Many, but not all patients experience weight gain 1 year after a breast cancer diagnosis; clearly defined, clinically relevant groups at risk of weight gain have yet to be described. We set out to determine the factors associated with weight gain over time in patients with invasive breast cancer during a period of predominantly anthracycline-based adjuvant chemotherapy and to identify groups with differing weight gain risks. Breast cancer patients (stage I-IIIB) were identified in a retrospective chart review. Evaluated parameters included weight at diagnosis and 1, 2, and 3 years later, height, body mass index (BMI), age, menopausal and change in menopausal status, as well as therapy and pathologic stage. Regression models identified significant independent predictors of weight change. Recursive partitioning analysis (RPA) was employed to divide the dataset into relevant and significant groups. In 185 identified patients, regression models and RPA demonstrated that weight gain at 1 year was associated with younger age, adjuvant chemotherapy, and lower BMI. Weight gain at 2 years (n = 176) was greater than at year 1, and in addition to weight gain at year 1, was associated with younger age and adjuvant chemotherapy in regression analysis; RPA found that anthracycline therapy, age, and BMI were important. Weights at 3 years were similar to those seen at 2 years. Early-stage breast cancer patients treated with chemotherapy continue to gain weight 2 years after diagnosis, and this weight gain appears to be persistent at year 3. Observation beyond 1 year is needed to adequately evaluate weight gain in early-stage breast cancer patients, particularly for those receiving contemporary adjuvant chemotherapy.

Weight gain occurs in the majority of women following breast cancer treatment. An overview of studies describing weight gain amongst women treated with early to modern chemotherapy regimens is included. Populations at higher risk include women who are younger, closer to ideal body weight and who have been treated with chemotherapy. Weight gain ranges between 1 to 5 kg, and may be associated with change in body composition with gain in fat mass and loss in lean body mass. Women are unlikely to return to pre-diagnosis weight. Possible mechanisms including inactivity and metabolic changes are explored. Potential interventions are reviewed including exercise, dietary changes and pharmacologic agents. Although breast cancer prognosis does not appear to be significantly impacted, weight gain has negative consequences on quality of life and overall health. Future studies should explore change in body composition, metabolism and insulin resistance. Avoiding weight gain in breast cancer survivors following initial diagnosis and treatment should be encouraged.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Breast cancer; Weight gain; Exercise; Survivorship; Insulin resistance Core tip: Weight gain occurs in the majority of women following breast cancer treatment, especially those who are younger, closer to ideal body weight and who have been treated with chemotherapy. Although weight gain may be modest, changes are consistent with sarcopenic obesity. Women are unlikely to return to pre-diagnosis weight. Although the degree of weight gain does not appear to significantly alter prognosis, associated changes in metabolism and inactivity are of concern. Interventions should be promoted to avoid weight gain. INTRODUCTIONWeight gain following a diagnosis of breast cancer has been reported consistently in women treated for breast cancer, but was an unexpected finding when first described Dixon and colleagues in 1978 [1] . After subsequent reports confirmed this observation, weight gain was included as a known side effect of adjuvant chemotherapy [2] . Despite this, most women appear to be inadequately informed about this possibility, as demonstrated by one study reporting concern about treatment-associated weight gain in only 27% of survivors prior to therapy [3] . WHY IS POST-TREATMENT WEIGHT GAIN OF CONCERN?Obesity is a global issue associated with increased risk of developing post-menopausal breast cancer [4] and a worse prognosis at the time of diagnosis [5] . However, the effect of weight gain following a diagnosis of breast cancer is less well understood. While weight gain following diagnosis does not necessarily lead to obesity or its consequences, any impact on breast cancer prognosis and overall health, patient self-image, or quality of life (QoL) would be an undesirable outcome. These outcomes may be interrelated: weight gain can influence other medical conditions such as diabetes, heart disease, hypertension and hypercholesterolemia that may impact overall survival. For example, Erick...

SPC charts effectively monitor ongoing compliance and patient symptoms and represent appropriate outcome measurement and change facilitation tools. However, physician participation in guideline development and evidence of poor compliance alone did not improve prescribing performance. Only evidence of patient CINE experience coupled with noncompliance improved results.

BackgroundChronic diarrhea in patients treated with immunosuppressive agents or suffering from immunosuppressive disease can represent a diagnostic and therapeutic challenge to the clinician. Norovirus infection, a major cause of acute epidemic diarrhea, has been described as a cause of chronic diarrhea in patients who are immunosuppressed, including transplant recipients and the very young.Case presentationsWe describe two patients, a 64 year-old man and a 59 year-old woman, both suffering from chronic lymphocytic leukemia and hypogammaglobulinemia, who developed chronic diarrhea resistant to therapy. In both cases, after months of symptoms, persistent norovirus infection--documented by repeatedly-positive high-sensitivity stool enzyme immunoassay--was found to be the cause. Both patients died with active diarrheal symptoms.ConclusionsWe describe the first cases of advanced chronic lymphocytic leukemia to suffer from chronic symptomatic norovirus infection. Clinicians caring for such patients, particularly those with concomitant hypogammaglobulinema, who have chronic unexplained diarrhea, should consider norovirus infection in the differential diagnosis.