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.

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

Angel, I am so sorry your sister has to deal with this too. I'm so glad she has a sister like you to be with her! I have four sisters who I love dearly. None of which has had bc also none of which I have been comfortable with talking about private things. The two I'm closest with we have always had that line drawn. Just the way were raised. Hope and prayers going out to your sis also.

Your friend,

Nancy

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

Does it seem like some doctors have simply given up on the weight issue? Maybe they think it just causes too much stress and unhappiness if they focus on it?

I get weighed every time I go in, but I seem to be the only one paying attention to it. I think they just use it to calculate my Herceptin dose.

Excess weight causes so many other problems. It makes it hard to exercise. It makes the joints hurt. It interferes with sleep. You're right, AA, it's not a vanity thing. It's definitely a health thing.

Good luck helping your sister.

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

I think it managing weight gets caught up by health care providers because a) they are dealing with plenty of midriff bulge themselves and feel uncomfortable pointing the finger at someone else who is in denial, or b) they are young and fit and generally clueless about how difficult weight management IS, so they don't relate well to it. Even so, they shouldn't be let off the hook so easily, to where they just push more "miracle" drugs instead of encouraging stronger personal health responsibility.

And some cancer patients want to put aside whatever knowledge there is about body inflammation levels from excess fat, and instead hang onto the mind-set that "the medicine" will "take care of me" -- and they go for the "quick fix" involved in the belief that a one-time chemo/rads series and maybe daily pills will make it so they don't have to do the ongoing dieting and exercising.

I don't think it would be difficult for my sister to be weighed in at every visit, and given a graph of her progress or lack of it, with some kind of science-based estimate on the percentage of risk increase (or decrease) based on her height and weight.

I choose (somewhat unenthusiastically) to exercise and diet, knowing that it hasn't made me back into a person that is at all close to being Mrs. America.

A.A.

Zeroing in
 

http://www.cancernetwork.com/nurses/.../10165/2039497

The goal of optimum health includes taking personal responsibility for maintaining it, of course.

Sometimes they have to prove the obvious first. (People who are cancer-free have a higher likelihood for healthy living.....)

The next step ought to be to determine which patients in the study completed major treatment with chemotherapy and which ones did not, to see whether the treatment itself would tend to result in poorer health practices. (Go ahead, make your best guess.)

The next step would be to look at those with the least risk, to see if forgoing major treatment results in better health habits that then result in better outcomes, the same outcomes, or worse outcomes.

A.A.

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

I'm nagged about my weight every week, Amy. But, I'm skinny. They want me to gain. Herceptin apparently doesn't work well for me, although I still get it. My doctor says at my current weight (92) I have no reserves if I'm bed-ridden. My ideal weight is 100. I started Abraxane Wednesday and was able to eat some yesterday, so who knows? Maybe my body was missing chemo. :)

So yes, some are tracking weight only not for the reasons you think! :)

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

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

Debbie,
Well said and placed. In today's society the portions that are generally served are huge. Enough for two people.
The battle does not have to be a battle...I think often times the idea of dieting is a nightmare.

I found that just eating normal portions works. Pushing back the plate. It's not only what you eat but how much.
Growing up in a home where my Mother was a wonderful cook - she would prepare wholesome meals that were mostly fresh veggies and fish, lean meats. Fruit and nuts were our desert. So it was easy for me when I went off to college and did not gain the freshman 15 pds. I was rather shocked at what students ate...pure junk food and it continues. When I would visit my son I was shocked with all the updated information and technology the poor food choices being made.

Also so much is pressed upon us to exercise. I say keep it simple - if you can't make it to a gym, so walk and walk some more. Park the car far away from where you are going and walk. It is amazing what you can fit into a normal day with out making the gym.

While it does become more challenging as we age
(I clearly see the difference these last few years) it's a matter of going the extra mile. My Aunt who 97 broke her hip during the holidays and my first thought was - this is very bad - she was up and walking in 3 days after surgery - the lady is going strong. Her mind is strong and talk about a survivor...that generation expected so much less and had less - but eat well. Keep meals simple and eat as fresh as possible.

Best Wishes,
Jean

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

I don't have answers. In fact, when I read this thread, I wanted to post "HELP!!" in case anyone does have answers. I'd be afraid of a skinny pill -- side effects.

I go to the gym three-four times a week for an hour, which does not help me control my weight because I eat more. I am very strong, though. Strong and 35 pounds over my top normal weight range.

Sigh....

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

MJo,

To begin with I was a healthy food eater, not a junk food addict. I then got rid of every bit of anything that was not healthy food. No sugar, no flour, no corn products, etc.

Initially I did 30 minutes of jumping rope per day 7 days a week, and counted every calorie in everything (right down to the 20 calories in my daily fish oil pill). It took 6 years to lose 20 of the 25 pounds I gained during treatment. That worked.... but with the lower testosterone levels of postmenopause my ratio of muscle to fat was less muscle than prior to treatment, and in addition, my knee and ankle joints just couldn't take that on a continuing basis.

So I substituted some resistance/weight training but continued some aerobics. That helped, but the problem you are having with the constant hunger from the added exercise was intolerable for the long run. The weight all came back, even with the exercise and completely healthy food diet.

One especially disappointing learning for me was that although walking helps digestion and balance and is genuinely a good health practice and better than no exercise, it along with healthy food eating was completely inadequate in preventing slow weight gain. I think that is due to the lower testosterone level with aging. I was rapid-walking 3 miles 7 days a week using the highway markers, 1 hour a day. Using that hour of lost precious time every day for exercise, staying hungry, and continuing to lose ground by slowly continuing to gain weight was depressing.

The only thing that I have done in addition to healthy food diet and daily hour of combination exercising is the addition of 500 mg per day of metformin. The endocrinologist I saw tested me and I have no diabetes. I have no other chronic diseases. The metformin has helped. I know that the clinical trials they are doing that use the metformin to lessen recurrence are using a much higher dose per day.

AlaskaAngel

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

P.S. I was hoping to add the notation for my metformin use to my profile, but I am not seeing the category for accessing my profile on the top of the screen to be able to do that. Am I blind, or is it missing entirely?

A.A.

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

AA--

You're not blind. The "User CP" button is gone. But if you click on the "Private Messages" link you can get in that way.

Debbie said: "Like I said, no answers from me. But an awareness that this is a complex issue. Obesity, although important to cancer, is a much larger influence on other deadly diseases -- so finding ways to decrease its incidence would benefit us (the big "us", all of society) in so many ways."

Thank you, Debbie. So well said! I agree that it would be better if the solution were within people's control (even though a skinny pill would be so cool! Like Aladdin's Lamp!)

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

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

I read this the other day:

http://www.oncologystat.com/news/ASC...tients_US.html

A login is required to read the entire article (you can read the synopsis without a login), but signup is fast and easy.

It seems that those who are overweight are being shortchanged. Although excess weight may have its own impact on breast cancer, the fact that oncologists are undermedicating some of us may be skewing those statistics by quite a lot.

As for me, I'm trying out the intermittent low carb diet, and so far, I really enjoy it.

I started my breast cancer adventure hovering around 139-141 pounds, and two weeks ago, I hit 157. After a week doing the intermittent low carb plan (modified to one day low carb, followed by two days of normal eating), I'm at 154.2. (Yes, I know it's water, but almost 3 pounds right off the bat is soooooo motivating.)

Not being a dieter in the past (much less a low-carb dieter), I was surprised to find that my appetite is not overly active on low carb days or even the day following. This means that I've cut calories overall, as well as carbs.

Being the cautious sort, I meticulously planned my first day as if every little carb of the 50 carbs permitted were a precious jewel. Turns out, I came in at 35 carbs the first round and 37 the second without even trying. (And that doesn't even include a subtraction for fiber in my vegetables or sugar alcohol in my gum.)

My real problem is rebuilding muscle mass--my skeletal muscle percentage was 33%, but I'm now down to 29%. Every day, I tell myself to get down on the floor and plank, and every day, I just...don't.

Even if I do lose weight, I'm well on my way to becoming an amorphous blob.

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

I want to find the right combination that triggers my stubborn weight to drop a few pounds and I don't mean water.....I mean fat bUrned into muscles ...........that day will come if I c keep up this or that routine!
Pitch in some ideas!!! Love to have the
Lorraine

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

This thread is hitting me right where I live. After treatment I went on arimidex and have been on for about 2 years. In that time, my blood pressure and my weight went up despite eating healthily and walking. I went on a beta blocker for the blood pressure only to find I gained scary amounts of weight -- 20 pounds in a couple of months without changing my eating -- and also depression for the first time in my life. So I went off it and am now trying to drop the weight -- it's VERY tough. I think that arimidex may have fueled the blood pressure and the combo of arimidex and the beta blocker put on a lot of weight. I now need to lose 40-50 pounds. I won't go off arimidex but I wish I could figure out the "magic diet" that would help with the weight! I'm living on fruit, salads, quinoa, a little chicken and fish, legumes, and green juice! In the old days, I'd have been dropping weight at least 2 pounds a week, but now -- nada. Oh well, just glad to be alive. The extra weight makes me nervous though with studies like these...

diagnosed Sept 2009 with stage 3 her2+
treated at Dana Farber
3 months taxol/herceptin
bilateral mastectomy w/ node dissection Jan 2010
3 months A/C chemo
5 weeks radiation
herceptin till December 2010
now on arimidex and synthroid

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

Thanks, MTN girl - I added metformin to my signature.

I think those of us who are 50 or older are just glad to get thru treatment when it is over, and still believe we can do what we always did before to shed the weight, but... no can do. Nobody explains how greatly our metabolism has slowed down, or even seems to "get it" that it actually does.

It is so important to introduce our medical providers to thinking about including a metabolic specialist in the discussions about us at the time of diagnosis, so that the planning doesn't end with completion of toxic therapies.

Eating is a "background", daily part of life and when conscientious diet and exercise don't do the trick after we have gone through a long period of treatment, we are stuck in a loop of slow weight gain.

Even harder is the whole picture for those like my older sister, who was quite overweight to begin with. I figure if it is hard for me (when I was able to maintain my weight clear up to age 51 and how hard it has become for me after treatment), I can see why it seems to hopelessly absurd to her to seriously try to address it.

The small daily metformin has stopped the weight gain for me as long as I do continue the daily diet and exercise.

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

I am turning 58 in a couple of weeks. In early 2003 I experienced a sudden and devastating personal loss, and I simply lost my appetite. I dropped a lot of weight very quickly, without any effort. But when my broken heart began to heal and my appetite came back I just could not stop eating, and it was sugar and fat that I craved. Inadvertently, I became living proof that crash diets make you fat.

I have regained the lost muscle and improved my body composition, but for the last 5 years or so I have carried about 25 pounds more than I would like. Cancer treatment upped that to 40 pounds too many.

I am now back to what I weighed at diagnosis. I, too, think Arimidex may be complicating my efforts to shed excess fat.

I decided not to obsess about it. If I eat good food, avoid junk, and keep moving (including doing weight-bearing exercises to maintain muscle and bone) then I feel like I'm doing OK. I don't always hit those goals--the yoga DVDs and dumbbells are gathering dust right now--but I try to keep everything in perspective. I seem to be pretty healthy for someone with advanced cancer.

Although I actually weighed less after rebounding from the "crash diet," I appear to have less abdominal fat now. I won't pretend I have a flat stomach, but there's less bulging than there was.

Stress can increase cortisol, which can cause the body to store more fat, especially abdominal fat. So it seems that getting stressed about my weight might just create a vicious circle. . . .