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Diet Quality, Inflammation, and Quality of Life in Breast Cancer Survivors: A Cross-Sectional Analysis of Pilot Study Data.

ABSTRACT: BACKGROUND:Modifiable lifestyle factors, such as diet quality, could reduce inflammation and improve quality of life (QOL) in breast cancer survivors, but data are inconclusive. OBJECTIVE:To determine whether diet quality, as measured by Healthy Eating Index-2010 (HEI-2010) score, is associated with inflammation, health status, or functional outcomes affecting QOL in survivors of early-stage breast cancer. DESIGN:This is a cross-sectional, secondary analysis of baseline data collected from breast cancer survivors after completion of primary therapy and before random assignment to a pilot nutritional intervention aimed at reducing side effects of aromatase inhibitor treatment. PARTICIPANTS/SETTING:Participants were 44 postmenopausal women with stage I to III endocrine receptor-positive breast cancer receiving outpatient care at a midwestern cancer center between November 2011 and October 2013. MAIN OUTCOME MEASURES:Primary outcomes were serum proinflammatory cytokines (interleukin-6 [IL-6], IL-17, and tumor necrosis factor-? receptor 2 [TNFR-2]). Secondary outcomes included QOL measured by the Stanford Health and Disability Questionnaire and the Functional Assessment of Cancer Therapy-Breast with Endocrine Subscale. STATISTICAL ANALYSES PERFORMED:Pearson correlation coefficients (r) and linear regression models were used to evaluate the relationship of dietary variables with inflammatory cytokines and QOL measures. RESULTS:A higher overall HEI-2010 score (healthier diet) was associated with lower IL-6 (r=-0.46; P=0.002) and TNFR-2 (r=-0.41; P=0.006); however, associations were attenuated by body mass index (BMI) (IL=6 [r=-0.26; P=0.10]; TNFR-2 [r=-0.30; P=0.06]). In women with prior chemotherapy, a higher HEI-2010 score was strongly associated with lower IL-6 (r=-0.67; P=0.009) and TNFR-2 (r=-0.59; P=0.03) after BMI adjustment. There were no significant correlations between HEI-2010 score and QOL measures after adjustment for BMI. CONCLUSIONS:These data suggest the need for more rigorous investigation into the relationship of diet quality, BMI, and inflammation in breast cancer survivors.

SUBMITTER: Orchard TS

PROVIDER: S-EPMC5869134 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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Diet Quality, Inflammation, and Quality of Life in Breast Cancer Survivors: A Cross-Sectional Analysis of Pilot Study Data.

Orchard Tonya S TS Andridge Rebecca R RR Yee Lisa D LD Lustberg Maryam B MB

Journal of the Academy of Nutrition and Dietetics 20171209 4

<h4>Background</h4>Modifiable lifestyle factors, such as diet quality, could reduce inflammation and improve quality of life (QOL) in breast cancer survivors, but data are inconclusive.<h4>Objective</h4>To determine whether diet quality, as measured by Healthy Eating Index-2010 (HEI-2010) score, is associated with inflammation, health status, or functional outcomes affecting QOL in survivors of early-stage breast cancer.<h4>Design</h4>This is a cross-sectional, secondary analysis of baseline dat ...[more]

PMID: 29233615

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Project description:There is an ongoing need for solid evidence about the effects of healthy behaviors, and particularly diet, on the quality of life (QoL) among breast cancer survivors. We first conducted a cross-sectional study on 68 Italian stage I-III breast cancer survivors, to investigate the association of adherence to the Mediterranean diet (MD), physical activity and weight status with QoL. Adherence to MD and physical activity was assessed using structured questionnaires. QoL was assessed using the European Organization for the Research and Treatment of Cancer Quality-of-Life tools. We showed that low consumption of red meat and carbonated beverages, daily consumption of wine and high consumption of dishes seasoned with sofrito had beneficial effects on several QoL subscales. By contrast, using olive oil as the main culinary fat, low consumption of commercial sweets and high consumption of nuts were associated with negative effects. Overall, these findings resulted in a null effect of adherence to MD on QoL. Furthermore, we observed better QoL sub-scores among women who performed moderate physical activity (i.e., diarrhea) and those who were underweight/normal weight (i.e., physical functioning and dyspnea) if compared with their counterparts (p-values ? 0.003 after correction for multiple comparison). Next, we performed a systematic review of nine experimental studies to summarize whether dietary interventions might improve QoL among breast cancer patients. All the studies demonstrated significant improvements in overall QoL and/or its subscales after the interventions. However, differences in study design, interventions and tools used for QoL assessment did not allow us to provide an overall estimate. Moreover, only a single-arm trial evaluated the effect of an exclusive dietary-based intervention, while others combined dietary recommendations with physical activity and weight loss programs. For these reasons, our study encourages more efforts to improve the robustness of current evidence, through more homogenous tools, larger population-based studies and further randomized controlled trials.

Project description:Maintaining weight is important for better prognosis of breast cancer survivors. The associations between weight and cancer-related symptoms are not known. We examined associations among weight, weight change, inflammation, cancer-related symptoms, and health-related quality of life (HRQOL) in a cohort of stage 0-IIIA breast cancer survivors. Participants were recruited on average 6 months (2–12 months) after diagnosis. Height, weight, and C-reactive protein (CRP) were assessed at approximately 30 months post-diagnosis; cancer-related symptoms (chest wall and arm symptoms, vasomotor symptoms, urinary incontinence, vaginal symptoms, cognition/mood problems, sleep, sexual interest/function), and HRQOL (SF-36) were assessed at approximately 40 months post-diagnosis. Weight was measured at baseline in a subset. Data on 661 participants were evaluable for body mass index (BMI); 483 were evaluable for weight change. We assessed associations between BMI (<25.0, 25.0–29.9, ?30.0 kg/m2), post-diagnosis weight change (lost ?5 %, weight change <5 %, gained ?5 %), and CRP (tertile) with cancer-related symptoms and HRQOL using analysis of covariance. Higher symptoms scores indicate more frequent or severe symptoms. Higher HRQOL scores indicate better HRQOL. Compared with those with BMI <25 kg/m2, women with BMI ?30 kg/m2 had the following scores: increased for arm symptoms (+25.0 %), urinary incontinence (+40.0 %), tendency to nap (+18.9 %), and poorer physical functioning (?15.6 %, all p < 0.05). Obese women had lower scores in trouble falling asleep (?9.9 %; p < 0.05). Compared with weight change <5 %, participants with ?5 % weight gain had lower scores in physical functioning (?7.2 %), role-physical (?15.5 %) and vitality (?11.2 %), and those with weight loss ?5 % had lower chest wall (?33.0 %) and arm symptom scores (?35.5 %, all p < 0.05). Increasing CRP tertile was associated with worse scores for chest wall symptoms, urinary incontinence, physical functioning, role-physical, vitality and physical component summary scores (all P trend < 0.05). Future studies should examine whether interventions to maintain a healthy weight and reduce inflammation could alleviate cancer-related symptoms and improve HRQOL.

Project description:OBJECTIVE:To evaluate the association between health literacy (HL) and quality of life (QOL) among cancer survivors in China. DESIGN:Cross-sectional study in China. SETTING AND PARTICIPANTS:This is a cross-sectional observational study of 4589 cancer survivors aged 18 years and older from the Shanghai Cancer Rehabilitation Club. Participants were enrolled and completed the questionnaires between May and July 2017. MEASUREMENT:HL was assessed by three established screening questions and QOL was evaluated using the simplified Chinese version of the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire-Core 30 items. Answers to all questionnaires were collected through face-to-face interviews or through self-administered questionnaires for literate participants. Participants were excluded if they did not answer any one of the HL questions. Baseline characteristics were compared by levels of HL using ?2 test for categorical variables and Wilcoxon rank-sum test for non-normal continuous variables. The item response theory (IRT) was used to evaluate the existing measure of HL. Linear regression and logistic regression models were used to investigate the association between HL and QOL. SAS V.9.4 and MULTILOG V.7.03 were used in the analysis. RESULTS:There were 4589 participants included in the study. The calculated results of IRT scale parameters of HL entries indicate that the entries have better discrimination and difficulty. Of the 4589 respondents, 159 (3.5%) had low HL. After adjusting for sociodemographic characteristics, treatment regimen and years with cancers, for each one-point decrement in HL score the QOL score increased by 2.07 (p<0.001). Cancer survivors with low HL were less likely than those with adequate HL to achieve better QOL. In logistic regression, low HL was independently associated with poor QOL (adjusted OR, 2.81; 95% CI 1.94 to 4.06; p<0.001). CONCLUSIONS:Low HL was independently associated with poor QOL among cancer survivors of the Shanghai Cancer Rehabilitation Club.

Project description:BackgroundCompared to their white counterparts, Latina breast cancer survivors experience poorer quality of care and worse health-related quality of life. Limited English proficiency (LEP) and patient engagement in cancer care could help explain these disparities. We assessed associations between LEP status and difficulty engaging with physicians, with self-reported quality of breast cancer care and health-related quality of life (physical and emotional well-being) among rural and urban Latina breast cancer survivors.MethodsAnalyses used cross-sectional baseline survey data from two studies that tested a stress management program among rural and urban Latina breast cancer survivors in California. Medical information was collected through medical records review. Linear regression models examined bivariate and multivariable associations of LEP status (yes or no), difficulty engaging with doctors (asking questions and participating in treatment decisions) (1-4; higher score?=?greater difficulty), and rural versus urban site, with three outcomes: (1) quality of breast cancer care and information; (2) physical well-being; and (3) and emotional well-being, controlling for demographic and medical factors.ResultsThe total sample included 304 women (151 from urban and 153 from rural sites). Mean age was 52.7 years (SD 10.9). Most were limited English proficient (84.5%) and had less than a high school education (67.8%). Difficulty engaging with doctors was inversely associated with patient ratings of quality of breast cancer care and information (B?=?-?0.190, p?=?0.014), emotional well-being (B?=?-?1.866, p?<?0.001), and physical well-being (B?=?-?1.272, p?=?0.002), controlling for demographic and treatment factors. LEP (vs. not; B?=?1.987, p?=?0.040) was independently associated with physical well-being only. Rural/urban status was not related independently to any outcome.ConclusionsRural and urban Latina breast cancer survivors who report greater difficulty engaging with physicians experienced worse quality of breast cancer care and health-related quality of life. Promoting greater engagement of Latina breast cancer survivors in cancer care and providing medical interpreters when needed could improve patient outcomes among this vulnerable group.Trial registrationhttp://www.ClinicalTrials.gov identifier NCT02931552 and NCT01383174.

Dataset Information

Diet Quality, Inflammation, and Quality of Life in Breast Cancer Survivors: A Cross-Sectional Analysis of Pilot Study Data.

Publications

Diet Quality, Inflammation, and Quality of Life in Breast Cancer Survivors: A Cross-Sectional Analysis of Pilot Study Data.

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