Body weight changes in young breast cancer survivors and associated predictors.

11574 Background: Weight gain after cancer diagnosis is common in cancer survivors and has been linked to increased treatment toxicity, poor quality of life, and increased risk of second cancers and overall mortality. Young breast cancer (BC) survivors may be especially susceptible to weight changes given the impact of treatments such as chemotherapy and hormonal therapy on menopausal status. Methods: We identified women with Stage 0-III breast cancer diagnosed at ≤40 years (y) between 2006-2016 from a multi-center prospective cohort study. Clinical data including self-reported pre-diagnosis and follow-up weights were obtained using baseline and follow-up patient surveys. Participants missing baseline weight, pregnant at diagnosis/within 1y of diagnosis or with BC recurrence within 1y were excluded; those pregnant or with BC recurrence between 1-3y from diagnosis were excluded from the 3y analysis. Menopausal status at baseline and treatment-related amenorrhea (TRA) in follow-up were defined by self-reported last menstrual period. Factors associated with weight gain (>5%) were evaluated using univariate two-sided Fisher's exact test. Results: At baseline, 1y and 3y post diagnosis, 956, 899 and 687 women were eligible for analysis respectively. Median age at diagnosis was 37y (17 - 40), 65% received endocrine therapy and 74% chemotherapy. Premenopausal status was verified in 94% at baseline. Mean BMI at baseline was 24.4 (SD 5.3) kg/m2; 20% (187/956) were overweight and 12% (116/956) obese. At 1y and 3y, mean BMI increased modestly to 24.7 (SD 5.6) and 24.9 (SD 5.2), respectively with weight gain (>5%) observed in 18% (164/899) and 13% (87/687) respectively. 37% (300/804) and 32% (196/615) of eligible premenopausal subjects experienced TRA at 1y and 3y, respectively. Receipt of chemotherapy, receipt of endocrine therapy and TRA were not associated with weight gain at any timepoint. Conclusions: In this large prospective cohort of young BC survivors, mean BMI increased only modestly over time. Self-reported weight gain was not associated with treatment and not exacerbated by TRA. Further analysis to understand the effects of physical activity and other predictors of weight gain in this population are ongoing.

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Association of cancer treatment with excess heart age among young breast cancer survivors.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.12081 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 12081-12081

Author(s):

Jacqueline B Vo ◽

Shoshana M. Rosenberg ◽

Philip Daniel Poorvu ◽

Kathryn Jean Ruddy ◽

Rulla Tamimi ◽

...

Keyword(s):

Breast Cancer ◽

Blood Pressure ◽

Cancer Survivors ◽

Cancer Treatment ◽

Endocrine Therapy ◽

Breast Cancer Survivors ◽

Cvd Risk ◽

Young Breast Cancer ◽

Heart Age

12081 Background: Young women with breast cancer may be at increased risk for premature development of cardiovascular disease (CVD) in part due to their cancer treatment. Limited data are available on CVD risk among young breast cancer survivors. Methods: Women aged 30-40 years at diagnosis with stage 0-III breast cancer enrolled in a prospective cohort study of women diagnosed with breast cancer at ≤40 were eligible for inclusion in this analysis. Data were obtained from serial surveys and electronic medical records at breast cancer diagnosis and 5-year follow-up. We calculated “excess heart age,” which incorporates a CVD risk-based score (calculated using age, systolic blood pressure, blood pressure medication, diabetes, smoking, body mass index) to estimate the difference in years between an individual’s chronological age and their CVD-risk adjusted age. Multivariable logistic regression models (adjusting for age at diagnosis, stage, and race) were fitted to evaluate associations between treatment (radiation, endocrine therapy, anthracyclines, and trastuzumab) and having a change in excess heart age ≥2 years from baseline to 5 years. Results: Among 372 young breast cancer survivors, mean age at diagnosis was 36.6 (SD 2.89), 93% were white, and 79% were diagnosed with stage I or II breast cancer. Mean excess heart age was.32 (SD: 6.16) years at baseline, which declined to -.07 (SD 6.64) at 5-year follow-up (p=.17). At 5 years, 31% (n=114) of women experienced an increase of at least 2 years in their excess heart age since diagnosis, and their mean excess heart age was 4.34 years (range -9 to 30). In multivariable analyses, receipt of trastuzumab was associated with higher odds (OR: 1.68, 95% CI: 1.02-2.77) of experiencing an increase of ≥2 years in excess heart age between diagnosis and 5 years of follow-up. Endocrine therapy, anthracyclines, and radiation were not significantly associated with a change in excess heart age of ≥2 years at 5 years post-diagnosis. Conclusions: At 5 years post-diagnosis, approximately 1/3 of young breast cancer survivors experienced a change from baseline in their excess heart age of ≥2 years. Further research is warranted to confirm findings regarding trastuzumab and excess heart age, and potential effects on longer-term cardiac outcomes in this population. Extended follow-up of this cohort may further quantify CVD risk over time.[Table: see text]

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Does race affect outcomes in triple negative breast cancer (TNBC)?

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e17543 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e17543-e17543

Author(s):

S. Ahmed ◽

M. M. Mirza ◽

A. Farooq ◽

L. Kronish ◽

M. Jahanzeb ◽

...

Keyword(s):

Breast Cancer ◽

Racial Differences ◽

Statistical Significance ◽

Menopausal Status ◽

Cox Proportional Hazards ◽

Rank Test ◽

Stage At Diagnosis ◽

Cancer Specific Survival ◽

The Impact

e17543 Background: TNBC is associated with a worse prognosis than luminal subtypes. There is discordance among studies assessing the impact of race on outcomes of TNBC. Our objective was to assess whether African American (AA) vs. Caucasian (CA) race predicted survival outcomes for women with TNBC treated at a single institution in Memphis, TN. Secondary objectives were to examine the association of race with patient and tumor characteristics. Methods: Patients with stage I-III TNBC were identified from our breast cancer database and confirmed by review of pathology reports. Event free survival (EFS) was measured from the date of surgery to the date of first recurrence (locoregional, distant, or contralateral), death from breast cancer or last follow-up. Breast cancer specific survival (BCSS) was measured from the date of surgery to the date of death from breast cancer or last follow-up. Fisher's exact test was used for association between variables, Kaplan Meier method for survival estimates, and log rank test for survival comparison between groups (p < 0.05: significant). Cox proportional hazards models with patient, tumor and treatment variables were fitted for EFS and BCSS. Results: Of the 105 patients with TNBC, 71% were AA. There was no significant association between race and stage at diagnosis (p = 0.68). 71% of AA women were < 55 years old and 43% were pre-menopausal vs. 50% and 23% of CA women respectively. There was a trend towards association of race with age and menopausal status (p = 0.08). Ninety three percent of the patients received neo/adjuvant chemotherapy. With a median follow up of 26 months, 26% of AA vs. 20% of CA women had an event (p = 0.62). Overall 3 year EFS and BCSS estimates were 69% and 82% respectively. Racial differences in EFS and BCSS for AA vs. CA (65% vs. 80% and 78% vs. 89%, respectively) did not achieve statistical significance (log rank p = 0.22 for EFS and 0.26 for BCSS). Race was not a significant predictor of EFS or BCSS on uni-variable or multi-variable analysis. Stage at diagnosis retained significance for EFS and BCSS on uni-variable and multi-variable testing. Conclusions: Race did not affect outcomes in our cohort of TNBC patients treated similarly. The high event rate underscores the poor prognosis of TNBC and the need for more effective therapies. No significant financial relationships to disclose.

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Exploring Interactive Survivorship Care Plans to Support Breast Cancer Survivors: Protocol for a Randomized Controlled Trial

JMIR Research Protocols ◽

10.2196/23414 ◽

2020 ◽

Vol 9 (12) ◽

pp. e23414

Author(s):

Akshat Kapoor ◽

Priya Nambisan

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Self Management ◽

Survivorship Care Plans ◽

Survivorship Care ◽

Breast Cancer Survivorship ◽

Care Plans ◽

The Impact

Background Breast cancer is the most common form of cancer among American women, accounting for 23% of all cancer survivors nationally. Yet, the availability of adequate resources and tools for supporting breast cancer survivors has not kept up with the rapid advancement in treatment options, resulting in unmet supportive care needs, particularly among low-income and minority populations. This study explores an alternative means of delivering breast cancer survivorship care plans (SCPs), with the aim of improving survivor morbidity, patient knowledge, and self-management of treatment-related symptoms, as well as addressing inconsistencies in follow-up care visits. Objective The overall goal of this study is to improve the uptake of SCP recommendations via an educational intervention for breast cancer survivors, to improve treatment-related morbidity, patient knowledge, self-management, and adherence to follow-up visits. The specific aims of the study are to (1) evaluate the feasibility of the online SCP, and (2) assess the impact of the online SCP on survivorship outcomes. Methods We will enroll 50 breast cancer survivors who have completed initial breast cancer treatment into a 2-armed, randomized, waitlist-controlled pilot trial, and collect data at baseline and 6 months. For the first aim, we will use mixed methods, including surveys and personal interviews among the intervention group, to determine the feasibility of providing an online, interactive SCP (called ACESO) based on the survivors’ online user experience and their short-term adoption. For the secondary aim, we will compare the 2 groups to assess the primary outcomes of survivor knowledge, self-efficacy for self-management, perceived peer support, and adherence to SCP-recommended posttreatment follow-up visits to oncology and primary care; and the secondary outcomes of treatment-related morbidity (body weight, fatigue, depression, anxiety, sexual function, distress, and sleep quality). We assess these outcomes by using measurements from validated instruments with robust psychometric properties. Results We have developed and refined the online breast cancer survivorship plan, ACESO, with consultation from breast cancer oncologists, nurses, and survivors. Approval for the study protocol has been obtained from the Institutional Review Board. An advisory board has also been established to provide oversight and recommendations on the conduct of the study. The study will be completed over a period of 2 years. Conclusions The results of this pilot study will inform the feasibility and design of a larger-scale pragmatic trial to evaluate the impact of an online breast cancer SCP on treatment-related morbidity and self-efficacy for self-management. International Registered Report Identifier (IRRID) PRR1-10.2196/23414

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Impact of taxanes on weight gain during neoadjuvant chemotherapy (Ctx) for breast cancer (BC)

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.10606 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 10606-10606

Author(s):

M. E. Melisko ◽

C. A. Millerick ◽

P. Maniar ◽

D. Moore ◽

M. Rosenwein ◽

...

Keyword(s):

Weight Gain ◽

Weight Change ◽

Cox Regression ◽

Menopausal Status ◽

Baseline Body Mass Index ◽

Risk Of Recurrence ◽

Increased Risk ◽

Taxane Chemotherapy ◽

The Impact

10606 Background: Weight gain after the diagnosis of BC has been associated with increased risk of recurrence and mortality. Previous studies have documented weight gain after cyclophosphamide, methotrexate, and 5-fluoruracil (CMF) and adriamycin and cyclophosphamide (AC) chemotherapy, but the impact of taxane chemotherapy has not been described. Methods: We reviewed the charts of 119 patients (pts) who completed neoadjuvant Ctx between 1997–2005. Age, baseline body mass index (BMI), tumor size, nodal status, hormone receptor status, menopausal status, co-morbid illnesses and anti-depressant use were collected. Weight was recorded at each Ctx visit and at follow-up visits for two years. Results: 22 pts received AC only. 97 pts received AC followed by a taxane - 58 docetaxel (D), 39 paclitaxel (P). Median f/u time was 26.3 months. 66/119 (55%) of pts gained weight during Ctx, with a median change of + 1 pound (range -28 to +19.5 pounds) at the end of Ctx. 49/119 (41%) of pts gained weight during AC and 76/97 (78%) of pts gained weight during the taxane. Mean weight change after AC was -1.8 pounds compared to +3.2 pounds after the taxane (p < 0.001). Age, baseline BMI, and menopausal status prior to Ctx did not predict weight gain. There was no difference in weight gain between pts who received D vs. P (p = 0.19). 8/22 (36%) patients who received AC alone recurred, and 13/95 (14%) who received both AC and T recurred; however this was not statistically significant (p = 0.23). Total weight change during neoadjuvant Ctx did not predict recurrence; however weight gain during the AC portion was associated with a higher risk of recurrence when adjusted for weight gain during taxane Ctx (p = 0.035, Cox regression). Each one pound gained was associated with an 11% increase in risk of recurrence. Conclusions: Weight gain is common during neoadjuvant Ctx for BC, particulary during treatment with taxanes. Further follow up is required to establish if weight gain is maintained over time and to determine the impact of weight change on BC outcomes and health. No significant financial relationships to disclose.

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Follow-up of long-term young breast cancer survivors.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.34_suppl.8 ◽

2012 ◽

Vol 30 (34_suppl) ◽

pp. 8-8

Author(s):

Corinne Daly ◽

Elisabeth M. Del Giudice ◽

Rinku Sutradhar ◽

Lawrence Frank Paszat ◽

Drew Wilton ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Cancer Registry ◽

Breast Cancer Survivors ◽

Negative Binomial ◽

Population Based ◽

Cancer Center ◽

Physician Visits ◽

Young Breast Cancer

8 Background: Evidence suggests breast cancer patients can be offered follow-up by family physician without concern of important recurrence–related serious clinical events occurring more frequently or quality of life being negatively affected. This study describes population-based patterns of follow-up care in 5-year recurrence-free young breast cancer survivors to determine factors influencing continued oncology follow-up in Ontario, Canada. Methods: We conducted a retrospective population-based cohort study using cancer registry and administrative data. Women diagnosed with an incident breast cancer aged 20-44 between 1992 and 1999, survived for at least 5 years and recurrence-free for 5 years past diagnosis were identified in the Ontario Cancer Registry. Each survivor was matched to 5 control women with the same calendar year of birth and place of residence in Ontario. We determined outpatient physician visits with primary care, medical, radiation and surgical oncology physicians to investigate trends associated with increasing survivorship and compared visit rates to controls. We used negative binomial regression to investigate factors predicting high utilization of oncology services among survivors after 5-year recurrence survival. Results: We identified 4,581 survivors and 22,898 controls. By year 10, 51% breast cancer survivors were still being followed by an oncologist. In the survivors, fewer physician visits were observed among recurrence-free breast cancer survivors as time increased from diagnosis (Visit Rate Ratio [VRR] =0.95, 95% CI: 0.94, 0.96). Breast cancer survivors diagnosed from 1992-1995 had a higher rate of physician visits than those diagnosed from 1996-1999 (VRR = 1.16, 95% CI: 1.07, 1.25). More oncologist visits were associated with patients visiting a female oncologist (VRR = 1.20, 95% CI: 1.09, 1.33) and fewer visits were associated with patients visiting an oncologist who practiced outside of a regional cancer center (VRR = 0.67, 95% CI: 0.58, 0.77). Conclusions: Oncology visits of young breast cancer survivors after 5-year survival were associated with oncologist factors indicating that prolonged oncology follow-up in breast cancer survivors may be driven by practice patterns rather than patients’ needs.

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Measuring knowledge gained for young breast cancer survivors and co-survivors.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.3_suppl.213 ◽

2016 ◽

Vol 34 (3_suppl) ◽

pp. 213-213

Author(s):

Lori Atkinson ◽

Michelle Esser ◽

Nirmala Singh ◽

Jean Rowe ◽

Megan McCann ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Online Surveys ◽

Self Confidence ◽

Global Organization ◽

Critical Issues ◽

Baseline Knowledge ◽

Young Breast Cancer

213 Background: Cancer impacts not just the survivor, but those caring for her. Young Survival Coalition (YSC) is the premier global organization dedicated to critical issues in young breast cancer survivors (YBCS) and co-survivors. In 2015, targeted programming was introduced at YSC’s Northeast Regional Symposium. Prior to the event, YSC crafted pre- and post-surveys to measure knowledge gained through the Symposium as an intervention for YBCS and co-survivors. Methods: YSC disseminated pre- and post-event evaluations via online surveys. The pre-survey was sent to registrants (240; 75 completed), and the post-survey was sent to attendees (178; 99 completed). The surveys were designed to measure baseline and increased knowledge in the 4 areas presented at the Symposium: Sex and Intimacy (S&I), Practical Matters (PM), Resiliency and Communication. Questions included demographics, diagnosis, identification as YBCS/co-survivor and baseline knowledge in the 4 areas. Questions in the post-survey followed the same format and measured knowledge gained from the Symposium. Results: In pre-survey data, YBCS and co-survivors most wanted knowledge and resources in S&I and PM. Seventy-five percent reported S&I as a challenge since diagnosis, and 51% stated communication in relationships was difficult. Twenty-two percent felt they did not have the resources they needed to address PM, while 20% felt unsure about what resources they needed. Following the Symposium, 74% felt that they had tools and resources to help in their everyday life as it relates to S&I after the Symposium. Sixty-seven percent reported gaining knowledge they did not have prior to attending. S&I as it relates to YBCS (partnered or single) and rebuilding self-confidence were areas where more information was desired. Seventy-five percent indicated they received information on PM of which they were unaware prior to attending. Follow-up care, financial concerns and career were areas where more information was desired. Conclusions: YBCS and their co-survivors are in need of support and information that is targeted and easily accessible. YSC will continue crafting specific programming for YBCS and co-survivors and measuring the knowledge of both to stay current with their needs.

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Asymptomatic cardiotoxicity in long-term breast cancer survivors.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e24084 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e24084-e24084

Author(s):

Mohammed Alaeddine Saidi ◽

Soumeyya Ghomari

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Cancer Survivors ◽

Endocrine Therapy ◽

Early Breast Cancer ◽

Breast Cancer Survivors ◽

Left Ventricular ◽

Left Ventricular Ejection

e24084 Background: Multimodal approach in the adjuvant treatment of early breast cancer has led to a significant number of survivors. However, the combination of these treatments may increase the risk of long-term cardiotoxicity, particularly in the presence of cardiovascular risk factors (CVRF). Methods: We examined cardiac function in patients who had previously been treated for early breast cancer. Echocardiograms were performed at least 2 years after therapy. We measured left ventricular ejection fraction (LVEF) and reported pre-treatment LVEF and all CVRF. The initial Framingham Risk Score (FRS) has been calculated. Asymptomatic cardiotoxicity was defined by decrease of 5% or more in the LVEF value without clinical symptoms of CHF. Doxorubicin, Trastuzumab, Radiotherapy, older age, and CVRF (hypertension (HTN), diabetes, dyslipidemia, obesity, Waist circumference) were evaluated as potential risk factors for the development of cardiotoxicity. All statistical analysis was performed using SPSS version 25.0. Results: A total of 143 breast cancer survivors with a median age of 46 ± 10 years (range: 26-72) underwent Echocardiogram imaging after a median follow-up of 9,22 years (range: 2 - 22). 48 women were postmenopausal at diagnostic. 32,2% were obese. HTN was present in 15%, diabetes in 12%, and dyslipidemia in 12% of patients. ARA-II was the most used treatment of HTN (55%). 11,9% of patients were under statin therapy. FRS was low in 69%, moderate in 22% and high in 9% of patients. 4 patients had received endocrine therapy alone, none of whom developed cardiotoxicity. There was only one case of symptomatic cardiotoxicity. In the remaining 138 women who received multimodal treatment (Anthracyclines:100%, Docetaxel:62,9%, Endocrine therapy:72%, Trastuzumab:7%, Radiotherapy:83,2%), a statistical but non-clinically significant decrease was observed in LVEF (67.7 ± 3.6 to 65.4 ± 5.1, p < 0.001). 39 women (28,3%) developed asymptomatic cardiotoxicity. In multivariate analysis, factors that contributed to decreased LVEF were HTN (p = 0,006), diabetes (p = 0,008) and dyslipidemia (p = 0,03). Conclusions: The use of adjuvant therapy in breast cancer may increase long term cardiotoxicity particularly in survivors with CVRF. Long-term cardiac follow-up is essential in order to initiate cardioprotective therapy at the right time.

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Mindfulness based stress reduction (MBSR) to improve cardiovascular (CV) function and psychosocial outcomes in breast cancer survivors.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e24058 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e24058-e24058

Author(s):

Anne Hudson Blaes ◽

Patricia Jewett ◽

Prabhjot Nijjar ◽

Susan Everson-Rose

Keyword(s):

Breast Cancer ◽

Endothelial Dysfunction ◽

Endothelial Function ◽

Cancer Survivors ◽

Stress Reduction ◽

Breast Cancer Survivors ◽

Psychosocial Outcomes ◽

Ratio Measurement ◽

The Impact

e24058 Background: Breast cancer survivors on aromatase inhibitors (AIs) can develop endothelial dysfunction, a measure of increased CV risk. Stress modifying techniques such as MBSR may improve CV function and quality of life (QOL). We present data of a pilot study assessing the impact of MBSR on endothelial dysfunction and psychosocial outcomes. Methods: 31 women with locally advanced breast cancer and taking an AI were randomized 1:1 to 8 weekly MBSR classes or wait-list control. Subjects with tobacco use, known hypertension or hyperlipidemia were excluded. Participants completed surveys and vascular testing at baseline and 10 weeks. With the COVID-19 pandemic, MBSR classes were held on a virtual platform. Endothelial function was measured using the Endo-PAT2000 system; reductions in EndoPAT ratio (<1.6) are indicative of worsening endothelial function and increased CV risk. Questionnaires included the CDC’s 4-item Healthy Days Core Module (HRQOL), Patient Health Questionnaire (PHQ)-8 for depression, the Perceived Stress Scale, and the Generalized Anxiety Disorder Scale (GAD-7). Functional test markers were compared between groups using t-tests. Results: Baseline mean age was 59 years, body mass index was 28.4 kg/m2, mean systolic blood pressure was 128.1 mmHg and cholesterol was 226.9 mg/dL. These measures did not differ between groups. Baseline EndoPAT ratio (0.60) and follow up (0.52) were low in all participants. As statewide COVID-19 cases spiked, 3/31 participants did not return for a second assessment, and for another 5 participants, one EndoPAT ratio measurement was not interpretable. Both groups showed a decline in EndoPat ratio pre-to-post, but the decline among MBSR participants (all of whom completed the intervention) was five times less than that observed among controls [Table]. Groups did not differ on QOL or psychosocial outcomes. Conclusions: Breast cancer survivors on AIs have endothelial dysfunction, a measure of increased CV risk. Stress reduction techniques, using virtual platforms, are feasible and acceptable to this patient population, and may help improve endothelial function. Further research and longer follow up is warranted in understanding the long-term impact of these interventions on CV risk and psychosocial well-being. [Table: see text]

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