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Weight loss, physical and psychological patient reported outcomes (PROs) among obese patients (pts) with early breast cancer (BC)

Date

22 Oct 2018

Session

Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care

Presenters

Antonio Di Meglio

Citation

Annals of Oncology (2018) 29 (suppl_8): viii603-viii640. 10.1093/annonc/mdy300

Authors

A. Di Meglio1, M. El-Mouhebb2, S. Michiels3, L. Jones4, E. Martin1, M. Matias2, A.E. Lohmann Palhares5, F. Joly6, L. Vanlemmens7, S. Everhard8, A.L. Martin9, J. Lemonnier9, P. Arveux10, P.H. Cottu11, C. Coutant10, L. Del Mastro12, A.H. Partridge13, F. André14, J.A. Ligibel15, I. Vaz-Luis2

Author affiliations

  • 1 Medical Oncology, Institut Gustave Roussy, 94805 - Villejuif/FR
  • 2 Medical Oncology, Institut Gustave Roussy, 94800 - Villejuif/FR
  • 3 Team Oncostat, Cesp, Gustave Roussy, 94805 - Villejuif/FR
  • 4 Exercise Oncology Research Program, Memorial Sloan Kettering Cancer Center, New York/US
  • 5 Medical Oncology, University of Toronto, 21941-913 - Toronto/CA
  • 6 Na, GINECO & Centre Francois Baclesse Caen, 14000 - Caen/FR
  • 7 Medical Oncology, Centre Oscar Lambret, 59020 - Lille/FR
  • 8 Ucbg, UNICANCER, 75654 - Paris/FR
  • 9 Research & Develpment, Unicancer, 75654 - Paris/FR
  • 10 Medical Oncology, Centre Georges-François Leclerc (Dijon), 21000 - Dijon/FR
  • 11 Medical Oncology, Institut Curie, 75248 cedex5 - Paris/FR
  • 12 Medical Oncology, Ospedale Policlinico San Martino, 16132 - Genova/IT
  • 13 Medical Oncology, Dana-Farber Cancer Institute, MA 02215, - Boston/US
  • 14 Breast Cancer Unit, Department Of Medical Oncology, Gustave Roussy - Cancer Campus, 94805 - Villejuif/FR
  • 15 Medical Oncology, Dana-Farber Cancer Institute, Boston/US
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Background

Obesity and unfavorable energy balance affect physical and psychological outcomes among BC survivors. There is little data describing the impact of weight loss on PROs in obese pts.

Methods

We used a prospective French nationwide longitudinal cohort (CANTO, NCT01993498) to select obese (Body Mass Index ≥ 30 kg/m2) stage I-III BC pts diagnosed from 2012-14. Nurses assessed weight change from BC diagnosis (dx) to 3-6 months post treatment (surgery, chemo [CT] or radiotherapy [RT]), defined as weight gain (≥ 5%), stability (± 5%) or loss (≤ 5%). PROs were assessed by EORTC QLQ C30/BR23. Functional scores <60 and symptom scores ≥40 defined severe dysfunctions and symptoms, respectively (Giesinger, 2016). Multivariate logistic regression explored associations of weight change with severe PROs.

Results

We included 892 obese pts, 19% of CANTO population. Mean age was 59 y (range 27-87). 92% received RT, 54% CT and 84% endocrine therapy. Mean BMI at dx was 34.5 (range 30.0-59.0). 14% pts gained weight, 67% were stable and 19% lost weight post treatment. There was a significant differential reduction in physical activity in 39% pts who gained weight, 37% pts with stable weight, and 28% pts who lost weight (mean change [Standard Deviation] was -5 [77], -4 [66] and +4 [69] MET-hours/week, respectively [p=.036]). Prevalence of any severe dysfunction or symptom was 83% at dx and further increased over time, being highest in pts who gained weight. Weight loss was associated with lower odds of severe dysfunctions or symptoms vs weight gain, consistently across all PROs (Table).Table: 1739P

Prevalence of severe dysfunctions and symptoms at BC diagnosis and post treatment by weight change category among obese pts in CANTO (N = 892)

DiagnosisPost treatment
OverallOverallBy weight change category (% pts)
PRO Domain--Gain (14.0)Stable (67.0)Loss (19.0)
All domains combined ≥1 Function or Symptom ≥1 Function ≥1 Symptom82.8 76.0 56.188.9 78.3 75.992.2 82.6 78.388.6 78.7 75.887.4 73.6 74.2
Global Health Statusa % pts aOR (95% CI)34.2 -35.7 -40.7 Ref37.8 0.73 (0.44-1.21)24.5 0.42 (0.23-0.80)
Physical Functiona % pts aOR (95% CI)10.9 -20.4 -23.7 Ref20.8 0.59 (0.32-1.10)16.5 0.43 (0.20-0.95)
Emotional Functiona % pts aOR (95% CI)34.0 -29.5 -36.5 Ref29.7 0.67 (0.40-1.13)23.4 0.53 (0.28-1.00)
Social Functiona % pts aOR (95% CI)6.2 -14.4 -22.6 Ref13.8 0.56 (0.31-1.03)10.3 0.42 (0.19-0.92)
Paina % pts aOR (95% CI)14.3 -29.9 -43.5 Ref29.3 0.46 (0.28-0.75)22.0 0.29 (0.15-0.55)
Dyspneaa % pts aOR (95% CI)11.0 -17.2 -33.6 Ref16.0 0.32 (0.18-0.56)9.5 0.16 (0.07-0.35)
Body Imageb % pts aOR (95% CI)13.6 -28.7 -40.0 Ref27.4 0.60 (0.35-1.02)25.0 0.45 (0.23-0.87)
Systemic therapy side effectsb % pts aOR (95% CI)3.9* -15.3 -21.7 Ref14.6 0.62 (0.33-1.18)13.0 0.47 (0.21-1.04)

aOR= adjusted odds ratio; CI= Confidence Interval; aEORTC QLQ-C30 subscale; bEORTC QLQ-B23 subscale; *pts surveyed before start of treatment; All models adjusted for age, menopausal status, education, smoke, alcohol, physical activity, tumor stage, subtype, BC and axillary surgery, receipt of CT, RT, endocrine therapy, and level of the outcome at BC diagnosis.

Conclusions

The majority of obese pts report severe physical or psychological distress at BC dx and post treatment. A comprehensive approach to the care of obese BC pts should address the burden of morbidity caused by obesity and further post treatment weight gain. Weight loss may prevent physical and psychological deterioration, thus lifestyle interventions of purposeful weight loss should be encouraged.

Clinical trial identification

NCT01993498.

Legal entity responsible for the study

UNICANCER.

Funding

Has not received any funding.

Editorial Acknowledgement

Disclosure

A. Di Meglio: Recipient of the 2017 ESMO Clinical research Fellowship Award. I. Vaz-Luis: Recipient of research grants from Susan Komen for the Cure and the “Association pour la recherche sur le cancer (ARC)”. All other authors have declared no conflicts of interest.

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