BackgroundThe effect of endocrine therapy with tamoxifen (TMX) on weight gain has been reported in the literature, but the outcomes are still controversial. Moreover, previous treatment options, such as chemotherapy (CT), also include body changes. The focus of this study was to verify the temporal influence of endocrine therapy with TMX on nutritional risk and obesity and its association with CT in breast cancer patients.MethodsIn this cross-sectional study, 84 breast cancer surviving women were evaluated during endocrine therapy with TMX. Anthropometric, biochemical and body composition parameters were measured. A generalized estimating equation (GEE) was used to examine the association between CT and groups of women using TMX categorized by the duration of the treatment (group 1, women using TMX for the first 3 years; group 2, women using TMX between 3 and 4 years and group 3, women using TMX for more than 4 years).ResultsThe interaction of CT with duration of TMX use showed a significant effect on Body Mass Index (BMI), waist circumference (WC) and body fat percentage (BFP) (GEE p-value = 0.002, 0.000, 0.000, respectively). Women from group 1 who underwent CT presented higher values of body variables compared to those women from group 2 who also underwent CT (BMI = 29.14 ± 0.93, 26.76 ± 0.85 kg/m2; WC = 94.45 ± 1.96, 91.07 ± 2.44 cm; BFP = 36.36 ± 1.50, 33.43 ± 1.66%, respectively). On the other hand, women from group 1 who did not undergo CT presented lower values of body variables compared to those women from group 2 who also did not undergo CT (BMI = 25.29 ± 0.46, 28.40 ± 0.95 kg/m2; WC = 85.84 ± 0.90, 97.75 ± 0.88 cm; BFP = 30.32 ± 0.43; 42.95 ± 1.03%, respectively).ConclusionsWomen on endocrine therapy with TMX are mostly overweighed and obese, most evidently in women who received CT, and who were at the beginning of treatment. Women that did not undergo CT, despite presenting lower values of body variables in the first 3 years, still deserve special attention because significantly higher values were observed in women between 3 and 4 years of therapy.

The increased risk for cardiovascular diseases (CVDs) in breast cancer survivors has been widely discussed in the literature and occurs due to the cardiotoxicity of antineoplastic treatments, and also to the common risk factors between these diseases. Thus, the objective of our study was to evaluate, prospectively, the number of risk factors (NRF) for CVDs in women during endocrine therapy, and to associate the NRF with C reactive protein (CRP) and phase angle (PhA). The following risk factors for CVD were evaluated at three times: anthracycline chemotherapy, radiotherapy, comorbidities, inadequate diet, overweight, abdominal adiposity, alcoholism, smoking, physical inactivity and altered lipid profile. There was inadequacy in the most components of the Brazilian Healthy Eating Index—Revised and inadequate consumption of various types of fats and fibers. Most women in this study presented excessive abdominal fat and overweight, but these parameters have not changed over time (p < 0.005). Moreover, a high frequency of systemic arterial hypertension and physical inactivity was observed. The average NRF for CVDs was above ten, at the three evaluation times. Women with higher NRF had higher levels of CRP (p = 0.003), a predictor of cardiovascular risk, however, there was no significance with PhA (p = 0.256). Thus, intervention is needed to improve lifestyle.

This clinical research studied functional capacity level, length of time of receipt of therapy with aromatase inhibitors (AIs), and adiposity parameters. Women with breast cancer in the first years of the use of AIs showed greater functional disability and worse adiposity parameters, thus reinforcing the need for special attention during this time and emphasizing the importance of multiprofessional follow-up. Purpose: To study the use of functional capacity (FC) level and duration of aromatase inhibitor (AI) therapy with adiposity parameters in women with breast cancer. Patients and Methods: FC was evaluated through the Health Assessment Questionnaire, which was assessed by classification and divided into 3 groups: G1 ¼ mild to moderate difficulty, G2 ¼ moderate to severe disability, and G3 ¼ severe or very severe disability. Body mass, height, and waist circumference (WC) were measured, and body mass index (BMI) was calculated. Bioelectrical impedance analysis was used to calculate body fat (BF) and fat-free mass. The women were divided into 2 time groups (T1 and T2), which were determined by the median months of AI use (T1 29.5 and T2 > 29.5 months). Results: Impaired FC and adiposity parameters were significantly positively correlated. In addition, physical exercise was significantly lower in women assessed as G2 and G3 compared to those assessed as G1. The effect of FC on BMI, BF, and WC was also verified, as was the effect of the duration of AI receipt on BMI and BF. Women at T1 had significantly greater functional disability, BMI, and BF values. In addition, although not statistically significant, women in T1 who were assessed as G3 presented higher BMI, WC, and BF values than those in T2. Conclusion: Adiposity above the recommended parameters and impaired FC were associated with the shortest time of receipt of adjuvant endocrine therapy with AI.

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Purpose This study aimed to evaluate the association between chemotherapy (CT) time, nutritional status and the effect of the interaction between these variables on the symptoms and domains of Health-Related Quality of Life (HRQoL). Despite the adverse effects CT, it’s common the gain weight and unfavorable changes in the body composition of women during and after the treatment. And an inadequate nutritional status can negatively impact the HRQoL and can influence the prognosis of breast cancer (BC).Methods This study was carried out with 55 women with BC over three periods of CT, T0, before the first cycle; T1, intermediate period; and T2, after the end of CT. HRQoLwas assessed using the 30-Item Quality of Life Questionnaire (QLQ-C30) and its BC module, the Quality of Life Questionnaire Breast Cancer − 23 (QLQ-Br23).Results Overweight, waist circumference (WC) indicative of increased risk and substantially increased risk of metabolic complications, waist-hip ratio (WHR) indicative of risk of developing chronic diseases, waist-to-height ratio (WHtR) indicative of excess abdominal fat and longer CT times (T1 and T2), each separately, as well as the interaction of these anthropometric variables with CT time, were associated with worse symptom and HRQoL domains scores.Conclusion The course of treatment and a worse nutritional status, have negative effects on HRQoL, and it is relevant to encourage women with BC undergoing CT to adopt a healthy diet and to practice physical activity in order to maintain an adequate nutritional status, that could contribute to a better HRQoL.

This cross-sectional study aimed to verify the effect of meal timing and eating frequency on quantitative and qualitative food consumption, as well as the physical and biochemical measurements of breast cancer women undergoing endocrine therapy with tamoxifen. Quantitative dietary assessments of 84 women were performed by applying three nonconsecutive 24h dietary recalls. The Brazilian Healthy Eating Index Revised (BHEI-R) was used for the qualitative analysis of diet. Participants were dichotomized in Early and Late eaters for the main meals using the median values of hours as the cut-off point. The eating frequency was defined as the number of times per day of food or beverage consumption with at least 5 kcal and a minimum difference of 60 minutes between each eating episode. Body composition and biochemical measurements were investigated. The percentage values of the body fat were significantly higher among women with consumption ≤4 eating episodes when compared to those that consumed >4 per day. Furthermore, the Late dinner time women had significantly lower plasma levels of high density lipoprotein (HDL-C) compared to those of Early dinner time. Significant effects of eating frequency were observed for quantitative intake of energy and macronutrients, however no effects of main meal timing. Regarding the quality of diet, positive associations were observed for Early women: for breakfast time to Whole Grains; Milk and Dairy Products -for dinner time: to Calories from Solid Fats, Alcohol and Added Sugars and the Total BHEI-R score. The consumption ≥4 eating episodes was positively associated with consumption of Total Fruits, Whole Fruits, Meat, Eggs, and Beans and the Total BHEI-R score compared with women who consumed <4 per day. Therefore, late eaters and less eating frequency presented dietary patterns of lower quality, worse physical, and biochemical measurements, that could have an adverse impact in the health of women in endocrine treatment.

Background: Potentially, instruments to manage adverse effects may improve adherence and persistence of treatment, health-related quality of life (HRQL) and breast cancer (BC) outcomes. In this sense, we consider the Cervantes Scale an appropriate option to assess HRQL in BC survivors undergoing adjuvant endocrine therapy with Aromatase Inhibitors (AI), as it is a specific HRQL questionnaire that considers particularities of the perimenopausal and postmenopausal women. The purpose of this study was to analyze the psychometric properties of the 31-item Cervantes Scale (CS-31), 16-item Cervantes Short-Form Scale (CS-16) and 10-item Cervantes Scale (CS-10) and to promote the additional validation for breast cancer (BC) survivors during adjuvant endocrine therapy.Methods: This prospective study included 89 postmenopausal BC survivors in endocrine therapy. The women completed the CS, Functional Assessment of Chronic Illness Therapy - fatigue (FACIT-F) and Hospital Anxiety and Depression Scale (HADS). The internal consistency, convergent validity, responsiveness analyses and known-group validity of CS were evaluated. Also, simple linear regression assessed the predictive capacity of the CS in relation to the FACIT-F.Results: The internal consistency was good (Cronbach's alpha: CS-10=0.76; CS-16=0.80; CS-31=0.89). For convergent validity, in general, we identified negative and strong correlations (r>0.6) with exception of moderate correlation between Social/Family Well-Being of FACIT-F and Sexual (r=-0.453) and Couple (r=-0.436) of CS-31, and weak correlation between Social/Family Well-Being of FACIT-F and Sexual (r=-0.289) and Couple (r=-0.287) of CS-16. A prospective improvement in health-related quality of life (HRQL) were identified, except for domains Sexual and Couple of CS-16/CS-31, as well as FACT-G, Social/Family and Functional Well-Being of FACIT-F. The CSs were able to predict changes in the FACIT-F. Furthermore, women with anxiety and depression by HADS presented worse HRQL by CS (p<0.001).Conclusions: We identified that the CS, highlighting the CS-31, proved to be appropriate for use in routine medical oncology with BC survivors during adjuvant endocrine therapy, although larger studies are needed to confirm these results.

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