Deutsche Zeitschrift für Onkologie 2023; 55(02): 48-54
DOI: 10.1055/a-1962-0065
Forschung

Gewichtszunahme nach Brustkrebsdiagnose – ein noch unterschätztes Phänomen?

Weight Gain after Breast Cancer Diagnosis – a still underestimated Phenomenon?
Alessia Colatruglio
1   Berner Fachhochschule Gesundheit, Fachbereich Ernährung und Diätetik, Bern, Schweiz
,
Steffen Theobald
1   Berner Fachhochschule Gesundheit, Fachbereich Ernährung und Diätetik, Bern, Schweiz
› Author Affiliations

Zusammenfassung

Ziel Die Gewichtszunahme bei Brustkrebspatientinnen ist ein bekannter Nebeneffekt von Chemo- und endokriner Therapie, welche das Risiko für die Gesamt- und brustkrebsspezifische Mortalität von Brustkrebspatientinnen (BKP) erhöht, die psychosoziale Gesundheit gefährdet und deshalb möglichst vermieden/ behandelt werden sollte. Hierzu können Ernährungsinterventionen einen wirksamen Beitrag leisten. Diese Arbeit untersucht, wie sensibilisiert Onkologinnen und Onkologen (ONKO) für das Phänomen sind, wie sie bei Gewichtszunahme von BKP vorgehen und welche Rolle die Zusammenarbeit mit Ernährungsfachpersonen dabei spielt.

Methode Sieben auf gynäkologische Krebserkrankungen spezialisierte ONKO wurden anhand eines halbstrukturierten Interviewleitfadens interviewt. Die Datenanalyse erfolgte anhand einer qualitativ strukturierenden Inhaltsanalyse.

Ergebnisse Vier Hauptkategorien konnten identifiziert werden, welche die unterschiedlichen Sicht- und Handlungsweisen der ONKO bezüglich der Gewichtszunahme bei BKP nach Diagnosestellung strukturieren: 1. Das Phänomen: Beobachtung und Folgen einer Gewichtszunahme; 2. Patientinnenbezogene Perspektivenübernahme bezüglich der Gewichtszunahme; 3. Maßnahmen gegen eine Gewichtszunahme bei BKP; 4. Maßnahmenleitende/-hemmende Gedanken bei einer Gewichtszunahme.

Diskussion Die Handlungsweisen der ONKO (ungenügende Maßnahmen zur Prävention und Behandlung einer Gewichtszunahme bei BKP, seltene interprofessionelle Zusammenarbeit mit Ernährungsfachpersonen) lassen sich durch ihre Sichtweisen erklären: ONKO unterschätzen tendenziell: 1) die gesundheitliche Relevanz der Gewichtszunahme, 2) die für BKP subjektive Relevanz der Gewichtszunahme, 3) die fachliche Kompetenz von Ernährungsfachpersonen sowie 4) die Wirksamkeit von Ernährungsinterventionen.

Schlussfolgerung Zur Förderung der Intention von ONKO, Maßnahmen gegen eine Gewichtszunahme zu treffen, sollten ihre Risikowahrnehmung (bezüglich gesundheitlicher Folgen einer Gewichtszunahme) sowie ihre Handlungsergebniserwartung (bezüglich Zusammenarbeit mit Ernährungsfachpersonen) erhöht werden.

Abstract

Objective Weight gain in breast cancer patients is a known side effect of chemo- and endocrine therapy, which increases the risk of all-cause and breast cancer-specific mortality in breast cancer patients (BCP), endangers psychosocial health and should therefore be avoided/treated if possible. In this context, nutritional interventions can make an effective contribution. This study examines the level of awareness among oncologists regarding the phenomenon of weight gain in BCPs, how they manage it, and the extent to which they collaborate with nutrition professionals (registered dietitians) in addressing this issue.

Method Seven oncologists specialized in gynecological cancers were interviewed using a semi-structured interview questionnaire. Data analysis was done using a qualitative structuring content analysis.

Results Four main categories could be identified, which structure the different views and actions of the oncologists regarding weight gain in BCP after diagnosis: 1. the phenomenon: observation and consequences of weight gain; 2. oncologists’ assumption of the importance of the phenomenon for BCP; 3. measures against weight gain in BCP; 4. thoughts guiding/inhibiting measures in the case of weight gain.

Discussion The behavior of oncologists (insufficient measures for the prevention and treatment of weight gain in BCP, rare interprofessional cooperation with nutrition professionals) can be explained by their views: oncologists tend to underestimate: 1) the health relevance of weight gain, 2) the subjective relevance of weight gain for BCP, 3) the professional competence of registered dietitians and 4) the effectiveness of nutrition interventions.

Conclusion To promote oncologists’ intention to act against weight gain in BCP, their risk perception (regarding health consequences of weight gain) as well as their outcome expectancies (regarding cooperation with nutrition professionals) should be increased.



Publication History

Article published online:
21 June 2023

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  • Literatur

  • 1 Bundesamt für Statistik, Nationale Krebsregistrierungsstelle, Kinderkrebsregister.. Schweizerischer Krebsbericht 2021. Stand und Entwicklungen. Neuchâtel. 2021
  • 2 Runowicz CD, Leach CR, Henry NL. et al. American Cancer Society/American Society of Clinical Oncology breast cancer survivor-ship care guideline. CA Cancer J Clin 2016; 66: 43-73
  • 3 World Health Organization (WHO).. Basic documents: Forty-ninth edition (including amendments adopted up to 31 May 2019). WHO; Geneva: 2020
  • 4 Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Deutsche Krebsgesellschaft (DKG), Deutsche Krebshilfe (DKH).. Leitlinienprogramm Onkologie. S3-Leitlinie Früherkennung, Diagnose, Therapie und Nachsorge des Mammakarzinoms. Version 4.4. AWMF. 2021
  • 5 Gross AL, May BJ, Axilbund JE. et al. Weight change in breast cancer survivors compared to cancer-free women: a prospective study in women at familial risk of breast cancer. Cancer Epidemiol Biomarkers Prev 2015; 24: 1262-1269
  • 6 Caan BJ, Kwan ML, Shu XO. et al. Weight change and survival after breast cancer in the after breast cancer pooling project. Cancer Epidemiol Biomarkers Prev 2012; 21: 1260-1271
  • 7 Raghavendra A, Sinha AK, Valle J. et al. Determinants of weight gain during adjuvant endocrine therapy and association of such weight gain with recurrence in long-term breast cancer survivors. Clin Breast Cancer 2018; 18: e7-13
  • 8 Gandhi A, Copson E, Eccles D. et al. Predictors of weight gain in a cohort of premenopausal early breast cancer patients receiving chemotherapy. The Breast 2019; 45: 1-6
  • 9 Nichols HB, Trentham-Dietz A, Egan KM. et al. Body mass index before and after breast cancer diagnosis: Associations with all-cause, breast cancer, and cardiovascular disease mortality. Cancer Epidemiol Biomark Prev 2009; 18: 1403-1409
  • 10 Lee K, Kruper L, Dieli-Conwright CM, Mortimer JE.. Impact of obesity on breast cancer treatment. Curr Oncol Rep 2019; 21: 41 DOI: 10.1007/s11912-019-0787-1.
  • 11 Zhao C, Hu W, Xu Y. et al. Current Landscape: The mechanism and therapeutic impact of obesity for breast cancer. Front Oncol 2021; 11: 704893 DOI: 10.3389/fonc.2021.704893.
  • 12 Barone I, Caruso A, Gelsomino L. et al. Obesity and endocrine therapy resistance in breast cancer: Mechanistic insights and perspectives. Obes Rev 2022; 23: e13358 DOI: 10.1111/obr.13358.
  • 13 Fang Q, Huang J, Gan L. et al. Weight gain during neoadjuvant chemotherapy is associated with worse outcome among the patients with operable breast cancer. J Breast Cancer 2019; 22: 399-411
  • 14 Playdon MC, Bracken MB, Sanft TB. et al. Weight gain after breast cancer diagnosis and all-cause mortality: systematic review and meta-analysis. J Natl Cancer Inst 2015; 107: djv275
  • 15 Jung AY, Hüsing A, Behrens S. et al. Postdiagnosis weight change is associated with poorer survival in breast cancer survivors: A prospective population-based patient cohort study. Int J Cancer 2021; 148: 18-27
  • 16 Pang Y, Wei Y, Kartsonaki C.. Associations of adiposity and weight change with recurrence and survival in breast cancer patients: a systematic review and meta-analysis. Breast Cancer 2022; 29: 575-588
  • 17 Ussher JM, Perz J, Gilbert E.. Changes to sexual well-being and intimacy after breast cancer. Cancer Nurs 2012; 35: 456-465
  • 18 Fazzino TL, Hunter RC, Sporn N. et al. Weight fluctuation during adulthood and weight gain since breast cancer diagnosis predict multiple dimensions of body image among rural breast cancer survivors. Psychooncology 2015; 26: 392-399
  • 19 Kwok A, Palermo C, Boltong A.. Dietary experiences and support needs of women who gain weight following chemotherapy for breast cancer. Support Care Cancer 2015; 23: 1561-1568
  • 20 Vandendorpe B, Drouet Y, Ramiandrisoa F. et al. Psychological and physical impact in women treated for breast cancer: Need for multidisciplinary surveillance and care provision. Cancer/Radiotherapy 2021; 25: 330-339
  • 21 Nyrop KA, Lee JT, Deal AM. et al. Weight-related communications be-tween oncology clinicians and women with obesity at early breast cancer diagnosis: findings from a review of electronic health records. Nutr Cancer 2020; 72: 576-583
  • 22 Nyrop KA, O’Hare EA, Teal R. et al. Person-centered communication about weight and weight management: Focus group discussions in a diverse sample of women with nonmetastatic breast cancer and obesity. Cancer 2021; 127: 4266-4276
  • 23 Di Meglio A, Menvielle G, Dumas A. et al. Body weight and return to work among survivors of early-stage breast cancer. ESMO Open 2020; 5: e000908 DOI: 10.1136/esmoopen-2020-000908.
  • 24 Thomson ZO, Reeves MM.. Can weight gain be prevented in women receiving treatment for breast cancer? A systematic review of intervention studies. Obes Rev 2017; 18: 1364-1373
  • 25 Demark-Wahnefried W, Kenyon AJ, Eberle P. et al. Preventing sarcopenic obesity among breast cancer patients who receive adjuvant chemotherapy: results of a feasibility study. Clin Exerc Physiol 2002; 4: 44-49
  • 26 Villarini A, Pasanisi P, Raimondi M. et al. Preventing weight gain during adjuvant chemotherapy for breast cancer: A dietary intervention study. Breast Cancer Res Treat 2012; 135: 581-589
  • 27 Basen-Engquist KM, Raber M, Carmack CL. et al. Feasibility and efficacy of a weight gain prevention intervention for breast cancer patients receiving neoadjuvant chemotherapy: a randomized controlled pilot study. Support Care Cancer 2020; 28: 5821-5832
  • 28 Trestini I, Sperduti I, Caldart A. et al. Evidence-based tailored nutrition educational intervention improves adherence to dietary guidelines, anthropometric measures and serum metabolic biomarkers in early-stage breast cancer patients: A prospective interventional study. Breast 2021; 60: 6-14
  • 29 Wang S, Yang T, Qiang W. et al. Benefits of weight loss programs for breast cancer survivors: a systematic reviews and meta-analysis of randomized con-trolled trials. Support Care Cancer 2022; 30: 3745-3760
  • 30 Thomson CA, Stopeck AT, Bea JW. et al. Changes in body weight and metabolic indexes in overweight breast cancer survivors enrolled in a randomized trial of low-fat vs. reduced carbohydrate diets. Nutr Cancer 2010; 62: 1142-1152
  • 31 Hitzler R, Eberle TS.. Phänomenologische Lebensweltanalyse. In: Flick U, von Kardoff E, Steinke I, Hrsg. Qualitative Forschung – Ein Handbuch. 11. Aufl. Hamburg: Rowohlt Taschenbuch; 2015: 109-117
  • 32 Kelle U, Kluge S.. Vom Einzelfall zum Typus – Fallvergleich und Fallkontrastierung in der qualitativen Sozialforschung. 2. Aufl. Wiesbaden: VS Verlag; 2010
  • 33 Dr. Dresing & Pehl GmbH. f4transkript [Audiotranskription]. Marburg, 2008. Verfügbar unter: https://audiotranskription.de
  • 34 Kuckartz U.. Qualitative Inhaltsanalyse. Methoden, Praxis, Computerunterstützung. 4. Aufl. Weinheim: Beltz Juventa; 2018
  • 35 VERBI Software. MAXQDA 2022 [Computer Software]. Berlin: VERBI Software; 2021. Verfügbar unter: https://www.maxqda.com
  • 36 de Kruif JT, Scholtens MB, van der Rijt J. et al. Perceptions of Dutch health care professionals on weight gain during chemotherapy in women with breast cancer. Support Care Cancer 2019; 27: 601-607
  • 37 James-Martin G, Koczwara B, Smith EL, Miller MD.. Information needs of cancer patients and survivors regarding diet, exercise and weight management: A qualitative study. Eur J Cancer Care (Engl) 2014; 23: 340-348
  • 38 Saxton J, Pickering K, Wane S. et al. The experiences and perceptions of female breast cancer patients regarding weight management during and after treatment for oestrogen-receptor positive disease: a qualitative study. BMC Cancer 2022; 22: 1189
  • 39 Ligibel JA, Jones LW, Brewster AM. et al. Oncologists’ attitudes and practice of addressing diet, physical activity, and weight management with patients with cancer: findings of an ASCO survey of the Oncology Workforce. J Oncol Pract 2019; 15: e520-528
  • 40 Hursting SD.. Inflammatory talk: Linking obesity, NF-κB, and aromatase. Cancer Prev Res (Phila) 2011; 4: 285-287
  • 41 Pila E, Sabiston CM, Taylor VH, Arbour-Nicitopoulos K.. “The weight is even worse than the cancer”: exploring weight preoccupation in women treated for breast cancer. Qual Health Res 2018; 28: 1354-1365
  • 42 D’Amour D, Goulet L, Labadie JF. et al. A model and typology of collaboration between professionals in healthcare organizations. BMC Health Serv Res 2008; 8: 1-14
  • 43 Hepp SL, Suter E, Jackson K. et al. Using an interprofessional competency framework to examine collaborative practice. J Interprof Care 2015; 29: 131-137
  • 44 Sullivan ES, Rice N, Kingston E. et al. A national survey of oncology survivors examining nutrition attitudes, problems and behaviours, and access to dietetic care throughout the cancer journey. Clin Nutr ESPEN 2021; 41: 331-339
  • 45 Demark-Wahnefried W, Peterson B, McBride C. et al. Current health behaviors and readiness to pursue life-style changes among men and women diagnosed with early stage prostate and breast carcinomas. Cancer 2000; 88: 674-684
  • 46 Balneaves LG, Van Patten C, Truant TLO. et al. Breast cancer survivors’ perspectives on a weight loss and physical activity lifestyle intervention. Support Care Cancer 2014; 22: 2057-2065
  • 47 Schwarzer R.. Modeling health behavior change: How to predict and modify the adoption and maintenance of health behaviors. Appl Psychol 2008; 57: 1-29