Body composition in early breast cancer

Abstract

Introduction: It is frequently, though not consistently, reported that women gain weight with treatment for breast cancer. Furthermore, it is known that overweight/obese patients with breast cancer are more likely to experience poorer short and long-term outcomes. BMI is weight standardised for height (kg/m2); however, additional prognostic information may be provided by understanding the specific composition of weight in terms of fat mass index (FMI: kg fat mass/m2) and fat free mass index (FFMI: kg lean (fat-free) mass/m2)
Aims: To determine if significant changes in weight and body composition occur in women with early breast cancer undergoing adjuvant treatment using Bioelectrical Impedance Spectroscopy (BIS) and if patient, disease and treatment-related factors influence changes seen in weight and body composition. Additionally, to determine whether baseline body composition influences the treatment outcome of chemotherapy toxicity. Methods: Data was collated for 170 patients recruited into the BeGIN study (REC: 14/EE/1297). Using a SECA mBCA515 BIS analyser, body composition measurements, including BMI, FMI AND FFMI, were obtained. Patient records were assessed to obtain demographic, histological and treatment characteristics as well as the incidence of grade 3 chemotherapy-related toxicity.
Results: Women with early breast cancer in this cohort did not display change in their weight and BMI over 1 year (post surgery) (mean difference: weight 0.07kg, p=0.69; BMI 0.04 kg/m2, p=0.78). However, this masked changes both at an individual level and in body composition. 5.8% of patients experienced a clinically significant (>5%) gain in weight and 7.6% a clinically significant loss in weight.
Overall, there was loss of lean (FFMI decreased; 0.44 kg/m2; p=0.002) whilst FMI change was more variable at an individual level, but with a less apparent increase at an overall cohort level (0.14 kg/m2 increase; p=0.78). Being over 50, a smoker/ex-smoker, higher tumour grade, node positivity, oestrogen receptor negativity, undergoing a mastectomy and axillary surgery appear to be associated with a comparatively unfavourable body composition at the beginning of their adjuvant journey and/or 1 year later. The likelihood of receiving a complete and planned regimen of chemotherapy appeared to reduce with increasing FMI (p=0.67), with a suggestion that chemotherapy toxicity was
more likely to experienced by women at extremes of FMI (p=0.14).
Conclusions: These results may challenge the view that weight gain is inevitable with breast cancer treatment, although body composition changes do occur for some individuals. Understanding body composition may yield additional prognostic information compared to weight/BMI alone and predict short-term outcomes such as chemotherapy toxicity. This is currently now being tested in a prospective study (CANDO-3; ISRCTN79577461). Furthermore, an understanding of the effect of patient, disease and treatment effects on body composition may influence the development of interventional, nutritional, educational and physical education programmes that can aid in optimising body composition and consequently breast cancer outcomes.

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