trends that weight management is going to be important in treating HER2-positive brea
 

Re: trends that weight management is going to be important in treating HER2-positive
 

Sort of dosen't surprise me that people who are overweight don't fare as well as those of a healthy weight. Fat produces estrogen, which can fuel breast cancer. And people who are overweight generally have more complicating health issues which can contribute to mortality and aggrevate side effects of chemo.

Re: trends that weight management is going to be important in treating HER2-positive
 

Along with a cure would love for someone to develop a skinny pill...lol

Re: trends that weight management is going to be important in treating HER2-positive
 

Jean,
Thanks for posting info on this interesting and important study.
karen

Re: trends that weight management is going to be important in treating HER2-positive
 

I'd like to know people's thoughts about this study vs weight gain with the estrogen fighting drugs (particularly arimidex, femara, aromasin). I seem to be seeing some pretty strong anecdotal evidence that bs patients are losing weight much easier after going off these drugs. Unfortunately, in addition to the inability to lose weight issue, Ruth has been having a heck of a time with these drugs with the other issues such as joint pain on Arimidex and hair loss,. on Aromasin. She's about to try Femara. I know these side affects are talked about on other threads, but I look at a study like this and wonder how the benefits stack up against the negatives. She's not by any means obese, but is definitely carrying extra lbs that she did not have pre-treatment.

Re: trends that weight management is going to be important in treating HER2-positive
 

I have gained too much weight since my diagnosis and "instant" menopause at 53 (wasn't menopausal going in). But this could be do to Femara, anti-depressants, stress/anxiety, and a relatively sedentary life (compared to some) as a professor- and with increased joint pain. My weight has gone up each year and it has been extremely difficult for me to manage. I think the key for me is more exercise- not easy to do when one feels achy but probably the best thing to do to relieve symptoms. I wish there was more research teasing out the unique contributors of weight gain (I have seen some fascinating studies on the effects of chemo on body composition) because many of us are walking around as examples of "bad studies" (i.e., with too many confounding variables going on to make sense of our own "data").

Re: trends that weight management is going to be important in treating HER2-positive
 

I agree with Jean, bring on the skinny pill!!! I have struggled to lose the 20 lbs I gained during all my treatments. I know20 lbs doesnt seem like much but I weighed 110 when this began and % wise, 20 lbs is too much for me. Now my thyroid is not functioning properly and that makes weight control much more difficult. Grrr

Re: trends that weight management is going to be important in treating HER2-positive
 

I started Herceptin Aug 11 same day as chemo. I began Arimidex January 2012.
My weight increased during chemo, lack of activity and diet choices (ate whatever I wanted.....pasta, ice cream and Indian food! Total gained 10lbs.
By Febuary I'd added 5 more! I've been doing water aerobics, walking 10,000 steps a day and have reduced food portions and sugar. I stay between 120 to 122. Can not get below 120!!!
My issue is with my wardrobe. I can't afford to go buy an entire wardrobe nor can I afford to buy a new set of uniforms for my job!!
Has anyone found a way to reduce their weight while on Arimidex/ Herceptin ?
Thanks,
Lorraine

Re: trends that weight management is going to be important in treating HER2-positive
 

If I knew, I'd be rich!:)

Risk management
 

Risk management in regard to breast cancer is skewed.

Each of us is at some percentage of risk for recurrence, and the recommendations for treatment are based upon that risk.

They know that weight gain adds risk. They know that menopause slows the metabolism, and along with the lowering of hormonal levels of testosterone (which had been helping to sustain more muscle tissue and less fat tissue) that comes with menopause, plus the repeated periods of feeling ill, plus the contribution by steroid use during chemotherapy... contribute to weight problems.

But that risk is never added into the calculation in estimating risk in the first place.

So, the effect is that treatment is given to reduce the risk for recurrence by "x" amount....

And then that treatment causes weight gain that then increases the risk by "?" amount.

What I'd like to know is, how many people are going through treatment for a benefit that is then zeroed out by the weight gain? Or even worse, how many would possibly be recurring because the weight gain adds more risk than the amount of benefit that the treatment provided?

This is one of those never-discussed aspects of considering the pro's and con's of treatment, in part because they "don't know" who is going to gain weight and who is not, due to menopause.

Some people will immediately favor doing chemotherapy anyway, "just to be on the safe side". But without any way to define and understand or calculate the added risk, that is actually mostly a form of positive (or wishful) thinking.

Those who discuss risk with patients at time of choosing treatment blow it off entirely.

In the last few years, some of the cancer centers are starting to finally admit and emphasize the importance of proper weight management during and post-treatment.

I was of proper weight at time of diagnosis, and after treatment it took 6 years after treatment to lose the weight I had gained. As my metabolism continued to slow down even further, all of the weight came back despite doing much greater diet and exercise than I ever did up to age 51.

So as a stage 1 who did treatment, am I at greater risk because I did treatment? About the same risk? Less risk? And where in my medical record can I find that evaluation and calculation done in my behalf?

A.A.

Re: trends that weight management is going to be important in treating HER2-positive
 

AA,

I really liked your post. Somethings I'd never thought about , risk factors using additional weight (as fat) increasing estrogen levels. It's a cycle isn't is....I take Arimidex....it lowers my estrogen....joints hurt.....painful to excersize as much (as apparently needed) thus first time I have a ton of belly weight. ....which increases the estrogen my body produces!
No one ever discussed this with me while making OUR plan to succeed over the cancer.

Thanks for posting,
Lorraine

Re: trends that weight management is going to be important in treating HER2-positive
 

this thread is comforting to me, even though we dont have any answers. It helps to know that others are in the same situation. I blame myself but need to remember that the meds play a big role and it is not my fault! Keep the faith.

Re: trends that weight management is going to be important in treating HER2-positive
 

I note that the study defines obesity as a BMI over 30. I weigh about 25 to 30 pounds more than I think I should, and I've been trying hard to get it off with very little to show for it. But even though I'm overweight my BMI is less than 30. That's a relief.

I did manage to lose the chemo/steroid-induced weight (about 12 lbs.) and am back to where I was before diagnosis.

To me there's a kind of triage protocol for weight management. My top priority is to eat healthy food and avoid eating anything with empty calories. Next on my list is to get some exercise every day. Third is to get enough sleep. I do think the Arimidex is making it hard to lose weight, but hopefully it's also being hard on the cancer.

I always like AA's perspective on things. Thanks, Angel.

Re: trends that weight management is going to be important in treating HER2-positive
 

The intensity of trying to understand just the basics at first leaves out much chance to have the confidence to ask common sense questions.

Those who are younger have a harder time getting and staying genuinely postmenopausal, and are at some degree of higher risk because of that. More of them tend to be HR negative. They tend to be able to lose any weight that was gained during chemo, and keep it off because they have more testosterone and proportionally more muscle and less fat.

Most of those who are older and tend to become more genuinely postmenopausal with chemo are at higher risk for weight management issues, and tend to be more HR+. Maybe that is why they tend to recur later on, as weight continues to become more and more difficult to manage with slower and slower metabolism. In addition, by then whatever protective effect there is from doing chemo is far less.

What especially seems obvious is that there needs to be some calculation that estimates risk that includes BMI (or something similar) at time of diagnosis. Why would anyone fail to take into account the starting excess weight when calculating risk and benefit, especially for those whose likelihood of complete postmenopausal status with chemo is high to begin with based on age?

My older sister is in her 60's and obese, and the recommendation for chemo for her under the standard guidelines is the same as the recommendation is for someone who is age 25. What good is all the heavy-duty analysis of tumor, if they don't get the common sense picture to begin with in making recommendations for treatment?

A.A.

Re: trends that weight management is going to be important in treating HER2-positive
 

Angel, Your posts are always thought provoking! Thank you for your posts!

Re: trends that weight management is going to be important in treating HER2-positive
 

AlaskaAngel,

I would just like to add that some of the steriods that are given as supportive drugs to chemotherapy also affect the metabolism by causing insulin resistance that can lead to diabetes, but, at the least, causes additional weight management issues for patients. This is a "hidden" risk factor that the medical establishment is also not addressing with patients entering treatment. It may also explain why metformin is being tested as a cancer treatment support drug that has the potential to reduce recurrence - it is addressing the steroid induced insulin resistance patients experience as a result of treatment.

Hopeful

Metformin
 

Hopeful,

Thanks for those reminders about steroids and about metformin! I'm also hoping that metformin is helpful in actually causing stem cell death, which chemotherapy doesn't seem to provide.

A.A.

A little hope....
 

... and a little chocolate, goes a long way....

http://www.nydailynews.com/life-styl...sEnabled=false

Re: trends that weight management is going to be important in treating HER2-positive
 

AlaskaAngle and Hopeful,

Thank you for all the things you do to contribute to this board. I enjoy reading all of your post.

Amelia

Re: trends that weight management is going to be important in treating HER2-positive
 

I appreciate all the comments very much. I am very thankful that others share the interest in giving thoughtful consideration of the underlying reasons for what to do or not do, to improve our own care.

My older sister has her health care through a major reputable institution. I accompanied her to see her surgeon once I was aware of the damage she had as part of her surgery. To me the complete failure to track her weight at every visit and counsel her about weight management was a strong indicator of the failure to recognize and actively deal with a definite issue involved directly with her breast cancer.

It is hard for her personally to be evaluated about her weight, and it is difficult to be someone who discusses it with her. It isn't about looks. She very much wants to live longer, and that is what it is about for me. I want her doctor to have the intelligence and concern to participate actively in that part of her care.

A.A.