Innovating and expanding weight loss strategies for breast cancer survivors

Abstract

Overweight and obesity are prevalent in over two thirds of the general population in the United States and are associated with an increased risk of malignancies, including breast cancer [1]. Up to 96% of women gain weight following a diagnosis of breast cancer [2]. This weight gain may increase risk of recurrence by 40–50%, and breast cancer-related mortality by 53–60% [3–5]. Compared to those with ideal body weight, women who have excess weight experience inferior outcomes once diagnosed with breast cancer, despite standard local and adjuvant therapy [6]. Obesity at and following a breast cancer diagnosis is associated with poor quality of life and increased risk of adverse treatment effects (Refer to (Figure 1)) [7–19]. Clinically significant weight loss of ≥ 5% is associated with decreased all-cause mortality and prevalence of prediabetes and cardiovascular disease [20, 21]. Thus, survivorship guidelines recommend that weight loss should be a priority for overweight/obese survivors [22]. Numerous clinical trials have tested behavioral strategies for weight loss in survivors of early stage breast cancer, including modifications in diet, remote or group interventions [23]. The original Practice-based Opportunities for Weight Reduction (POWER) study in obese individuals with a risk for cardiovascular disease demonstrated equivalent weight loss outcomes between in-person coaching and a remote intervention [24]. Our group compared the remote-based POWER intervention (telephone calls by a coach, access to online learning materials, online self-directed dietary/activity monitoring) to self-directed weight loss in overweight or obese survivors of early-stage breast cancer [25]. We evaluated several outcomes including: (i) whether a 12-month remotely delivered behavioral weight loss intervention (POWER-remote) allows a greater proportion of breast cancer survivors to achieve ≥ 5% weight compared to a self-directed approach, (ii) modulation of biomarkers of cancer risk including metabolism, inflammation, and Editorial