. Given the importance placed on thinness in our culture, this finding is not surprising (32). Others have suggested that this weight gain is especially demoralizing because it occurs in vulnerable patients already suffering from a loss of self-esteem and altered self-image (3), (6), (18), (20), (33). Knobf et al (3) found a

Associations Between Body Weight and Breast Cancer

The relationship of increased body weight and breast cancer risk was first documented in the classic studies of Tannenbaum (36). The finding that excess body weight may predispose women to breast cancer, especially after menopause, continues to gain the support of more recent epidemiologic efforts as well as laboratory research (37), (38). Additional research by Ballard-Barbash et al (39) suggests that the amount of weight gained during adulthood may be even a stronger correlate of breast

Mechanisms Potentially Accountable for Energy Imbalance in Patients with Breast Cancer

Although weight gain appears to be a pervasive and serious problem for patients with breast cancer, the mechanisms behind it are poorly understood (6). Nutrition theory argues that weight gain only occurs in the presence of increased energy intake or decreased energy expenditure (components of basal metabolic rate, thermogenesis, and physical activity), or a combination of both forces. Efforts to investigate underlying mechanisms responsible for weight-gain in patients with breast cancer,

Current Dietary Intervention Programs Targeted to Women with Breast Cancer

Dietary interventions aimed at patients with breast cancer have focused on dietary fat rather than energy reduction (70), (71), (72), (73), (74), (75), (76), (77), (78), (79). Such interventions are both logical and laudable, as increased dietary fat (total, saturated, and/or polyunsaturated) has been linked to increased levels of unbound estrogens, eicosanoids, and kinases, which have been associated with cancer promotion and metastasis (41), (60). Although the low-fat diet, in theory, does

Summary

Weight gain, rather than weight loss, is a common occurrence in women diagnosed with breast cancer. It is a phenomenon that may decrease quality of life and may potentially threaten survival. This review of literature suggests that the problem of weight gain may be of greater magnitude in women who receive systemic therapies than in those who receive localized therapies, in women who receive more prolonged, higher dose courses of treatment rather than less rigorous regimens, and among

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