Reasons of Weight Gain After Breast Cancer Therapy - A Discussion

Introduction:

Weight gain is cumulatively caused due to increased intake of food, a surplus of energy, or decreased energy expenditure. More than half of the population affected with breast cancer has reported weight gain. According to the researchers, too much weight gain can limit the chances of recovery. Chemotherapy is particularly linked with weight gain, along with other therapies like steroid medications and hormonal therapy. Chemotherapy has been known to cause premature menopause and slow down the metabolism. However, women who have undergone surgery or radiation therapy have not reported significant weight gain.

What Are the Ill Effects of Weight Gain in Cancer Patients?

Weight gain is commonly seen in young women and women who are in the ideal weight category. The weight gain after chemotherapy ranges from one to five kilograms. In the body composition, there has been an increase in fat mass and a decrease in lean body mass. Some women gain weight if they have lymphedema (swelling caused due to fluid build-up). Weight gain can affect women in many ways, causing distress, a negative body image, and low self-esteem. It has also increased the death rates for a few affected women. It will affect the quality of life of patients. Hence, a weight acceptance program (intervening to prevent weight gain during therapy) is focused on middle-aged women, and it has been proven to reduce the number of cardiovascular events and help women by reducing the risk factors precipitating morbid cardiovascular conditions.

How Does Cancer Therapy Lead To Weight Gain?

Weight gain usually starts after the first year of diagnosis, and grows rapidly after starting chemotherapy, steroid medications, and hormones. Weight gain can affect the metabolic changes in cells and interfere with ATP (adenosine triphosphate) production and mitochondrial function, which can result in adverse effects on the body. Physical inactivity is also a major cause of weight gain. Drug regimens containing Cyclophosphamide, Methotrexate, and Fluorouracil (CMF) have been shown to cause significant weight gain of up to eight to ten kilograms when combined with Prednisolone as an anticancer agent. Doxorubicin and Cyclophosphamide are some of the anthracycline-containing drugs causing significant weight gain in patients receiving chemotherapy within a period of two years.

1. Chemotherapy:

Chemotherapy can cause weight gain through the following modalities:

• It will cause edema in the body by holding on to excess fluid.

• Chemotherapy can cause fatigue and the affected individuals find it hard to exercise.

• Nausea is prevalent in individuals under chemotherapy which will trigger intense food cravings, thereby eating more food.

• Chemotherapy has also been shown to reduce metabolism, and hence weight gain.

• It also causes premature menopause in some women, and there will be a slower metabolism.

2. Hormonal Therapy:

Hormonal therapy is used to treat breast cancer and other cancers like prostate, uterine, and testicular types. Hormonal therapy can decrease certain hormonal levels, especially estrogen, progesterone, or testosterone. This will, in turn, lead to increased fat, and decreased muscle. Women who took Tamoxifen have reported significant amounts of weight gain. Women who received both hormonal therapy and chemotherapy have reported much higher weight gain.

3. Steroid Medication:

Steroid medications help reduce swelling and pain caused due to inflammation. They are also used to treat nausea. But steroids lead to weight gain as they can increase the appetite, stop muscle wasting, and increase fat tissue deposition.

4. Menopause:

In premenopausal women, the weight gain is more compared to postmenopausal women. Chemotherapy-induced amenorrhea (absent menstruation) is a significant risk factor in young women undergoing cancer therapy. According to a study about weight gain after a cancer diagnosis, conducted in January 2011 in Australia, 43 % of women were premenopausal and 12 % were perimenopausal when diagnosed.

What Are the Possible Risks Associated With Weight Gain?

Weight gain can precipitate a number of health conditions. It can increase blood pressure, and it can also lead to many heart diseases. It can also lead to hypercholesterolemia (the presence of cholesterol in the blood), diabetes, and other types of cancers. Obesity is also known to be associated with postmenopausal breast cancer. Usually, weight loss or pre-diagnosis weight is rarely achieved by women after therapy.

How to Prevent Weight Gain Caused by Cancer Therapy?

Biological mechanisms like hormonal changes, especially those involved in glucose and energy metabolism like leptin, insulin, and adiponectin, steroid metabolism, cellular growth factors such as insulin-like growth factors, inflammatory mediators, and DNA (deoxyribonucleic acid) oxidative damage can lead to a poor cancer prognosis as a result of obesity. Lifestyle and dietary modification, along with physical exercise backing, has led to improved quality of life and enhanced survival rate. There is limited evidence to prove the outcomes of weight loss in protocols carried out in breast cancer patients. Hence, a proper weight loss regimen still needs to be formulated.

Prevention of weight gain is as important as breast cancer prognosis due to the side effects of obesity that can lessen the chances of survival. According to a study and a few researches the following have helped in weight management in patients undergoing cancer therapy. The American Cancer Society has suggested a few lifestyle changes to prevent weight gain in women affected with breast cancer and undergoing treatment:

1. Meeting with a dietitian before and during the therapy will help in managing weight through personalized diet plans and simple workouts.

2. Cutting back on sugar and opting for low-calorie healthy food from natural sources.

3. Drink more water. In patients with edema, limiting fluid intake is necessary to prevent weight gain.

4. Limiting the intake can significantly affect weight gain.

5. Simple exercise like walking or bicycling daily for 20 minutes can help in weight loss.

6. Portion control should be followed in case of cravings.

7. Restrict or limit using fats, refined flour, and processed foods.

8. Include plenty of whole grains, fruits, and vegetables in the diet.

9. Try to include strengthening exercises as they can help regain muscle mass in patients with muscle wasting.

10. Always prefer home cooking whenever feasible.

Conclusion:

Breast cancer is the most common cancer affecting women. Studies have reported significant amounts of weight gain in women affected by breast cancer after undergoing therapies including chemotherapy, hormonal therapy, and steroid medications. Weight gain prevention during cancer therapy is quite challenging, and studies are still under process for identifying the correct amount of dosage that will provide a better prognosis and lesser side effects. Affected women find it difficult to exercise during therapy as they have fatigue and other chemotherapy-associated symptoms.