Patients with stage II or III breast cancer who participated in a remote weight-loss intervention program lost an average of 4.7% of their baseline body weight after one year, whereas those in the education-only control group gained an average 1% of their baseline weight, according to findings from the Breast Cancer Weight Loss (BWEL) clinical trial published in JAMA Oncology.
The phase III trial, supported by the National Cancer Institute and the Susan G. Komen Foundation, enrolled nearly 3,180 women from more than 637 cancer treatment centers in the United States and Canada. Participants had been diagnosed with stage II or III HER2-negative breast cancer and had completed chemotherapy and radiation therapy before being randomly assigned to receive either a telephone-based weight-loss program plus health education or health education alone.
Significant Weight Loss Outcomes
In the planned 12-month analysis, 46.5% of patients in the weight-loss intervention group lost 5% of their baseline body weight, and 22.5% lost 10%. In contrast, only 14.3% of those in the control group lost 5% of their baseline body weight, and 5% of controls lost 10%. Additionally, 21.9% of control group participants gained more than 5% of their baseline body weight compared with 8.2% of those in the weight-loss intervention group.
"This remotely delivered intervention was successful in helping women lose weight across many different patient and treatment factors, and it worked well across a large number of sites across the U.S. and Canada," said principal investigator Dr. Jennifer A. Ligibel of Dana-Farber Cancer Institute. "These results put us in a great position to be able to determine whether the weight-loss program will help reduce the risk of cancer recurrence."
Addressing Critical Medical Need
Obesity is a risk factor for recurrence of breast cancer, other related health problems, and poor quality of life. The telephone-based weight-loss program coached patients in reducing their calorie intake and increasing exercise, addressing a significant unmet need in breast cancer survivorship care.
"It is very hard after being diagnosed with breast cancer to lose weight, and many people gain weight," said Dr. Ligibel. "This study underscores that it is important to help patients with their weight after a breast cancer diagnosis."
Broad Effectiveness Across Patient Groups
Patients experienced weight loss on the intervention arm regardless of education level, socioeconomic status, and treatment types, including patients on antiestrogen therapies. However, the results showed less weight loss in premenopausal, Black, and Latina patients, highlighting areas for further research refinement.
"More research is needed to fine-tune weight-loss interventions for different groups of breast cancer survivors," said Dr. Ligibel.
Culturally Inclusive Approach
The study provided the intervention in both English and Spanish and offered a toolbox of recipe recommendations to support a range of dietary preferences, including vegetarian, vegan, and low-carbohydrate diets. Recipes included Caribbean, Mexican, and Indian foods. Commercial partners supported the trial by donating activity monitors, wireless scales, meal replacement shakes, and food scales for patients to use if desired.
"We tried to meet people where they were—as long as they were adhering to a healthy diet, the caloric restrictions, and activity levels," said Dr. Ligibel. "Patients need support and an infrastructure, and this study offers an intervention that works across many sites and across a wide range of people."
Future Implications
The long-term goal of the BWEL study will be to determine whether the intervention reduces breast cancer recurrence. If successful, the program may become more widely available to patients through insurance reimbursement.
"We are working toward insurance reimbursement for weight-loss programs for patients with breast cancer, making this kind of intervention available for patients, regardless of their ability to pay for it themselves," Dr. Ligibel concluded.
"Every person deserves the chance to be as healthy as possible after a breast cancer diagnosis," said Kimberly Sabelko, Ph.D., vice president of scientific strategy and programs at Susan G. Komen. "We are so grateful to the patients who are participating in it, as the findings are poised to provide us with evidence-based behavioral interventions that could help many patients live longer, better lives."
