The Voice of Experience: Diet and Weight Change in Women with Breast Cancer Associate with Psychosocial and Treatment-Related Challenges
Publication: Canadian Journal of Dietetic Practice and Research
1 February 2017
Abstract
Purpose: This study investigated relationships between psychosocial and treatment-related factors, diet, and weight change in women treated with chemotherapy for early-stage breast cancer.
Methods: Comprehensive qualitative interviews were conducted with 28 women who were within 12 months of completing chemotherapy treatment.
Results: Changes in food intake and eating patterns were universal over the course of chemotherapy, with broad variability in treatment effects and associated dietary responses linked to weight change. Increased appetite, food cravings, and intake of energy-dense comfort foods were more common among women who gained weight during treatment (n = 11). Changes in taste, nausea, and emotional distress were central in promoting these dietary responses. Women who lost weight during treatment (n = 6) tended to report more severe and persistent side effects of treatment leading to poor appetite and lower food intake, and they were more likely to live alone.
Conclusions: While the etiology of weight change in this population is complex, this study suggests that changes in food intake related to treatment and psychosocial challenges may play an important role for some women. These findings may help to identify women who are most at risk of weight change during treatment and may inform the development of tailored dietary interventions.
Résumé
Objectif : Cette étude portait sur la relation entre les facteurs psychosociaux et ceux liés au traitement, l’alimentation et le changement de poids chez les femmes recevant de la chimiothérapie pour un cancer du sein de stade précoce.
Méthodes : Des entrevues qualitatives exhaustives ont été menées auprès de 28 femmes qui étaient à moins de 12 mois de terminer leur chimiothérapie.
Résultats : Les changements en matière d’apport alimentaire et d’habitudes alimentaires étaient universels durant la chimiothérapie, et la grande variabilité des effets du traitement et de la réponse alimentaire associée était liée à un changement de poids. L’appétit accru, les fringales et la consommation d’aliments réconfortants riches en énergie étaient plus courants chez les femmes qui ont pris du poids durant le traitement (n = 11). Les changements de goût, les nausées et la détresse émotionnelle étaient des éléments centraux de ces réponses alimentaires. Les femmes qui ont perdu du poids durant leur traitement (n = 6) ont généralement signalé des effets secondaires plus graves et persistants du traitement, entraînant un faible appétit et un apport alimentaire moindre. Elles étaient aussi plus susceptibles de vivre seules.
Conclusions : Même si l’étiologie du changement de poids chez cette population est complexe, cette étude suggère que les changements à l’apport alimentaire liés au traitement et aux défis psychosociaux peuvent jouer un rôle important chez certaines femmes. Ces résultats pourraient aider à identifier les femmes qui sont plus susceptibles de connaître un changement de poids durant leur traitement et pourraient guider l’élaboration d’interventions nutritionnelles adaptées.
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Financial support: This research was supported by the Canadian Foundation for Dietetic Research-Grant# RG11-06. VV was funded by a Doctoral Research Award from the Canadian Institutes of Health Research
Conflicts of interest: The authors declare no conflict of interest.
References
1
Canadian Cancer Society’s Steering Committee on Cancer Statistics. Canadian cancer statistics, 2015. Toronto, ON: Canadian Cancer Society; 2015.
2
National Cancer Institute. Surveillance, epidemiology and end results (SEER) Program; 2016 [cited 2016 Feb 12]. Available from: http://seer.cancer.gov/statfacts/html/breast.html.
3
Canadian Breast Cancer Foundation. Breast cancer in Canada; 2016 [cited 2016 Feb 21]. Available from: http://www.cbcf.org/ontario/AboutBreastCancerMain/FactsStats/Pages/Breast-Cancer-Canada.aspx.
4
Demark-Wahnefried W, Rimer BK, and Winer EP.Weight gain in women diagnosed with breast cancer. J Am Diet Assoc.1997;97:519–29.
5
Vance V, Mourtzakis M, McCargar L, and Hanning R.Weight gain in breast cancer survivors: prevalence, pattern and health consequences. Obes Rev.2011;12:282–94.
6
Halbert CH, Weathers B, Esteve R, Audrain-McGovern J, Kumanyika S, and DeMichele A, et al.Experiences with weight change in African-American breast cancer survivors. Breast J.2008;14(2):182–87.
7
Knobf MT. Physical and psychological distress associated with adjuvant chemotherapy in women with breast cancer. J Clin Oncol.1986;4(5):678–84.
8
Brown BW, Brauner C, and Minnotte MC. Noncancer deaths in white adult cancer patients. J Natl Cancer Inst.1993;85(12):979–87.
9
Wingo PA, Gloeckler Ries LA, Parker SL, and Heath CW.Long-term cancer patient survival in the United States. Cancer Epidemiol Biomarkers Prev.1998;7:271–82.
10
Robinson LE and Graham TE.Metabolic syndrome, a cardiovascular disease risk factor: role of adipocytokines and impact of diet and physical activity. Can J Appl Physiol.2004;29(6):808–29.
11
Prado CMM, Baracos VE, McCargar LJ, Mourtzakis M, Mulder KE, and Reiman T, et al.Body composition as an independent determinant of 5-Fluorouracil-based chemotherapy toxicity. Clin Cancer Res.2007;13(11):3264–8.
12
Prado CMM, Baracos VE, McCargar LJ, Reiman T, Mourtzakis M, and Tonkin K, et al.Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment. Clin Cancer Res.2009;15(8):2920–6.
13
Kroenke CH, Chen WY, Rosner B, and Holmes MD.Weight, weight gain, and survival after breast cancer diagnosis. J Clin Oncol.2005;23(7):1370–8.
14
Nichols HB, Trentham-Dietz A, Egan KM, Titus-Ernstoff L, Holmes MD, and Bersch AJ, et al.Body mass index before and after breast cancer diagnosis: Associations with all-cause, breast cancer and cardiovascular disease mortality. Cancer Epidemiol Biomarkers Prev.2009;18(5):1403–9.
15
Chen X, Lu W, Zheng W, Gu K, Chen Z, and Zheng Yet al.Obesity and weight change in relation to breast cancer survival. Breast Cancer Res Treat.2010;122:823–33.
16
Thivat E, Therondel S, Lapirot O, Abrial C, Gimbergues P, and Gadea E, et al.Weight change during chemotherapy changes the prognosis in non metastatic breast cancer for the worst. BMC Cancer.2010;10:648.
17
Daly K. Qualitative methods for family studies & human development. Los Angeles: Sage Publications; 2007.
18
Canadian Breast Cancer Foundation. Staging and grading breast cancer; 2016 [cited 2016 July 13]. Available from: http://www.cbcf.org/ontario/AboutBreastCancerMain/Diagnosis/Pages/StagingGrading.aspx.
19
Rock CL, Flatt SW, Newman V, Caan BJ, Haan MN, and Stefanick ML, 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):1212–21.
20
Herman DR, Ganz PA, Petersen L, and Greendale GA.Obesity and cardiovascular risk factors in younger breast cancer survivors: The Cancer and Menopause Study (CAMS). Breast Cancer Res Treat.2005;93:13–23.
21
World Health Organization. Global database on body mass index. BMI classifications; 2011 [cited 2016 Feb 15]. Available from http://apps.who.int/bmi/index.jsp?introPage=intro_3.html.
22
Charmaz K. Constructing grounded theory: a practical guide through qualitative analysis. Los Angeles; Sage Publications; 2006.
23
Eldridge B, Hamilton, KK. Management of nutrition impact symptoms in cancer and educational handouts. 2nd ed. US: Library of Congress; 2004.
24
Grant, B, Byron, J. Nutritional implications of chemotherapy. In: Elliott L, Molseed LL, McCallum PD, editors. The clinical guide to oncology nutrition. 2nd ed. US: Library of Congress; 2006. p. 72–87.
25
Heasman KZ, Sutherland HJ, Campbell JA, Elhakim T, and Boyd NF.Weight gain during adjuvant chemotherapy for breast cancer. Breast Cancer Res Treat.1985;5(2):195–200.
26
Huntington MO.Weight gain in patients receiving adjuvant chemotherapy for carcinoma of the breast. Cancer.1985;56(3):472–74.
27
DeGeorge D, Gray JJ, Fetting JH, Rolls BJ. Weight gain in patients with breast cancer receiving adjuvant treatment as a function of restraint, disinhibition, and hunger. Oncol Nurs Forum. 1990;17(3 Supp):23–30.
28
Demark-Wahnefried W, Hars V, Conaway MR, Havlin K, Rimer BK, and McElveen G, et al.Reduced rates of metabolism and decreased physical activity in breast cancer patients receiving adjuvant chemotherapy. Am J Clin Nutr.1997;65:1495–1501.
29
Harvie MN, Campbell IT, Baildam A, and Howell A.Energy balance in early breast cancer patients receiving adjuvant chemotherapy. Breast Cancer Res Treat.2004;83:201–10.
30
Kumar N, Allen KA, Riccardi D, Bercu BB, Cantor A, and Minton S, et al.Fatigue, weight gain, lethargy and amenorrhea in breast cancer patients on chemotherapy: is subclinical hypothyroidism the culprit?Breast Cancer Res Treat.2004;83:149–59.
31
Del Rio G, Zironi S, Valeriani L, Menozzi R, Bondi M, and Bertolini, et al.Weight gain in women with breast cancer treated with adjuvant cyclophosphomide, methotrexate and 5-fluorouracil. Analysis of resting energy expenditure and body composition. Breast Cancer Res Treat.2002;73:267–73.
32
Kutynec C, McCargar L, Barr S, and Hislop G.Energy balance in women with breast cancer during adjuvant treatment. J Am Diet Assoc.1999;99:1222–7.
33
Foltz AT.Weight gain among stage 11 breast cancer patients: a study of five factors. Oncol Nurs Forum.1985;12(3):21–6.
34
Nissen MJ, Shapiro A, and Swenson KK.Changes in weight and body composition in women receiving chemotherapy for breast cancer. Clinical Breast Cancer.2011;11(1):52–60.
35
Lankester KJ, Phillips JE, and Lawton PA.Weight gain during adjuvant and neoadjuvant chemotherapy for breast cancer: an audit of 100 women receiving FEC or CMF chemotherapy. Clin Oncol.2002;14:64–7.
36
Freedman RJ, Aziz N, Albanes D, Hartman T, Danforth D, and Sebring N, et al.Weight and body composition changes during and after adjuvant chemotherapy in women with breast cancer. J Clin Endocrinol Metab.2004;89(5):2248–53.
37
Ingram C and Brown JK.Patterns of weight gain and body composition change in premenopausal women with early stage breast cancer. Cancer Nursing.2004;27(6):483–90.
38
Gu K, Chen X, Zheng Y, Chen Z, Zheng W, and Lu W, et al.Weight change patterns among breast cancer survivors: results from the Shanghai breast cancer survival study. Cancer Causes Control.2010;21:621–9.
39
Caan BJ, Edmond JA, Natarajan L, Castillo A, Gunderson EP, and Habel L, et al.Post-diagnosis weight gain and breast cancer recurrence in women with early stage breast cancer. Breast Cancer Res Treat.2006;99:47–57.
40
Demark-Wahnefried W, Peterson BL, Winer EP, Marks L, Aziz N, and Marcom PK, et al.Changes in weight, body composition, and factors influencing energy balance among premenopausal breast cancer patients receiving adjuvant chemotherapy. J Clin Oncol. 2001;19(9):2381–9.
41
Goodwin PJ, Ennis M, Pritchard KI, McCready D, Koo J, and Sidlofsky S, et al.Adjuvant treatment and onset of menopause predict weight gain after breast cancer diagnosis. J Clin Oncol.1999;17:120–9.
42
Gordon AM, Hurwitz S, Shapiro CL, and LeBoff MS.Premature ovarian failure and body composition changes with adjuvant chemotherapy for breast cancer. Menopause.2011;18(11):1244–8.
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Published In
Canadian Journal of Dietetic Practice and Research
Volume 78 • Number 2 • June 2017
Pages: 74 - 80
History
Version of record online: 1 February 2017
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© 2017.
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VivienneVancePhD, SharonCampbellPhD, LindaMccargarPhD, MarinaMourtzakisPhD, and RhonaHanningPhD. 2017. The Voice of Experience: Diet and Weight Change in Women with Breast Cancer Associate with Psychosocial and Treatment-Related Challenges. Canadian Journal of Dietetic Practice and Research.
78(2): 74-80. https://doi.org/10.3148/cjdpr-2016-034
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