Factors that influence oncology nutrition efficacy in breast cancer patients under antiestrogenic treatment

Abstract

Background: Many breast cancer patients gain weight during treatment increasing recurrence, metastasis and mortality risks. The diagnosis overthrows patients' lifestyle aggravating sedentariness and any pre‐existing weight gain causes like insulin and leptin resistance, sleep disturbances and hedonic eating. Methods: To test the efficacy of an at‐home oncology nutrition intervention meant to stop weight gain during antiestrogenic treatment we proposed a diet based on foods naturally high in proteins, omega‐3 fatty acids, calcium, probiotics and prebiotics. 331 patients were randomly assigned to the control group, with no oncology nutrition advice besides the physician recommendation to avoid weight gain. 283 patients were randomly assigned to the intervention group and asked to follow the proposed diet. We measured weight and body composition and we compared results at 24 months between intervention and control groups. Then we analysed the results based on the administered oncology treatment type and patients' age, comorbidities, lifestyle characteristics. Results: At 24 months, patients within the intervention group reached a modest but statistically significant weight loss and fat loss with no sarcopenia (2.44kg weight loss, 2.37% subcutaneous fat loss, 0.65% visceral fat loss, 1,24% muscle mass increase), while those in the control group maintained weight, increased fat and lost muscle (0.35kg weight loss, 0.34% subcutaneous fat increase, 0.4% visceral fat increase, 0.42 muscle mass decrease). Efficacy was influenced by: age ‐ 31‐40 yo patients having worse results than 41‐50 yo patients and than 51‐80 yo patients; AET type ‐ patients on letrozole having best results; De novo thyroidal disease ‐ lowered fat loss; depression ‐ lowered fat loss; statins ‐ when co‐administrated throughout exemestane treatment ‐ lowered fat loss; sleep disturbances ‐ increased sarcopenia. Efficacy was not influenced by: chemotherapy or radiotherapy administration, type of surgery, cardiovascular disease, smoking or by the dieting history. Conclusions: Oncology nutrition interventions can counteract sarcopenic obesity during antiestrogenic treatment, but the efficacy of the intervention can be influenced by patients' age and comorbidities.