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Among women with nonmetastatic breast cancer, low muscle mass and excess body fat are significantly associated with worse survival, investigators report.
An observational study of 3,241 women diagnosed with stage II or III breast cancer showed that low muscle mass (sarcopenia) was independently associated with a 41% increase in risk for overall mortality, and that total adipose tissue (TAT) measures were associated with a 35% increase in overall mortality.
Women with sarcopenia and high total TAT scores had a nearly twofold higher risk for death, reported Bette J. Caan, DrPH, of Kaiser Permanente in Oakland, Calif., and her colleagues.
Although low muscle mass was found to be a significant risk factor for death, neither poor muscle quality, measured by radiodensity, nor body mass index (BMI) were significantly associated with overall mortality, the investigators reported in a study published online in JAMA Oncology.
“Both muscle and adiposity represent modifiable risk factors in patients with breast cancer. In addition to weight loss, we should also consider interventions to improve muscle mass, such as resistance training or protein supplementation. In the era of precision medicine, the direct measurement of muscle and adiposity will help to guide treatment plans and interventions to optimize survival outcomes,” they wrote.
Although moderate to severe obesity measured by high BMI has been associated with worse outcomes for patients with breast cancer and other malignancies, the evidence is mixed for those who are merely overweight or have borderline obesity, the authors noted.
BMI is a simple ratio of height to weight, and does not measure body composition, and “low BMI can mask excess adiposity while high BMI can mask low muscularity,” they wrote.
To determine whether associations between measures of body composition could be prognostic for overall mortality, the investigators conducted a retrospective cohort study with patients from Kaiser Permanente Northern California and the Dana-Farber Cancer Institute in Boston.
The cohort included 3,241 women diagnosed with stage II or III invasive breast cancer during 2005-2013 in California and during 2000-2012 in Boston. All of the patients included had either abdominal or pelvic CT scans or PET-CT scans at the time of diagnosis.
The investigators looked at the associations between sarcopenia, TAT, and low muscle radiodensity, and created hazard ratio (HR) estimates of the effects of the various interactions on overall mortality, adjusted for sociodemographics, tumor characteristics, treatment, BMI, and other body composition measures.
They found that after a median follow-up of 6 years, patients with sarcopenia had a significantly greater risk for overall mortality than did patients without sarcopenia (HR, 1.41; 95% confidence interval, 1.18-1.69).
Additionally, patients in the highest tertile of TAT also had significantly higher overall mortality, compared with patients in the lowest tertile (HR, 1.35; CI, 1.08-1.69).
As noted before, poor muscle quality was not significantly associated with overall mortality.
Looking at both sarcopenia and TAT, the authors found that the highest risk for death was in those patients with both sarcopenia and high TAT (HR, 1.88; CI, 1.30-2.73).
However, they also found that BMI was not an independent predictor of overall mortality, and did identify those patients who were at risk because of their body composition.
“We demonstrate that sarcopenia is not a condition restricted to patients with later-stage disease but rather is highly prevalent among patients with nonmetastatic disease across all levels of BMI. Our findings are likely generalizable across many other nonmetastatic cancers because the associations with muscle and improved survival for those with metastatic cancer has been observed across a variety of solid tumors,” Dr. Caan and her associates wrote in their conclusion.
The article did not report a funding source for the study. The investigators reported having no conflicts of interest to disclose.
SOURCE: Cann BJ et al. JAMA Oncol. 2018 Apr 5. doi: 10.1001/jamaoncol.2018.0137.
Obesity is highly prevalent among breast cancer survivors, and in addition to its effects on cancer development and outcomes, it also can affect treatment efficacy and adverse effects and complicate clinical management of breast cancer from obesity-related comorbidities such as hypertension and diabetes. As such, the American Society of Clinical Oncology made obesity and cancer one of their core priorities in 2013 and launched the Obesity & Cancer Initiative with activities ranging from education and awareness to clinical guidance, promotion of research, and policy and advocacy.
Despite its limitations, body mass index remains an easy tool to help health care clinicians identify patients at greater risk for poor outcomes and adverse effects and guide their recommendations, as well as to educate patients in self-assessing their weight status. Weight management and control are likely to have many benefits for breast cancer survivors but should always be tailored to individual patients’ needs. When CT imaging is available, the study by Caan et al. suggests that body composition measures can be useful in identifying women at higher risk of mortality. Their findings are an important reminder that weight loss and/or weight control programs must always incorporate physical activity with the goal of not just reducing adiposity, but also maintaining and increasing muscle mass, which would not only reduce the risk of death, but might also help improve quality of life after a cancer diagnosis.
Elisa V. Bandera, MD, PhD, is with the Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick. Esther M. John, PhD, is with Stanford (Calif.) University. Both editorialists reported having no conflicts of interest to disclose. Their remarks are adapted from an accompanying invited commentary (JAMA Oncol. doi: 10.1001/jamaoncol.2018.0137).
Obesity is highly prevalent among breast cancer survivors, and in addition to its effects on cancer development and outcomes, it also can affect treatment efficacy and adverse effects and complicate clinical management of breast cancer from obesity-related comorbidities such as hypertension and diabetes. As such, the American Society of Clinical Oncology made obesity and cancer one of their core priorities in 2013 and launched the Obesity & Cancer Initiative with activities ranging from education and awareness to clinical guidance, promotion of research, and policy and advocacy.
Despite its limitations, body mass index remains an easy tool to help health care clinicians identify patients at greater risk for poor outcomes and adverse effects and guide their recommendations, as well as to educate patients in self-assessing their weight status. Weight management and control are likely to have many benefits for breast cancer survivors but should always be tailored to individual patients’ needs. When CT imaging is available, the study by Caan et al. suggests that body composition measures can be useful in identifying women at higher risk of mortality. Their findings are an important reminder that weight loss and/or weight control programs must always incorporate physical activity with the goal of not just reducing adiposity, but also maintaining and increasing muscle mass, which would not only reduce the risk of death, but might also help improve quality of life after a cancer diagnosis.
Elisa V. Bandera, MD, PhD, is with the Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick. Esther M. John, PhD, is with Stanford (Calif.) University. Both editorialists reported having no conflicts of interest to disclose. Their remarks are adapted from an accompanying invited commentary (JAMA Oncol. doi: 10.1001/jamaoncol.2018.0137).
Obesity is highly prevalent among breast cancer survivors, and in addition to its effects on cancer development and outcomes, it also can affect treatment efficacy and adverse effects and complicate clinical management of breast cancer from obesity-related comorbidities such as hypertension and diabetes. As such, the American Society of Clinical Oncology made obesity and cancer one of their core priorities in 2013 and launched the Obesity & Cancer Initiative with activities ranging from education and awareness to clinical guidance, promotion of research, and policy and advocacy.
Despite its limitations, body mass index remains an easy tool to help health care clinicians identify patients at greater risk for poor outcomes and adverse effects and guide their recommendations, as well as to educate patients in self-assessing their weight status. Weight management and control are likely to have many benefits for breast cancer survivors but should always be tailored to individual patients’ needs. When CT imaging is available, the study by Caan et al. suggests that body composition measures can be useful in identifying women at higher risk of mortality. Their findings are an important reminder that weight loss and/or weight control programs must always incorporate physical activity with the goal of not just reducing adiposity, but also maintaining and increasing muscle mass, which would not only reduce the risk of death, but might also help improve quality of life after a cancer diagnosis.
Elisa V. Bandera, MD, PhD, is with the Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick. Esther M. John, PhD, is with Stanford (Calif.) University. Both editorialists reported having no conflicts of interest to disclose. Their remarks are adapted from an accompanying invited commentary (JAMA Oncol. doi: 10.1001/jamaoncol.2018.0137).
Among women with nonmetastatic breast cancer, low muscle mass and excess body fat are significantly associated with worse survival, investigators report.
An observational study of 3,241 women diagnosed with stage II or III breast cancer showed that low muscle mass (sarcopenia) was independently associated with a 41% increase in risk for overall mortality, and that total adipose tissue (TAT) measures were associated with a 35% increase in overall mortality.
Women with sarcopenia and high total TAT scores had a nearly twofold higher risk for death, reported Bette J. Caan, DrPH, of Kaiser Permanente in Oakland, Calif., and her colleagues.
Although low muscle mass was found to be a significant risk factor for death, neither poor muscle quality, measured by radiodensity, nor body mass index (BMI) were significantly associated with overall mortality, the investigators reported in a study published online in JAMA Oncology.
“Both muscle and adiposity represent modifiable risk factors in patients with breast cancer. In addition to weight loss, we should also consider interventions to improve muscle mass, such as resistance training or protein supplementation. In the era of precision medicine, the direct measurement of muscle and adiposity will help to guide treatment plans and interventions to optimize survival outcomes,” they wrote.
Although moderate to severe obesity measured by high BMI has been associated with worse outcomes for patients with breast cancer and other malignancies, the evidence is mixed for those who are merely overweight or have borderline obesity, the authors noted.
BMI is a simple ratio of height to weight, and does not measure body composition, and “low BMI can mask excess adiposity while high BMI can mask low muscularity,” they wrote.
To determine whether associations between measures of body composition could be prognostic for overall mortality, the investigators conducted a retrospective cohort study with patients from Kaiser Permanente Northern California and the Dana-Farber Cancer Institute in Boston.
The cohort included 3,241 women diagnosed with stage II or III invasive breast cancer during 2005-2013 in California and during 2000-2012 in Boston. All of the patients included had either abdominal or pelvic CT scans or PET-CT scans at the time of diagnosis.
The investigators looked at the associations between sarcopenia, TAT, and low muscle radiodensity, and created hazard ratio (HR) estimates of the effects of the various interactions on overall mortality, adjusted for sociodemographics, tumor characteristics, treatment, BMI, and other body composition measures.
They found that after a median follow-up of 6 years, patients with sarcopenia had a significantly greater risk for overall mortality than did patients without sarcopenia (HR, 1.41; 95% confidence interval, 1.18-1.69).
Additionally, patients in the highest tertile of TAT also had significantly higher overall mortality, compared with patients in the lowest tertile (HR, 1.35; CI, 1.08-1.69).
As noted before, poor muscle quality was not significantly associated with overall mortality.
Looking at both sarcopenia and TAT, the authors found that the highest risk for death was in those patients with both sarcopenia and high TAT (HR, 1.88; CI, 1.30-2.73).
However, they also found that BMI was not an independent predictor of overall mortality, and did identify those patients who were at risk because of their body composition.
“We demonstrate that sarcopenia is not a condition restricted to patients with later-stage disease but rather is highly prevalent among patients with nonmetastatic disease across all levels of BMI. Our findings are likely generalizable across many other nonmetastatic cancers because the associations with muscle and improved survival for those with metastatic cancer has been observed across a variety of solid tumors,” Dr. Caan and her associates wrote in their conclusion.
The article did not report a funding source for the study. The investigators reported having no conflicts of interest to disclose.
SOURCE: Cann BJ et al. JAMA Oncol. 2018 Apr 5. doi: 10.1001/jamaoncol.2018.0137.
Among women with nonmetastatic breast cancer, low muscle mass and excess body fat are significantly associated with worse survival, investigators report.
An observational study of 3,241 women diagnosed with stage II or III breast cancer showed that low muscle mass (sarcopenia) was independently associated with a 41% increase in risk for overall mortality, and that total adipose tissue (TAT) measures were associated with a 35% increase in overall mortality.
Women with sarcopenia and high total TAT scores had a nearly twofold higher risk for death, reported Bette J. Caan, DrPH, of Kaiser Permanente in Oakland, Calif., and her colleagues.
Although low muscle mass was found to be a significant risk factor for death, neither poor muscle quality, measured by radiodensity, nor body mass index (BMI) were significantly associated with overall mortality, the investigators reported in a study published online in JAMA Oncology.
“Both muscle and adiposity represent modifiable risk factors in patients with breast cancer. In addition to weight loss, we should also consider interventions to improve muscle mass, such as resistance training or protein supplementation. In the era of precision medicine, the direct measurement of muscle and adiposity will help to guide treatment plans and interventions to optimize survival outcomes,” they wrote.
Although moderate to severe obesity measured by high BMI has been associated with worse outcomes for patients with breast cancer and other malignancies, the evidence is mixed for those who are merely overweight or have borderline obesity, the authors noted.
BMI is a simple ratio of height to weight, and does not measure body composition, and “low BMI can mask excess adiposity while high BMI can mask low muscularity,” they wrote.
To determine whether associations between measures of body composition could be prognostic for overall mortality, the investigators conducted a retrospective cohort study with patients from Kaiser Permanente Northern California and the Dana-Farber Cancer Institute in Boston.
The cohort included 3,241 women diagnosed with stage II or III invasive breast cancer during 2005-2013 in California and during 2000-2012 in Boston. All of the patients included had either abdominal or pelvic CT scans or PET-CT scans at the time of diagnosis.
The investigators looked at the associations between sarcopenia, TAT, and low muscle radiodensity, and created hazard ratio (HR) estimates of the effects of the various interactions on overall mortality, adjusted for sociodemographics, tumor characteristics, treatment, BMI, and other body composition measures.
They found that after a median follow-up of 6 years, patients with sarcopenia had a significantly greater risk for overall mortality than did patients without sarcopenia (HR, 1.41; 95% confidence interval, 1.18-1.69).
Additionally, patients in the highest tertile of TAT also had significantly higher overall mortality, compared with patients in the lowest tertile (HR, 1.35; CI, 1.08-1.69).
As noted before, poor muscle quality was not significantly associated with overall mortality.
Looking at both sarcopenia and TAT, the authors found that the highest risk for death was in those patients with both sarcopenia and high TAT (HR, 1.88; CI, 1.30-2.73).
However, they also found that BMI was not an independent predictor of overall mortality, and did identify those patients who were at risk because of their body composition.
“We demonstrate that sarcopenia is not a condition restricted to patients with later-stage disease but rather is highly prevalent among patients with nonmetastatic disease across all levels of BMI. Our findings are likely generalizable across many other nonmetastatic cancers because the associations with muscle and improved survival for those with metastatic cancer has been observed across a variety of solid tumors,” Dr. Caan and her associates wrote in their conclusion.
The article did not report a funding source for the study. The investigators reported having no conflicts of interest to disclose.
SOURCE: Cann BJ et al. JAMA Oncol. 2018 Apr 5. doi: 10.1001/jamaoncol.2018.0137.
FROM JAMA ONCOLOGY
Key clinical point: Helping women with nonmetastatic breast cancer control weight and improve muscle strength could lower their risk of death.
Major finding: Women with sarcopenia and high total adipose tissue had a hazard ratio of 1.89 for overall mortality.
Study details: Retrospective cohort study of 3,241 women diagnosed with stage II or III invasive breast cancer in California and Massachusetts.
Disclosures: The article did not report a funding source for the study. The investigators reported having no conflicts of interest to disclose.
Source: Cann BJ et al. JAMA Oncol. 2018 Apr 5. doi:10.1001/jamaoncol.2018.0137.