Given the prevalence of remote-based medical care, nutrition counseling, and therapy during COVID-19, our May Science Nook highlights the below study on a remote-based weight loss intervention program in breast cancer survivors.
The Effects of a Remote-based Weight Loss Program on Adipocytokines, Metabolic Markers, and Telomere Length in Breast Cancer Survivors: the POWER-Remote Trial
Journal: Clinical Cancer Research
This randomized controlled trial included women with stages 0-III breast cancer who had undergone local therapy and chemotherapy, and with a BMI of 25 or higher. Participants were randomized to one of two groups: a 12 month POWER-remote weight loss program (adapted from the POWER–Practice-based Opportunities for Weight Reduction–study) or a self-directed approach.
The POWER-remote group received behavioral weight loss coaching via telephone (they were offered 21 phone calls over the 12 months), dietary recommendations based on the DASH diet, and self-monitoring and learning using web-based platforms. They also had access to a message center to communicate with the health coach as well as a support group wall to communicate with other participants in the study.
The self-directed approach group had one behavioral weight loss coaching session via telephone and received a guide on how to maintain a healthy weight from the National Heart, Lung, and Blood Institute. Outcomes looked at were: weight loss and waist circumferences, adipocytokines, metabolic factors, and telomere length [National Heart, Lung, and Blood Institute, as cited in reference i].
The authors found:
1. 51% of women in the POWER-remote arm and 12% of women in the self-directed arm lost at least 5% of their baseline weight at 6 months.
2. 51% of women in the POWER-remote arm and 17% of women in the self-directed arm lost at least 5% of their baseline weight at 12 months.
3. Reductions in waist circumference in both groups after 6 months, although not significantly different between groups. Reductions in waist circumference significantly greater in the POWER-remote arm compared to the self-directed arm after 12 months.
4. A reduction in leptin concentrations in the POWER-remote arm compared to the self-directed arm at 6 months.
5. Lower triglycerides and total cholesterol ratio in those who achieved at least 5% weight loss at 6 months. No differences in insulin, glucose, and lipid panels between the two groups.
6. A slightly but significantly shorter telomere length in participants compared to historic controls. No differences in telomere length at 6 months compared to baseline.
For the Patient and Caregiver
Being overweight is a risk factor for numerous diseases, including breast cancer [Abe et al., 1976 & Wiseman, 2008 as cited in reference i]. Further, individuals with breast cancer who are overweight or obese have poorer outcomes, related to metabolic and inflammatory pathways [Sparano et al., 2012 & Vance et al., 2011 as cited in reference i]. For tips on how to reach and maintain a healthy body weight, take a look at this post. Seeking care and support, particularly remote care during this time, can help with weight loss and weight management efforts.
For the Healthcare Team
The findings on leptin in this study are especially meaningful, as leptin has been shown to “increase breast cancer cell proliferation, invasion, and migration” [Saxena et al., 2007; Saxena & Sharma, 2013; Saxena et al., 2008; Knight et al., 2011 as cited in reference i]. In addition, telomere length was looked at as a variable, as breast cancer is associated with shorter telomere length [Ornish et al., 2008; Ornish et al., 2013; Takubo et al., 1998 as cited in reference i]. Remote programs such as the one used in this study are important to consider, especially with changes in how we provide care since the start of the COVID-19 pandemic.
[i] Santa-Maria CA, Coughlin JW, Sharma D, Armanios M, Blackford AL, Schreyer C…Stearns V (2020). The effects of a remote-based weight loss program on adipocytokines, metabolic markers, and telomere length in breast cancer survivors: the POWER-remote trial. Clinical Cancer Research. DOI: 10.1158/1078-0432.CCR-19-2935