Meeting NewsPerspective

Lifestyle intervention improves outcomes for some breast cancer survivors

SAN ANTONIO — Completion of a lifestyle intervention program that focused on healthy habits appeared associated with weight loss and increased DFS among a cohort of early-stage breast cancer survivors, according to results of an interim analysis of the SUCCESS C study presented at San Antonio Breast Cancer Symposium.

“Increasing data suggest that obesity and low levels of physical activity are associated with a higher risk for developing cancer, and also for recurrence and reduced survival outcomes,” Wolfgang Janni, MD, chair of the department of obstetrics and gynecology at University of Ulm in Germany, said during a press conference. “Our trial was successful in demonstrating that a telephone-based intensified intervention program can lead to significant weight loss and better outcomes [among] survivors of breast cancer.”

Janni and colleagues conducted an interim analysis of the randomized phase 3 SUCCESS C study, which compared DFS among 2,292 survivors of HER2-negative early-stage breast cancer treated with one of two chemotherapy regimens. All participants had BMI between 24kg/m2 and 40 kg/m2.

Half of the women received an intensified telephone-based lifestyle intervention that included individualized guidance designed to help patients achieve moderate weight loss, optimize a healthy diet and increase physical activity.

Components included 19 telephone contacts with trained lifestyle coaches, a detailed workbook supplemented with mailings that focused on weight management, regular mailings of newsletters with weight loss intervention materials, and up to three additional phone calls and mailings to address key issues or problems.

The other half of patients served as controls. They received standardized mail-based educational support that focused on healthy living, as well as lifestyle information by newsletter or magazine.

Follow-up was 2 years.

Results showed women in the intervention group lost an average of 2.2 pounds (95% CI, 0.6-1.39), whereas women in the control group gained an average of 2 pounds (95% CI, 0.61-1.3).

An intention-to-treat analysis showed no significant difference in DFS or OS between patients assigned to the intervention group and the control group.

Sixty-four percent of patients in the control group and fewer than half of the patients in the intervention group completed the final telephone component of the program, Janni said.

An exploratory analysis showed patients who completed the lifestyle intervention program achieved longer median DFS (64.4 months vs. 58.9 months) and median OS (64.7 months vs. 63.3 months) than those who did not (P < .001 for both). Researchers calculated an HR for DFS of 0.51 (95% CI, 0.33-0.78) in favor of those who completed the program.

Program completers also attained greater weight loss, with a difference of approximately 7 pounds.

Janni noted several limitations of the study, including the low adherence to the lifestyle intervention program, the relatively low number of events, and the potential bias of health status and motivation, which were unaccounted for.

“We were negatively surprised by the low adherence to the lifestyle intervention program,” Janni said. “This was an ambitious intervention and perhaps too much of an intervention. Based upon the potential bias between completers and noncompleters of the program, the results of this analysis should be interpreted with appropriate caution. We plan to further analyze our study with longer follow-up and more events.” – by Jennifer Southall

Reference:

Janni W., et al. Abstract GS5-03. Presented at: San Antonio Breast Cancer Symposium; Dec. 4-8, 2018; San Antonio.

Disclosures: Chugai, GlaxoSmithKline, Janssen Diagnostics, Pfizer, and Sanofi funded this study. Janni reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.

SAN ANTONIO — Completion of a lifestyle intervention program that focused on healthy habits appeared associated with weight loss and increased DFS among a cohort of early-stage breast cancer survivors, according to results of an interim analysis of the SUCCESS C study presented at San Antonio Breast Cancer Symposium.

“Increasing data suggest that obesity and low levels of physical activity are associated with a higher risk for developing cancer, and also for recurrence and reduced survival outcomes,” Wolfgang Janni, MD, chair of the department of obstetrics and gynecology at University of Ulm in Germany, said during a press conference. “Our trial was successful in demonstrating that a telephone-based intensified intervention program can lead to significant weight loss and better outcomes [among] survivors of breast cancer.”

Janni and colleagues conducted an interim analysis of the randomized phase 3 SUCCESS C study, which compared DFS among 2,292 survivors of HER2-negative early-stage breast cancer treated with one of two chemotherapy regimens. All participants had BMI between 24kg/m2 and 40 kg/m2.

Half of the women received an intensified telephone-based lifestyle intervention that included individualized guidance designed to help patients achieve moderate weight loss, optimize a healthy diet and increase physical activity.

Components included 19 telephone contacts with trained lifestyle coaches, a detailed workbook supplemented with mailings that focused on weight management, regular mailings of newsletters with weight loss intervention materials, and up to three additional phone calls and mailings to address key issues or problems.

The other half of patients served as controls. They received standardized mail-based educational support that focused on healthy living, as well as lifestyle information by newsletter or magazine.

Follow-up was 2 years.

Results showed women in the intervention group lost an average of 2.2 pounds (95% CI, 0.6-1.39), whereas women in the control group gained an average of 2 pounds (95% CI, 0.61-1.3).

An intention-to-treat analysis showed no significant difference in DFS or OS between patients assigned to the intervention group and the control group.

Sixty-four percent of patients in the control group and fewer than half of the patients in the intervention group completed the final telephone component of the program, Janni said.

An exploratory analysis showed patients who completed the lifestyle intervention program achieved longer median DFS (64.4 months vs. 58.9 months) and median OS (64.7 months vs. 63.3 months) than those who did not (P < .001 for both). Researchers calculated an HR for DFS of 0.51 (95% CI, 0.33-0.78) in favor of those who completed the program.

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Program completers also attained greater weight loss, with a difference of approximately 7 pounds.

Janni noted several limitations of the study, including the low adherence to the lifestyle intervention program, the relatively low number of events, and the potential bias of health status and motivation, which were unaccounted for.

“We were negatively surprised by the low adherence to the lifestyle intervention program,” Janni said. “This was an ambitious intervention and perhaps too much of an intervention. Based upon the potential bias between completers and noncompleters of the program, the results of this analysis should be interpreted with appropriate caution. We plan to further analyze our study with longer follow-up and more events.” – by Jennifer Southall

Reference:

Janni W., et al. Abstract GS5-03. Presented at: San Antonio Breast Cancer Symposium; Dec. 4-8, 2018; San Antonio.

Disclosures: Chugai, GlaxoSmithKline, Janssen Diagnostics, Pfizer, and Sanofi funded this study. Janni reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.

    Perspective

    It is hard to imagine that a 2-pound weight loss would impact survival. It is important to note that a patient does not always have to lose weight to impact survival. Physical activity alone can be valuable. It is also important to understand that the physical activity that we are talking about in these studies does not have to entail running a marathon. Simply walking 30 minutes per day has been shown to improve outcomes. One might be surprised to know how little activity patients undergo after their diagnosis, partially related to their families telling them they need to rest. This is wrong. Patients need to be as active as they can, and they will have better outcomes. On another note, patients on these early-phase trials of new agents are often significantly affected by the cancer itself and feeling poorly. Physicians should encourage exercise [for] these specific patients, as it is the right thing to do. It is valuable for physicians to get patients active.

    • C. Kent Osborne, MD
    • Dan L. Duncan Comprehensive Cancer CenterBaylor College of Medicine

    Disclosures: Osborne reports no relevant financial disclosures.

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