Basic Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Dec 24, 2019; 10(12): 382-390
Published online Dec 24, 2019. doi: 10.5306/wjco.v10.i12.382
Body mass index trends and quality of life from breast cancer diagnosis through seven years’ survivorship
Allison Brandt Anbari, Chelsea B Deroche, Jane M Armer
Allison Brandt Anbari, Chelsea B Deroche, Jane M Armer, Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, United States
Author contributions: Anbari AB designed the research questions for secondary analysis, assisted with analysis of the data, and wrote the background and significance; Deroche CB ran the analysis, assisted with interpretation, and completed the graph/table design; Armer JM conducted the data collection during the seven-year study, assisted with analysis and interpretation of the data, and contributed to the implications and discussion of the work.
Supported by the National Institute for Nursing Research, National Institutes of Health, No. R01 NR05342 and R01 NR010293.
Institutional review board statement: This study was approved by the institutional review board of University of Missouri.
Conflict-of-interest statement: The authors have declared no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Allison Brandt Anbari, PhD, RN, Assistant Professor, Sinclair School of Nursing, University of Missouri, S312 School of Nursing, Columbia, MO 65211, United States. anbaria@missouri.edu
Telephone: +1-573-8820287 Fax: +1-573-8844544
Received: May 31, 2019
Peer-review started: June 4, 2019
First decision: August 2, 2019
Revised: September 9, 2019
Accepted: November 4, 2019
Article in press: November 4, 2019
Published online: December 24, 2019
Processing time: 202 Days and 10.8 Hours
Abstract
BACKGROUND

Weight gain is a potential negative outcome of breast-cancer treatment, occurring in 50%-to-96% of breast-cancer patients, although the amount of weight gain is inconsistently reported in the literature. Research has also shown a relationship between overweight/obesity and breast-cancer mortality. Correspondingly, weight management is a self-care approach known to benefit quality of life (QOL). These research questions and analysis add to existing literature by examining participants’ body mass index (BMI) trend and its relationship with QOL indicators over seven years.

AIM

To examine: (1) BMI trends among breast cancer survivors; and (2) The trends’ relationship to QOL indicators over seven years.

METHODS

During the Breast Cancer and Lymphedema Project, 378 patients’ weight and height were recorded by nurses prior to or just after beginning breast cancer treatment and repeated at quarterly-to-semiannual intervals over seven years. Additionally, participants annually completed the 36-Item Short Form Health Survey (SF-36), a valid and reliable tool assessing QOL and health concepts, including physical function, pain, and emotional well-being. BMI trends, change in BMI, and change in SF-36 subscales over seven years were calculated using a random-intercept repeated-measures regression. Patients were placed into BMI categories at each time point: Normal, Overweight and Obese. As patients’ weights changed, they were categorized accordingly.

RESULTS

During the seven-year study and while controlling for age and residence, participants gained an average of 0.3534 kg/m2 (P = 0.0009). This amount remained fairly consistent across BMI categories with those in the normal-weight category (n = 134) gaining 0.4546 kg/m2 (P = 0.0003); Overweight (n = 190) gaining 0.2985 kg/m2 (P = 0.0123); and obese (n = 199) gaining 0.3147 kg/m2, (P = 0.0649). Age (under or over 55) and region (metro/micro vs small/rural) were significantly associated with BMI increase in both the normal and obese categories. There were statistically significant (P < 0.0100) changes in five of the eight SF-36 domains; however, the directions of change were different and somewhat divergent from that hypothesized. Controlling for age and region, these five were statistically significant, so there were no change or differences between the micropolitan/metropolitan and small town/rural groups.

CONCLUSION

Although only modest increases in mean BMI were observed, mean BMI change was associated with selected QOL indicators, suggesting the continued need for self-care emphasis during breast cancer survivorship.

Keywords: Breast cancer; Survivorship; Breast cancer treatment effects; Quality of life

Core tip: This analysis examined body mass index (BMI) and quality of life (QOL) data from over 300 breast cancer patients from diagnosis to seven years’ survival. BMI trends and quality of life adjustments were recognized. The need for continued support and surveillance through the years of survivorship is underscored. The results support continued research in this important area. Application of such findings for survivorship care-planning in the clinical setting has potential to enhance optimal self-care and QOL in living with a chronic condition such as breast cancer survivorship.