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Less weight gain seen with modern chemo regimens: the classical regimen is notorious for causing nausea; many women self-medicate against nausea by eating.

SAN ANTONIO -- Weight gain in the first year or two following diagnosis of early-stage breast cancer appears to be less pervasive in the modern era of chemotherapy and endocrine therapy than in times past, results of a retrospective study suggest.

Numerous older studies have reported average weight gains ranging from 2.9 to more than 5 kg in the year following adjuvant chemotherapy in women with early-stage breast cancer.

In contrast, the average weight gain in a 90-patient study reported at the San Antonio Breast Cancer Symposium was just 0.8 kg at 24 months.

The most likely explanation for these disparate results is that the great majority of patients in older studies received non-tax-ane-based chemotherapy--most commonly cyclophosphamide, methotrexate, and fluorouracil--while patients in the recent series typically got taxane-based chemotherapy intravenously every 3 weeks along with a long-term daily aromatase inhibitor, explained Dr. Gary Schwartz of Dartmouth-Hitchcock Medical Center, Lebanon, N.H.

The classical cyclophosphamide, methotrexate, fluorouracil regimen is notorious for causing nausea. Many women self-medicate against this side effect by eating; thus, the marked weight gain. Affected women often see the increased pounds as a major setback and a source of considerable psychological distress. There also is some evidence to suggest that weight gain after diagnosis of breast cancer is linked to higher recurrence rates and increased breast cancer-specific mortality.

Nausea is much less of a problem with modern chemotherapy regimens, said Dr. Schwartz, an oncologist.

His retrospective study included 45 consecutive patients who received chemotherapy after being diagnosed with early breast cancer during 2001-2002, and 45 consecutive patients who did not.

In univariate and multivariate analyses, weight gain during the first 24 months following breast cancer diagnosis proved unrelated to age, the use of chemotherapy or endocrine therapy, menopausal status, hypothyroidism, selective serotonin reuptake inhibitor therapy for treatment of depression, or anemia.

In fact, the only factor predictive of weight gain was a lower baseline body mass index. The lower a woman's BMI at baseline, the more weight she gained. This observation is consistent with the notion that weight gain after breast cancer diagnosis is caused more by a reduced activity level than by increased caloric intake.

"Breast cancer results in a global decrease in performance status and activity level that may not affect someone's weight if they're not active at baseline, but if you are active and fitter and have a lower BMI at baseline, it's going to affect your weight more," Dr. Schwartz explained in an interview.

"In speaking with patients who are going through the experience of breast cancer, I don't really get a sense that they're dealing with an increased appetite. What people tell me is they're eating the same as always, but they're gaining weight," he continued. "Just about everyone is more fatigued and becomes less active. Instead of walking to the corner market you take the car now. A lot of people cut back on their work schedule, maybe retire or partially retire. All those sorts of things add up."

He plans to address this problem by introducing an organized fitness program with healthy eating tips for breast cancer patients in his community. The idea is to help maintain fitness and a favorable BMI in the high-risk patients--those who were more physically active prior to diagnosis--while encouraging women who were heavier at baseline to adopt a more active lifestyle as a means of combatting their cancer.


Denver Bureau
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Title Annotation:Women's Health
Author:Jancin, Bruce
Publication:Internal Medicine News
Geographic Code:1USA
Date:Mar 1, 2008
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