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BMC Cancer
Published in: BMC Cancer 1/2017

Open Access 01-12-2017 | Research article

Temporal influence of endocrine therapy with tamoxifen and chemotherapy on nutritional risk and obesity in breast cancer patients

Authors: Mariana Tavares Miranda Lima, Kamila Pires de Carvalho, Fernanda Silva Mazzutti, Marcelo de Almeida Maia, Paula Philbert Lajolo Canto, Carlos Eduardo Paiva, Yara Cristina de Paiva Maia

Published in: BMC Cancer | Issue 1/2017

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Abstract

Background

The effect of endocrine therapy with tamoxifen (TMX) on weight gain has been reported in the literature, but the outcomes are still controversial. Moreover, previous treatment options, such as chemotherapy (CT), also include body changes. The focus of this study was to verify the temporal influence of endocrine therapy with TMX on nutritional risk and obesity and its association with CT in breast cancer patients.

Methods

In this cross-sectional study, 84 breast cancer surviving women were evaluated during endocrine therapy with TMX. Anthropometric, biochemical and body composition parameters were measured. A generalized estimating equation (GEE) was used to examine the association between CT and groups of women using TMX categorized by the duration of the treatment (group 1, women using TMX for the first 3 years; group 2, women using TMX between 3 and 4 years and group 3, women using TMX for more than 4 years).

Results

The interaction of CT with duration of TMX use showed a significant effect on Body Mass Index (BMI), waist circumference (WC) and body fat percentage (BFP) (GEE p-value = 0.002, 0.000, 0.000, respectively). Women from group 1 who underwent CT presented higher values of body variables compared to those women from group 2 who also underwent CT (BMI = 29.14 ± 0.93, 26.76 ± 0.85 kg/m2; WC = 94.45 ± 1.96, 91.07 ± 2.44 cm; BFP = 36.36 ± 1.50, 33.43 ± 1.66%, respectively). On the other hand, women from group 1 who did not undergo CT presented lower values of body variables compared to those women from group 2 who also did not undergo CT (BMI = 25.29 ± 0.46, 28.40 ± 0.95 kg/m2; WC = 85.84 ± 0.90, 97.75 ± 0.88 cm; BFP = 30.32 ± 0.43; 42.95 ± 1.03%, respectively).

Conclusions

Women on endocrine therapy with TMX are mostly overweighed and obese, most evidently in women who received CT, and who were at the beginning of treatment. Women that did not undergo CT, despite presenting lower values of body variables in the first 3 years, still deserve special attention because significantly higher values were observed in women between 3 and 4 years of therapy.
Literature
1.
2.
Early Breast Cancer Trialists Collaborative Group (EBCTCG), Davies C, Godwin J, Gray R, Clarke M, Cutter D, et al. Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials. Lancet. 2011;378(9793):771–84.CrossRef
3.
Davies C, Pan H, Godwin J, Gray R, Arriagada R, Raina V, et al. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet. 2013;381(9869):805–16.CrossRefPubMedPubMedCentral
4.
Lorizio W, Wu AH, Beattie MS, Rugo H, Tchu S, Kerlikowske K, et al. Clinical and biomarker predictors of side effects from tamoxifen. Breast Cancer Res Treat. 2012;132(3):1107–18.CrossRefPubMed
5.
Vance V, Mourtzakis M, McCargar L, Hanning R. Weight gain in breast cancer survivors: prevalence, pattern and health consequences. Obes Rev. 2011;12(4):282–94.CrossRefPubMed
6.
7.
Azrad M, Demark-Wahnefried W. The association between adiposity and breast cancer recurrence and survival: a review of the recent literature. Curr Nutr Rep. 2014;3(1):9–15.CrossRefPubMedPubMedCentral
8.
San Felipe MJR, Martínez AA, Manuel-Y-Keenoy B. Influencia del peso corporal en el pronóstico de las supervivientes de cáncer de mama; abordaje nutricional tras el diagnóstico. Nutr Hosp. 2013;28(6):1829–41.
9.
Kawai M, Minami Y, Nishino Y, Kukamachi K, Ohuchi N, Kakugawa Y. Body mass index and survival after breast cancer diagnosis in Japonese woman. BMC Cancer. 2012;12:149.CrossRefPubMedPubMedCentral
10.
Irwin ML, McTiernan A, Baumgartner RN, Baumgartner KB, Bernstein L, Gilliland FD, et al. Changes in body fat and weight after a breast cancer diagnosis: influence of demographic, prognostic, and lifestyle factors. J Clin Oncol. 2005;23(4):774–82.CrossRefPubMedPubMedCentral
11.
Goodwin PJ, Ennis M, Pritchard KI, McCready D, Koo J, Sidlofsky S, et al. Adjuvant treatment and onset of menopause predict weight gain after breast cancer diagnosis. J Clin Oncol. 1999;17(1):120–9.CrossRefPubMed
12.
Tredan O, Bajard A, Meunier A, Roux P, Fiorletta I, Gargi T, et al. Body weight change in women receiving adjuvant chemotherapy for breast cancer: a French prospective study. Clin Nutr. 2010;29(2):187–91.CrossRefPubMed
13.
Saquib N, Flatt SW, Natarajan L, Thomson CA, Bardwell WA, Caan B, et al. Weight gain and recovery of pre-cancer weight after breast cancer treatments: evidence from the women’s healthy eating and living (WHEL) study. Breast Cancer Res Treat. 2007;105(2):177–86.CrossRefPubMed
14.
Harvie MN, Campbell IT, Baildam A, Howell A. Energy balance in early breast cancer patients receiving adjuvant chemotherapy. Breast Cancer Res Treat. 2004;83(3):201–10.CrossRefPubMed
15.
Bender CM, Gentry AL, Brufsky AM, Casillo FE, Cohen SM, Dailey MM, et al. Influence of patient and treatment factors on adherence to adjuvante andocrine therapy in breast cancer. Oncol Nurs Forum. 2014;41(3):274–85.CrossRefPubMedPubMedCentral
16.
Sheean PM, Hoskins K, Stolley M. Body composition changes in females treated for breast cancer: a review of the evidence. Breast Cancer Res Treat. 2012;135(3):663–80.CrossRefPubMedPubMedCentral
17.
Longcope C, Baker R, Johnston CC. Androgen and estrogen metabolism: relationship to obesity. Metabolism. 1986;35(3):235–7.CrossRefPubMed
18.
Bulun SE, Chen D, Moy I, Brooks DC, Zhao H. Aromatase, breast cancer and obesity: a complex interaction. Trends Endocrinol Metab. 2012;23(2):83–9.CrossRefPubMed
19.
Dee A, McKean-Cowdin R, Neuhouser ML, Ulrich C, Baumgartner RN, McTiernan A, et al. DEXA measures of body fat percentage and acute phase proteins among breast cancer survivors: a cross-sectional analysis. BMC Cancer. 2012;12:343.CrossRefPubMedPubMedCentral
20.
Seynaeve C, Hille E, Hasenburg A, Rea D, Markopoulos C, Hozumi Y, et al. The impact of body mass index on the efficacy of adjuvant endocrine therapy in postmenopausal hormone sensitive breast cancer patients: exploratory analysis from the TEAM study. Cancer Res. 2010;70(Suppl 24):S2–3.
21.
Bell KE, Di Sebastiano KM, Vance V, Hanning R, Mitchell A, Quadrilatero J, et al. A comprehensive metabolic evaluation reveals impaired glucose metabolism and dyslipidemia in breast cancer patients early in the disease trajectory. Clin Nutr. 2014;33(3):550–7.CrossRefPubMed
22.
Singh HK, Prasad MS, Kandasamy AK, Dharanipragada K. Tamoxifen-induced hypertriglyceridemia causing acute pancreatitis. J Pharmacol Pharmacother. 2016;7(1):38–40.CrossRefPubMedPubMedCentral
23.
Jenaa SK, Suresha S, Sangamwarb AT. Modulation of tamoxifen-induced hepatotoxicity by tamoxifen-phospholipid complex. J Pharm Pharmacol. 2015;67(9):1198–206.CrossRef
24.
Gaibar M, Fernández G, Romero-Lorca A, Novillo A, Tejerina A, Bandrés F, et al. Tamoxifen therapy in breast cancer: do apolipoprotein E genotype and menopausal state affect plasma lipid changes induced by the drug? Int J Biol Markers. 2013;28(4):371–6.CrossRef
25.
Khosrow-Khavar F, Filion KB, Al-Qurashi S, Torabi N, Bouganim N, Suissa S, et al. Cardiotoxicity of Aromatase inhibitors and Tamoxifen in post-menopausal women with breast cancer: a systematic review and meta-analysis of randomized controlled trials. Ann Onc. 2016; doi:10.​1093/​annonc/​mdw673.
26.
Ewer MS, Glück S. A woman's heart. A woman's heart: the impact of adjuvant endocrine therapy on cardiovascular health. Cancer. 2009;115(9):1813–26.CrossRefPubMed
27.
van de Velde CJ, Rea D, Seynaeve C, Putter H, Hasenburg A, Vannetzel JM, et al. Adjuvant tamoxifen and exemestane in early breast cancer (TEAM): a randomised phase 3 trial. Lancet. 2011;377(9762):321–31.CrossRefPubMed
28.
Sestak I, Distler W, Forbes JF, Dowsett M, Howell A, Cuzick J. Effect of body mass index on recurrences in tamoxifen and anastrozole treated women: an exploratory analysis from the ATAC trial. J Clin Oncol. 2010;28(21):3411–5.CrossRefPubMed
29.
Faul F, Erdfelder E, Lang AG, Buchner A. G*power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175–91.CrossRefPubMed
30.
31.
32.
Lohamn TG, Going SB. Assessment of body composition and a energy balance. In: Lamb DR, Murray R, editors. Exercise, nutrition, and weight control. Perspective in exercise science and sports medicine, vol. 11; 1998. p. 61–105.
33.
Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Gómez JM, et al. Composition of the ESPEN working group. Bioelectrical impedance analysis--part I: review of principles and methods. Clin Nutr. 2004;23(5):1226–43.CrossRefPubMed
34.
35.
TACO. Tabela Brasileira de Composição de Alimentos. 4ª ed. rev. e ampl. Campinas: NEPA - UNICAMP; 2011.
36.
USDA. United States Dietetic Association. Dietary guidelines for Americans. 2005. Accessed 10 June 2017. Available: https://​health.​gov/​dietaryguideline​s/​dga2005/​document/​
37.
Xavier HT, Izar MC, Faria Neto JR, Assad MH, Rocha VZ, Sposito AC, et al. Sociedade Brasileira de Cardiologia. V Diretriz Brasileira sobre Dislipidemias e Prevenção da Aterosclerose. Arq Bras Cardiol. 2013;101(Suppl. 1):1–20.CrossRef
38.
39.
Lorenzi TF. Manual de Hematologia. Propedêutica e clínica. 3rd ed. São Paulo: Editora Médica Científica; 2003.
40.
Sendur MAN, Aksoy S, Ozdemir NY, Zengin N, Yazici O, Sever AR, et al. Effect of body mass index on the efficacy of adjuvant tamoxifen in premenopausal patients with hormone receptor positive breast cancer. JBUON. 2016;21(1):27–34.PubMed
41.
Schmitz KH, Ahmed RL, Hannan PJ, Yee D. Safety and efficacy of weight training in recent breast cancer survivors to alter body composition, insulin, and insulin-like growth factor axis proteins. Cancer Epidemiol Biomark Prev. 2005;14(7):1672–80.CrossRef
42.
Jiralerspong S, Kim ES, Dong W, Feng L, Hortobagyi GN, Giordano SH. Obesity, diabetes, and survival outcomes in a large cohort of early-stage breast cancer patients. Ann Oncol. 2013;24(10):2506–14.CrossRefPubMedPubMedCentral
43.
Goodwin PJ, Ennis M, Pritchard KI, Trudeau ME, Koo J, Taylor SK, et al. Insulin- and obesity-related variables in early-stage breast cancer: correlations and time course of prognostic associations. J Clin Oncol. 2012;30(2):164–71.CrossRefPubMed
44.
Ewertz M, Jensen MB, Gunnarsdottir KA, Jakobsen EH, Nielsen D, Stenbygaard LE, et al. Effect of obesity on prognosis after early-stage breast cancer. J Clin Oncol. 2011;29(1):25–31.CrossRefPubMed
45.
van den Brandt PA, Spiegelman D, Yaun SS, Adami HO, Beeson L, Folson AR, et al. Pooled analysis of prospective cohort studies on height, weight, and breast cancer risk. Am J Epidemiol. 2000;152(6):514–27.CrossRefPubMed
46.
Howell A, Cuzick J, Baum M, Buzdar A, Dowsett M, Forbes JF, et al. Results of the ATAC (Arimidex, Tamoxifen, alone or in combination) trial after completion of 5 years’ adjuvant treatment for breast cancer. Lancet. 2005;365(9453):60–2.CrossRefPubMed
47.
Fisher B, Costantino JP, Wickerham DL, Redmond CK, Kavanah M, Cronin WM, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and bowel project P-1 study. J Natl Cancer Inst. 1998;90(18):1371–88.CrossRefPubMed
48.
49.
Bayley JP, Devilee P. Warburg tumours and the mechanisms of mitochondrial tumour supressor genes.Barkingup the right tree? Curr Opin Genet Dev. 2010;20(3):324–9.CrossRefPubMed
50.
Trédan O, Bajard A, Meunier A, Roux P, Fiorletta I, Gargi T, et al. Body weight change in women receiving adjuvant chemotherapy for breast cancer: a French prospective study. Clin Nutr. 2010;29(2):187–91.CrossRefPubMed
51.
Judson GM, Braun B, Jerry DJ, Mertens W. Weight gain following breast cancer diagnosis: implication and proposed mechanisms. World J Clin Oncol. 2014;5(3):272–82.CrossRef
52.
Demark-Wahnefried W, Peterson BL, Winer EP, Marks L, Aziz N, 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.CrossRefPubMed
53.
Custódio IDD, Marinho EC, Gontijo CA, Pereira TSS, Paiva CE, Maia YC. Impact of chemotherapy on diet and nutritional status of women with breast cancer: a prospective study. PLoS One. 2016;11(6):e0157113.CrossRefPubMedPubMedCentral
54.
Gudny Geirsdottir O, Thorsdottir I. Nutritional status of cancer patients in chemotherapy; dietary intake, nitrogen balance and screening. Food Nutr Res. 2008; doi:10.​3402/​fnr.​v52i0.​1856.
55.
Kumar NB, Allen K, Cantor A, Cox CE, Greenberg H, Shah S, et al. Weight gain associated with adjuvant tamoxifen therapy in stage I and II breast cancer: fact or artifact? Breast Cancer Res Treat. 1997;44(2):135–43.CrossRefPubMed
56.
Fisher B, Dignam J, Bryant J, DeCillis A, Wickerham DL, Wolmark N, et al. Five versus more than five years of tamoxifen therapy for breast cancer patients with negative lymph nodes and estrogen receptor-positive tumors. J Natl Cancer Inst. 1996;88(21):1529–42.CrossRefPubMed
57.
Vriens IJ, De Bie AJ, Aarts MJ, de Boer M, van Hellemond IE, Roijen JH, et al. The correlation of age with chemotherapy-induced ovarian function failure in breast cancer patients. Oncotarget. 2017; doi:10.​18632/​oncotarget.​14532.
58.
Ben-Aharon I, Granot T, Meizner I, Hasky N, Tobar A, Rizel S, et al. Long-term follow-up of chemotherapy-induced ovarian failure in young breast cancer patients: the role of vascular toxicity. Oncologist. 2015;20(9):985–91.CrossRefPubMedPubMedCentral
59.
Pedro AO, Pinto Neto AM, Paiva LH, Osis MJ, Herdy E. Age at natural menopause among Brazilian women: results from a population-based survey. Cad Saude Publica. 2003;19(1):17–25.CrossRefPubMed
60.
Rechia F, Necozione S, Bratta M, Rosselli M, Guerriero G, Rea S. LH-RH analogues in the treatment of young women with early breast cancer: long-term follow-up of a phase II study. Int J Oncol. 2015;46(3):1354–60.
61.
Tham YL, Sexton K, Weiss H, Elledge R, Friedman LC, Kramer R. The rates of chemotherapy-induced amenorrhea in patients treated with adjuvant doxorubicin and Cyclophosphamide followed by a taxane. Am J Clin Oncol. 2007;30(2):126–32.CrossRefPubMed
62.
Cho GJ, Lee JH, Park HT, et al. Postmenopausal status according to years since menopause as an independent risk factor for the metabolic syndrome. Menopause. 2008;15(3):524–9.CrossRefPubMed
63.
Sowers M, Zheng H, Tomey K, et al. Changes in body composition in women over six years at midlife: ovarian and chronological aging. J Clin Endocrinol Metab. 2007;92(3):895–901.CrossRefPubMed
64.
Zainal NZ, Nick-Jaafar NR, Baharudin A, Sabki ZA, Ng CG. Prevalence of depression in breast cancer survivors: a systematic review of observational studies. Asian Pac J Cancer Prev. 2013;14(4):2649–56.CrossRefPubMed
65.
Quirk SE, Williams LJ, O’Neil A, Pasco JA, Jacka FN, Housden S, et al. The association between diet quality, dietary patterns and depression in adults: a systematic review. BMC Psychiatry. 2013;13:175.CrossRefPubMedPubMedCentral
66.
van Noord PAH, Seidell JC, den Tonkelaar I, Baanders-van Halewijn EA, Ouwehand ZJ. The relationship between fat distribution and some chronic diseases in 11,825 women participating in the DOM project. Int J Epidemiol. 1990;19(3):564–70.CrossRefPubMed
67.
Folsom AR, Prineas RJ, Kaye SA, Soler JT. Body fat distribution and self-reported prevalence of hypertension, heart attack, and other heart disease in older women. Int J Epidemiol. 1989;18(2):361–7.CrossRefPubMed
68.
Viale G, Giobbie-Hurder A, Regan MM, Coates AS, Mastropasca MG, Dell'Orto P, et al. Prognostic and predictive value of centrally reviewed Ki-67 labeling index in postmenopausal women with endocrine-responsive breast cancer: results from breast international group trial 1–98 comparing adjuvant tamoxifen with letrozole. J Clin Oncol. 2008;26(34):5569–75.CrossRefPubMedPubMedCentral
69.
Viale G, Regan MM, Dell'Orto P, Mastropasca MG, Maiorano E, et al. Which patients benefit most from adjuvant aromatase inhibitors? Results using a composite measure of prognostic risk in the BIG 1–98 randomized trial. Ann Oncol. 2011;22(10):2201–7.CrossRefPubMedPubMedCentral
70.
Lankester KJ, Phillips JE, Lawton PA. Weight gain during adjuvant and neoadjuvant chemotherapy for breast cancer: anaudit of 100 women receiving FEC or CMF chemotherapy. Clin Oncol (R Coll Radiol). 2002;14(1):64–7.CrossRef
Metadata
Title
Temporal influence of endocrine therapy with tamoxifen and chemotherapy on nutritional risk and obesity in breast cancer patients
Authors
Mariana Tavares Miranda Lima
Kamila Pires de Carvalho
Fernanda Silva Mazzutti
Marcelo de Almeida Maia
Paula Philbert Lajolo Canto
Carlos Eduardo Paiva
Yara Cristina de Paiva Maia
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2017
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-017-3559-z

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