Impact of an individualized counseling program on weight loss and quality of life in breast cancer survivors.
Authors: Jabbal Iktej Singh , Bilani Nadeem , Dominguez Barbara , Stevenson Amanda , Liang Hong , Hadeh Anas , Nahleh Zeina A. , Stone Elizabeth Rodriguez 
Published: June 2022

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Background: Survivors of breast cancer who are obese have a greater than two-fold increase in mortality compared to their counterparts. We assessed the feasibility of an individualized nutrition counseling and exercise program with the goal of helping participants achieve a loss of 10% body weight. Secondary endpoints included impact on multiple metabolic parameters, cardiovascular health, and quality of life. Methods: We present preliminary data from a single-arm pilot trial (NCT04365569) whereby survivors of breast cancer with BMI ≥ 25 kg/m2 participated in a 6-month, individualized counseling program. A registered dietitian (RD) counseled patients based upon recommendations by the American Cancer Society. The intervention included in-person (baseline, months 3 and 6) and telephone visits (months 1, 2, 4, and 5). The nutrition component included weight and body composition measures and blood work, including lipid panel and hemoglobin A1c. Cardiovascular fitness and extrapolated VO2 max were measured using SHAPE study. Quality of life was evaluated using: the Functional Assessment of Cancer Therapy – Breast Cancer (FACT-B), the Brief Pain Inventory (BPI), the Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the NCCN Distress Thermometer. Paired statistics were used to compare changes in these aforementioned outcomes pre-and post-intervention. Results: A total of n=55 female breast cancer survivors (mean age 58.1± 9.13) were enrolled. N=28 completed the trial to date. While 14.3% of participants lost >10% of their baseline weight, 21.4% lost 5-10 % of their weight. Patients had a mean 45.30% drop in body fat composition overall (p<0.001). There was no statistically significant difference in lipids and hemoglobin A1c. In terms of cardiovascular function, a decline in mean VO2 max of -4.71 (SD 4.71, p <0.001) was observed, accompanied by a decline in mean METS of -1.09 (SD 0.84, p <0.001). Higher compliance with the intervention was associated with losing weight (p 0.001). FACT-B scoring revealed improvements in Physical (mean +1.92, SD 3.82), Emotional (mean +1.03, SD 2.71), and Functional well-being (mean +2.70, SD 4.34) (p <0.05). This trial was also associated with lower indicators of depression, as evaluated by PHQ-9 scoring (mean -1.32, SD 3.19, p 0.038). Even in patients with weight gain, improvements in QoL surveys were observed, although not statistically significant, likely due to the small sample size in this subpopulation (n = 7). Conclusions: An individualized counseling program benefits survivors of breast cancer who are overweight by helping them reduce weight and improve their overall quality of life. While no improvements in VO2 max levels were observed, this may be partially explained by a decrease in effort on the part of participants. Further investigation into the utility of extrapolated VO2 max using the SHAPE study is ongoing. Clinical trial information: NCT04365569.