Patients with stage II or III breast cancer who participated in a remote weight-loss intervention program lost an average of 4.7% of their baseline body weight after 1 year, whereas those in the education-only control group gained an average 1% of their baseline weight, according to a recent report published by Jennifer A. Ligibel, MD, FASCO, and colleagues in JAMA Oncology. The findings from the Breast Cancer Weight Loss (BWEL) clinical trial set the stage for ongoing research to determine whether weight loss after breast cancer treatment can reduce the risk of cancer recurrence and extend survival.
“This remotely delivered intervention was successful in helping women lose weight across many different patient and treatment factors, and it worked well across a large number of sites across the U.S. and Canada,” said principal investigator Dr. Ligibel, of Dana-Farber Cancer Institute. “These results put us in a great position to be able to determine whether the weight-loss program will help reduce the risk of cancer recurrence.”
Jennifer A. Ligibel, MD, FASCO
About BWEL
Obesity is a risk factor for recurrence of breast cancer, other related health problems, and poor quality of life. There is a need to find an effective and reliable way to help patients lose weight after diagnosis and treatment of breast cancer. The phase III BWEL trial, which is supported by the National Cancer Institute and the Susan G. Komen Foundation, enrolled nearly 3,180 women from more than 637 cancer treatment centers in the United States and Canada. The participants, who had been diagnosed with stage II or III HER2-negative breast cancer, had completed chemotherapy and radiation therapy (if it was to be administered) and were randomly assigned to participate in a telephone-based weight-loss program plus health education or receive health education alone. The weight-loss program, conducted by phone, coached patients in reducing their calorie intake and increasing exercise.
1-Year Analysis
In this planned analysis of results for patients after 12 months, 46.5% of patients on the weight-loss intervention lost 5% of their baseline body weight, and 22.5% lost 10%. In contrast, 14.3% of those in the control group lost 5% of their baseline body weight, and 5% of those in the control group lost 10%. Further, 21.9% of those in the control group gained more than 5% of their baseline body weight compared with 8.2% of those in the weight-loss intervention group.
“It is very hard after being diagnosed with breast cancer to lose weight, and many people gain weight,” said Dr. Ligibel. “This study underscores that it is important to help patients with their weight after a breast cancer diagnosis.”
Patients experienced weight loss on the intervention arm regardless of education level, socioeconomic status, and treatment types, including patients on antiestrogen therapies. The results did show less weight loss in premenopausal, Black, and Latina patients. “More research is needed to fine-tune weight-loss interventions for different groups of breast cancer survivors,” said Dr. Ligibel.
Specialized Considerations
The study provided the intervention in both English and Spanish and provided a toolbox of recipe recommendations to support a range of dietary preferences, including vegetarian, vegan, and low-carbohydrate diets. Recipes included Caribbean, Mexican, and Indian foods. Commercial partners supported the trial by donating activity monitors, wireless scales, meal replacement shakes, and food scales for patients to use if desired.
“We tried to meet people where they were—as long as they were adhering to a healthy diet, the caloric restrictions, and activity levels,” said Dr. Ligibel. “Patients need support and an infrastructure, and this study offers an intervention that works across many sites and across a wide range of people.”
The long-term goal of the BWEL study will be to determine whether the intervention reduces breast cancer recurrence. If it does, the program may become something more widely available to patients.
“We are working toward insurance reimbursement for weight-loss programs for patients with breast cancer, making this kind of intervention available for patients, regardless of their ability to pay for it themselves,” she concluded.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.