Remote Behavioral Weight Loss Intervention Is Effective for Breast Cancer Survivors

Key Points:

  • Approximately one-half of breast cancer survivors receiving a behavioral weight loss intervention, with or without the addition of pharmacotherapy, achieved at least 5% weight loss at 8 weeks.
  • The proportion of individuals with ≥ 5% weight loss with behavioral intervention was similar to that observed in a population without cancer.

Almost half of breast cancer survivors who were categorized as overweight or obese based on body mass index (BMI) who participated in a behavioral weight loss (BWL) intervention lost ≥ 5% of their body weight during early follow-up. This result is similar to that observed in a noncancer population with obesity.1 These preliminary findings from an ongoing single-arm nonrandomized clinical trial known as A-NEW (Adaptive Nutrition and Exercise Weight loss) were presented during the virtual National Comprehensive Cancer Network 2022 Annual Conference.

“While cancer guidelines recommend that cancer survivors with obesity lose weight, interventions of lifestyle modification, diet, and exercise only work for approximately half of breast cancer survivors,” said presenter Jennifer Y. Sheng, MD, from Johns Hopkins University School of Medicine. “Thus, the development and implementation of effective weight loss interventions with adaptive and novel strategies are urgently needed.”

A-NEW incorporated 2 novel concepts for weight loss in cancer survivors: 2-month weight loss response and the use of anti-obesity pharmacotherapy. The primary objective was to evaluate the proportion of breast cancer survivors with obesity and < 5% weight loss after 8 weeks of BWL intervention and designated slow responders (SLOW BWL) who went on to achieve ≥ 5% weight loss at 6 months with the addition of pharmacotherapy. The medication used was naltrexone HCl/bupropion HCl, which was approved by the U.S. Food and Drug Administration for this purpose.

The ultimate goal is to recruit a total of 55 patients with stage 0-3 breast cancer and a BMI ≥ 30 kg/m2 or a BMI ≥ 27 kg/m2 with obesity-related morbidity (noninsulin-dependent diabetes, hypertension, or dyslipidemia). Over the 6-month study, participants attend 3 in-person visits: at baseline, 9 weeks, and 6 months. All participants received a 6-month BWL intervention, consisting of remote coaching for the duration of the study; they also undergo tracking of activity, diet, and weight and receive a learning curriculum.

“This intervention is based on the results from the published POWER study1 demonstrating that this remote behavioral intervention yielded equivalent weight loss outcomes as an in-person intervention, and that this was superior to self-directed weight loss,” Dr. Sheng said. The POWER BWL intervention was adapted to breast cancer survivors in the POWER-Remote trial, which showed that the BWL intervention yields greater weight loss than self-directed weight loss. 2

After 8 weeks of BWL in the A-NEW study, all participants return for an in-person visit and an evaluation for total weight loss. Those who have lost ≥ 5% of baseline weight, designated fast responders (FAST BWL), continue with the behavioral intervention alone. The SLOW BWL group continues the BWL intervention and initiates naltrexone/bupropion, which is prescribed for at least 16 weeks. The researchers have performed a descriptive analysis of demographic and weight loss data from baseline to 2 months.

Since the study opened in February 2021, 73 patients have been screened; 42 were ineligible because they were already taking bupropion or tamoxifen. Of the 31 who were recruited, 30 started the BWL intervention and 1 withdrew immediately after consent. One additional patient withdrew prior to the week-9 visit. Of the 28 active participants, 20 have completed the trial; 9 of these were on the BWL intervention alone, and 11 had pharmacotherapy added.

The median age of the 28 active participants was 60.5 years, with an average time of 2.6 years from diagnosis to the start of intervention. Three-quarters were White, 21.5% were Black or African American, and 3.6% were of Asian descent. Almost 90% were postmenopausal and 78.6% had an Eastern Cooperative Oncology Group performance status of 0. None reported tobacco use within the past month. The median number of alcoholic drinks consumed per week was 1.

Stage 1 breast cancer was most common, present in 60.7% of participants; 25% had stage 2, and 3.6% had stage 3. Lumpectomy was performed in 57.1% of participants, while 50% received chemotherapy, 10.7% were treated with anti-HER2 therapy, and 75% received endocrine therapy after surgery.

The mean weight of participants at baseline was 213.4 lb, and the mean BMI was 35.9 kg/m2. Four (14%) participants were overweight as defined by body mass index, 10 (36%) had class I obesity, 8 (28%) had class II obesity, and 6 (21%) had class III obesity.

“Similar to a noncancer population, approximately half of the breast cancer survivors receiving the BWL intervention attained at least 5% weight loss early on.” – Dr. Jennifer Y. Sheng

After 8 weeks of remote behavioral intervention, 11 of 27 fast responders (40.7%) achieved ≥ 5% weight loss, and 16 of 27 slow responders (59.3%) did not. “Similar to a noncancer population, approximately half of the breast cancer survivors receiving the BWL intervention attained at least 5% weight loss early on,” Dr. Sheng said. “As targeted enrollment is 55 patients, updated data will be reported at a future conference.”

References

  1. Appel LJ, Clark JM, Yeh H-C, et al. Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med. 2011;365(21):1959-1968.
  2. Santa-Maria CA, Coughlin JW, Sharma D, et al. The effects of a remote-based weight loss program on adipocytokines, metabolic markers, and telomere length in breast cancer survivors: the POWER-remote trial. Clin Cancer Res. 2020;26(12):3024-3034.
Published: April 13, 2022
Author(s): Wayne Kuznar

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