title: Quality of life outcomes from the Exercise and Nutrition Enhance Recovery and Good Health for You (ENERGY)-randomized weight loss trial among breast cancer survivors.
abstract: Obesity is a poor prognostic factor and is negatively related to quality of life (QOL) in breast cancer survivors. Exercise and Nutrition to Enhance Recovery and Good Health for You is the largest weight loss trial completed among cancer survivors. Percent losses in body weight with an intensive group-based intervention versus an attention control were 6.0 versus 1.5 % (p < 0.0001) and 3.7 versus 1.3 % (p < 0.0001) at 12 and 24 months, respectively. ENERGY also was designed to answer the research question: Does weight loss significantly improve vitality and physical function (key components of QOL)? 692 breast cancer survivors (BMI: 25-45 kg/m(2)) at 4 US sites were randomized to a year-long intensive intervention of 52 group sessions and telephone counseling contacts versus a non-intensive (control) of two in-person counseling sessions. Weight, self-reported QOL, and symptoms were measured semi-annually for two years. Significant decreases in physical function and increases in symptoms were observed among controls from baseline to 6 months, but not in the intervention arm, -3.45 (95 % Confidence Interval [CI] -6.10, -0.79, p = 0.0109) and 0.10 (95 %CI 0.04, 0.16, p = 0.0021), respectively. Improvements in vitality were seen in both arms but trended toward greater improvement in the intervention arm -2.72 (95 % CI -5.45, 0.01, p = 0.0508). These differences diminished over time; however, depressive symptoms increased in the intervention versus control arms and became significant at 24 months, -1.64 (95 % CI -3.13, -0.15, p = 0.0308). Increased QOL has been reported in shorter term diet and exercise trials among cancer survivors. These longer term data suggest that diet and exercise interventions improve some aspects of QOL, but these benefits may diminish over time.
authors.affiliation: Department of Nutrition Sciences, Wallace Tumor Institute, University of Alabama at Birmingham (UAB), 1824 6th Avenue, Rm 310D, Birmingham, AL, 35294, USA. demark@uab.edu.
authors.forename: Wendy
authors.initials: W
authors.lastname: Demark-Wahnefried
authors.affiliation: Department of Surgery, Washington University in St. Louis (WUSTL), St. Louis, MO, 63110, USA.
authors.forename: Graham A
authors.initials: GA
authors.lastname: Colditz
authors.affiliation: Department of Family Medicine and Public Health, University of California, San Diego (UCSD), La Jolla, CA, 92093-0901, USA.
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Rock
authors.affiliation: Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus (UC), Aurora, CO, 80045, USA.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Sedjo
authors.affiliation: Department of Surgery, WUSTL, St. Louis, MO, 63110, USA.
authors.forename: Jingxia
authors.initials: J
authors.lastname: Liu
authors.affiliation: Coeus Health, Chicago, IL, 60654, USA.
authors.forename: Kathleen Y
authors.initials: KY
authors.lastname: Wolin
authors.affiliation: Department of Surgery, UAB, Birmingham, AL, 35294, USA.
authors.forename: Helen
authors.initials: H
authors.lastname: Krontiras
authors.affiliation: Department of Epidemiology, Colorado School of Public Health, UC, Aurora, CO, 80045, USA.
authors.forename: Tim
authors.initials: T
authors.lastname: Byers
authors.affiliation: Department of Family Medicine and Public Health, UCSD, La Jolla, CA, 92093, USA.
authors.forename: Bilgé
authors.initials: B
authors.lastname: Pakiz
authors.affiliation: Department Of Medicine, UCSD, La Jolla, CA, 92093, USA.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Parker
authors.affiliation: Department of Medicine, WUSTL, St. Louis, MO, 63110, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Naughton
authors.affiliation: Department of Medicine, UC, Aurora, CO, 80045, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Elias
authors.affiliation: Department of Health Policy & Management and Medicine, Schools of Public Health and Medicine, University of California - Los Angeles, Los Angeles, CA, 90095, USA.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Ganz
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D015897:Comorbidity; D004032:Diet; D015444:Exercise; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011788:Quality of Life; D017741:Survivors; D015431:Weight Loss
keywords: Breast cancer; Obesity; Physical function; Quality of life; Symptoms; Weight loss