A total of 17 women participated in this study. The median age was 58 but ranged from 43 to 75 years old. Most participants (70.6%) identified as non-Hispanic Black; 11.8%, 11.8%, and 5.9% of participants self-identified as Hispanic, non-Hispanic White, and Asian, respectively. The median BMI was 34.6 kg/m2 and ranged from 26.6 to 51.8 kg/m2. More than half of patients (58.9%) were privately-insured, with 41.1% insured by Medicaid and Medicare. Nearly half of participants (47.1%) were diagnosed with stage 2 disease. Most patients underwent either lumpectomy or bilateral mastectomy; 11.8% of participants had unilateral mastectomy. Over 75% of participants reported receiving adjuvant radiation, and 70.6% were taking adjuvant endocrine therapy. Nearly half of patients (47.1%) had either neoadjuvant or postoperative chemotherapy (Table 1).
Table 1
Characteristics of participants (n = 17)
Variable | N | Percentage (%) |
Demographics | | |
Age | | |
40–50 years | 3 | 17.6 |
51–60 years | 6 | 35.3 |
61–70 years | 5 | 29.4 |
71–80 years | 3 | 17.6 |
Race/Ethnicity | | |
Asian | 1 | 5.9 |
Hispanic | 2 | 11.8 |
Non-Hispanic Black | 12 | 70.6 |
Non-Hispanic White | 2 | 11.8 |
Body Mass Index (BMI) (kg/m2) | | |
25–30 | 6 | 35.3 |
31–40 | 7 | 41.2 |
> 40 | 4 | 23.5 |
Insurance | | |
Medicaid | 3 | 17.6 |
Medicare | 4 | 23.5 |
Private | 10 | 58.9 |
Marital Status | | |
Divorced | 1 | 5.9 |
Married | 8 | 47.1 |
Single | 7 | 41.2 |
Widowed | 1 | 5.9 |
Treatment Characteristics | | |
AJCC Stage* | | |
0 | 5 | 29.4 |
1 | 1 | 5.9 |
2 | 8 | 47.1 |
3 | 3 | 17.6 |
Type of Breast Surgery | | |
Lumpectomy | 8 | 47.1 |
Unilateral mastectomy | 2 | 11.8 |
Bilateral mastectomy | 7 | 41.2 |
Received Adjuvant Radiation | 13 | 76.5 |
Received Adjuvant Endocrine Therapy | 12 | 70.6 |
Chemotherapy | 8 | 47.1 |
*AJCC = American Joint Committee on Cancer |
All but one participant felt comfortable being approached about weight management, yet less than half (41.2%) of participants reported that they knew about the link between breast cancer and body weight prior to the interview.
Themes
The major themes that emerged were lack of knowledge, barriers to weight management, previous attempts at weight loss, and approach (Table 2).
Major theme: Lack of knowledge
A major theme that emerged was that breast cancer patients lack the knowledge that body weight is linked to breast cancer risk. One participant reported that “I don’t really know anything. I’ve never really heard anything, um, about that. I really, I had no idea.” Another stated, “I don’t really know anything. I accept that there is a link, but I don’t know what it is exactly.”
Other participants expressed the motivation to learn more about the topic through self-directed reading. For example, one participant stated, “I can’t give you an answer on how the weight activates or deals with the cancer and stuff like that because honestly that part I didn’t know but it gives me something to go and research about.” Another stated “I’m a little familiar because I love to read, and I knew a lot of things about why I have the breast cancer and trying to read and see what was the reason why that happened to me beside my genetic things.” Another participant commented on doing her own research, “I can’t say I did a whole lot of reading, but I did reading on my own and looked up things.”
Several participants also expressed their own beliefs and understanding about the link between body weight and breast cancer risk. For example, one participant stated, “I’ve heard rumors, I don’t know how true it is that staying away from sugar, you know, when it comes to cancer, I’ve heard that.” Another explained that “maybe the cells have a larger area to grow, or the body is sort of compromised when its obese. I have no idea really, but I feel that anything when you’re not your ideal weight your body is kind of prone to attract any, like, anything and everything.”
Another subtheme that emerged was the lack of education provided to patients by members of their breast cancer care team. For example, one patient expressed how shocking it was to find out about the link only after her treatment was complete: “it was only a couple of months ago…that was the first time that I knew that being overweight had a connection with cancer…It really shook me up, really, really. I almost cried it really shook me up because if I knew that before maybe I would have done something positive.” Others reported not discussing weight management in the context of breast cancer risk factors at all, or if they did not in detail. For example, one participant stated, “we talked about it, but not really at length or at least I don’t remember talking about it at length.”
Theme: Barriers to weight management
This theme encompasses four distinct barriers to successful weight management that participants identified throughout and after their treatment.
First, some participants described that it was difficult to maintain healthy habits for themselves while managing the expectations and responsibilities of providing for their families. One patient said, “I didn’t know what to do anymore to get rid of the weight because your life, your [children], home, husband…you’re shopping separate for you, you’re cooking separate for you, and it becomes a bigger chore.” Another participant reported, “I have a big family, so different things do come into play that didn't make it the best situation. Right after my surgery, I had some family members that needed to move into my house. You know, the term was supposed to be two weeks, turned into three months and it kind of made it a little hard to stay focused on, uh, just myself.”
Second, participants expressed concerns over the high cost of healthier foods. Patients reported dealing with high family grocery bills that did not allow them the ability to choose foods for the purpose of their individual dietary needs. For example, one participant, in relation to meal preparatory services stated, “…to go to the supermarket and buy what [my family] likes and then spend the money to order from those places which is costly, it may seem like $35 but it turns into a huge cost per month, right?”
Third, participants described the negative effects of mental health disorders on their weight. One participant stated, “When you get depressed you want to eat, there’s a sense of like security in food but it doesn’t comfort you it only puts on weight.” Participants also noted that providers should be particularly attuned to identifying patients with mental health issues and help to address them: “…you have to figure out people’s mental…I know I have to lose weight, but there is some depression there,” one participant says.
Fourth, some participants noted that chronic medical conditions that affected their mobility limited their ability to maintain a healthy weight. Participants described dealing with cardiopulmonary disease, endocrine disorders, and orthopedic issues that made exercising a challenge. “I still have nerve damage to my feet, the chemo exacerbated the neuropathy that I have”, one participant noted. Another participant stated, “It’s the mobility also because I got both knees replaced and I do have like a kind of backbone issue.” While another participant said, “I have PCOS, so my weight tends to fluctuate even though I exercise and try to stay away from certain food, like carbs.”
Major theme: Previous attempts at weight loss
All 17 participants expressed prior attempts at weight loss. The subtheme of good food versus bad food was apparent based on how several participants described the need to change their diet to lose weight. For example, one participant stated, “If I get in the mood, I’ll throw away everything in the house that I know shouldn’t be in here. Another participant noted “I don’t eat too much bad food.” Several other participants commented on what they should and should not eat. Another noted that even growing up, “there was good food and bad food.”
Other participants reported utilizing structured weight loss programs to lose weight, such as Weight Watchers and Nutrisystem. However, these programs seemed to offer limited success at long term weight management. As one participant noted, “what I discovered with those diets is that once you get off their food, unless you’re really, really, very careful about how you’re eating and choosing your foods, you gain the weight back.”
The use of medical and surgical weight loss also emerged as a subtheme within previous attempts at weight loss. One participant reported that she “actually took Ozempic, the shot” and “saw a weight loss management doctor.” Additionally, two participants reported having had bariatric surgery years before being diagnosed with breast cancer. However, both reported that they gained the weight back, even after surgery. One participant described “I just couldn’t maintain the eating regimen.”
Major theme: Approach
Most participants expressed that they felt comfortable being approached regarding weight management by any member of their breast cancer team. As one participant stated, she felt comfortable talking to “everybody who would listen to me if they can help me.”
Another subtheme that emerged was that participants felt that weight management should be introduced early on in their breast cancer journey as opposed to waiting until survivorship. It became apparent that while receiving a breast cancer diagnosis can be overwhelming, given the link between weight and breast cancer risk, it should be discussed sooner rather than later as part of the treatment plan. For example, one participant noted, “I think the topic should be discussed the minute you’re diagnosed with breast cancer and all the things you have to do…in treating the cancer weight is part of it.” Another participant felt that for patients planned for chemotherapy, a conversation about weight management should happen before beginning chemotherapy. One participant felt that “there is no too early a time to discuss it.”