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Clinical Trial
. 2015 Nov;154(2):329-37.
doi: 10.1007/s10549-015-3627-5. Epub 2015 Oct 31.

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

Wendy Demark-Wahnefried  1 , Graham A Colditz  2 , Cheryl L Rock  3 , Rebecca L Sedjo  4 , Jingxia Liu  5 , Kathleen Y Wolin  6 , Helen Krontiras  7 , Tim Byers  8 , Bilgé Pakiz  9 , Barbara A Parker  10 , Michael Naughton  11 , Anthony Elias  12 , Patricia A Ganz  13 ; ENERGY Trial Group
Collaborators, Affiliations
Clinical Trial

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

Wendy Demark-Wahnefried et al. Breast Cancer Res Treat. 2015 Nov.

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.

Keywords: Breast cancer; Obesity; Physical function; Quality of life; Symptoms; Weight loss.

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Conflict of interest statement

Compliance with ethical standards: Conflict of interests All authors declare no competing interests, with the only exception being Dr. Wolin who reports equity from Scale Down LLC and Coeus Health LLC, personal fees from Takeda, and a pending patent for weight management software.

Figures

Fig. 1
Fig. 1. ENERGY CONSORT diagram for quality of life outcomes
Fig. 2
Fig. 2
Change in vitality and physical function over the 24-month study period. For vitality, differences between arms reach borderline significance (p = 0.0508) at 6 months but are non-significant at all other time points. For physical function, differences between arms are significant at 6 months (p = 0.0109), of borderline significance at 12 months (p = 0.0512), and non-significant at all other time points
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