Abstract
Purpose
The aim of this study is to explore breast cancer survivors’ experience of a weight loss intervention and identify potential facilitators and barriers of initiating and maintaining weight, dietary or physical activity changes.
Method
Fourteen women randomised to and completing the 12-month weight loss intervention completed semi-structured interviews 7.5 ± 0.5 months after intervention completion. An inductive thematic analysis was conducted whereby interviews were independently coded and themes identified.
Results
Women were (mean ± SD) 55.6 ± 8.5 years, 30.2 ± 4.6 kg/m2 and 17.1 ± 3.4 months post-diagnosis at study baseline. Four themes emerged: (1) perceived motivation to participate in the intervention, (2) facilitators, (3) challenges and (4) maintenance of weight loss and behaviour changes. All women noted the impact of social/family environments, either to facilitate (e.g., support from family members) or impede (e.g., major family event) changes. The structure and support of the intervention, particularly accountability to their coach, was also seen as facilitating. Formation of habitual physical activity facilitated dietary changes. Dietary change strategies most perceived to facilitate weight loss were reducing energy intake by dietary self-monitoring, increasing vegetable intake and portion control. Challenges included breast cancer-specific issues such as post-diagnosis weight gain, treatment-related side effects and psychological issues around readiness to change and self-regulation. Diminished accountability following intervention completion impacted the maintenance of weight loss and behaviour changes, notably dietary self-monitoring.
Conclusions
Results suggest that formal involvement of a support person (e.g. family member/friend) and referring women to ongoing, community-based services to maintain patient-perceived accountability may be particularly useful strategies for future weight loss intervention trials targeting women with breast cancer.
Similar content being viewed by others
References
Protani M, Coory M, Martin JH (2010) Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat 123(3):627–635. doi:10.1007/s10549-010-0990-0
Kroenke CH, Fung TT, FB H, Holmes MD (2005) Dietary patterns and survival after breast cancer diagnosis. J Clin Oncol 23(36):9295–9303. doi:10.1200/jco.2005.02.0198
Kwan ML, Weltzien E, Kushi LH, Castillo A, Slattery ML, Caan BJ (2009) Dietary patterns and breast cancer recurrence and survival among women with early-stage breast cancer. J Clin Oncol 27(6):919–926. doi:10.1200/jco.2008.19.4035
Ballard-Barbash R, Friedenreich CM, Courneya KS, Siddiqi SM, McTiernan A, Alfano CM (2012) Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review. J Natl Cancer Inst 104(11):815–840. doi:10.1093/jnci/djs207
Wiseman M (2008) The second World Cancer Research Fund/American Institute for Cancer Research expert report. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Proc Nutr Soc 67(3):253–256. doi:10.1017/s002966510800712x
Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, Bandera EV, Hamilton KK, Grant B, McCullough M, Byers T, Gansler T (2012) Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 62(4):243–274. doi:10.3322/caac.21142
Cancer Council Australia (2006) Position statement: benefits of healthy diet and physical activity for cancer survivors. http://wiki.cancer.org.au/policy/Position_statement_-_Benefits_of_healthy_diet_and_physical_activity_for_cancer_survivors#_ga=1.206335443.1984681587.1461727262. Accessed 20 February 2013
Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM (2005) Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol 23(24):5814–5830. doi:10.1200/jco.2005.01.230
Milliron BJ, Vitolins MZ, Tooze JA (2013) Usual dietary intake among female breast cancer survivors is not significantly different from women with no cancer history: results of the national health and nutrition examination survey, 2003-2006. J Acad Nutr Diet 114(6):932–937. doi:10.1016/j.jand.2013.08.015
O’Neill SC, Defrank JT, Vegella P, Richman AR, Henry LR, Carey LA, Brewer NT (2013) Engaging in health behaviors to lower risk for breast cancer recurrence. PLoS One 8(1):e53607. doi:10.1371/journal.pone.0053607
Reeves MM, Terranova CO, Eakin EG, Demark-Wahnefried W (2014) Weight loss intervention trials in women with breast cancer: a systematic review. Obes Rev 15(9):749–768. doi:10.1111/obr.12190
Chlebowski RT, Reeves MM (2016) Weight loss randomized intervention trials in female cancer survivors. J Clin Oncol. doi:10.1200/JCO.2016.69.4026
Goodwin PJ, Segal RJ, Vallis M, Ligibel JA, Pond GR, Robidoux A, Blackburn GL, Findlay B, Gralow JR, Mukherjee S, Levine M, Pritchard KI (2014) Randomized trial of a telephone-based weight loss intervention in postmenopausal women with breast cancer receiving letrozole: the LISA trial. J Clin Oncol 32(21):2231–2239. doi:10.1200/jco.2013.53.1517
Vagenas D, DiSipio T, Battistutta D, Demark-Wahnefried W, Rye S, Bashford J, Pyke C, Saunders C, Hayes SC (2015) Weight and weight change following breast cancer: evidence from a prospective, population-based, breast cancer cohort study. BMC Cancer 15:28. doi:10.1186/s12885-015-1026-2
Bazzan AJ, Newberg AB, Cho WC, Monti DA (2013) Diet and nutrition in cancer survivorship and palliative care. Evid Based Complement Alternat Med 2013:917647. doi:10.1155/2013/917647
Charlier C, Van Hoof E, Pauwels E, Lechner L, Spittaels H, Bourgois J, De Bourdeaudhuij I (2012) Treatment-related and psychosocial variables in explaining physical activity in women three weeks to six months post-treatment of breast cancer. Patient Educ Couns 89(1):171–177. doi:10.1016/j.pec.2012.06.029
Kwok A, Palermo C, Boltong A (2015) Dietary experiences and support needs of women who gain weight following chemotherapy for breast cancer. Support Care Cancer 23(6):1561–1568. doi:10.1007/s00520-014-2496-5
Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, Cannady RS, Pratt-Chapman ML, Edge SB, Jacobs LA, Hurria A, Marks LB, LaMonte SJ, Warner E, Lyman GH, Ganz PA (2016) American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline. CA Cancer J Clin 66(1):43–73. doi:10.3322/caac.21319
Reeves M, Winkler E, McCarthy N, Lawler S, Terranova C, Hayes S, Janda M, Demark-Wahnefried W, Eakin E (2016) The living well after breast cancer pilot trial: a weight loss intervention for women following treatment for breast cancer. Asia Pac J Clin Oncol. doi:10.1111/ajco.12629
Spark LC, Fjeldsoe BS, Eakin EG, Reeves MM (2015) Efficacy of a text message-delivered extended contact intervention on maintenance of weight loss, physical activity, and dietary behavior change. JMIR mHealth and uHealth 3(3):e88. doi:10.2196/mhealth.4114
National Health and Medical Research Council (2013) Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n57_obesity_guidelines_140630.pdf. Accessed 20 June 2014
Jensen MD, Ryan DH, Apovian CM, Loria CM, Ard JD, Millen BE, Comuzzie AG, Nonas CA, Donato KA, Pi-Sunyer FX, FB H, Stevens J, Hubbard VS, Stevens VJ, Jakicic JM, Wadden TA, Kushner RF, Wolfe BM, Yanovski SZ (2013) 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and The Obesity Society. J Am Coll Cardiol 129(Suppl 2):S102–S138. doi:10.1016/j.jacc.2013.11.004
Weathers B, Barg FK, Collier A, Halbert CH (2006) Perceptions of changes in weight among African American breast cancer survivors. Psychooncology 15(2):174–179. doi:10.1002/pon.939
Stolley MR, Sharp LK, Wells AM, Simon N, Schiffer L (2006) Health behaviors and breast cancer: experiences of urban African American women. Health Educ Behav 33(5):604–624. doi:10.1177/1090198106290845
Maley M, Warren BS, Devine CM (2013) A second chance: meanings of body weight, diet, and physical activity to women who have experienced cancer. J Nutr Educ Behav 45(3):232–239. doi:10.1016/j.jneb.2012.10.009
Lawler S, Spathonis K, Masters J, Adams J, Eakin E (2011) Follow-up care after breast cancer treatment: experiences and perceptions of service provision and provider interactions in rural Australian women. Support Care Cancer 19(12):1975–1982. doi:10.1007/s00520-010-1041-4
Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77–101. doi:10.1191/1478088706qp063oa
Balneaves LG, Van Patten C, Truant TL, Kelly MT, Neil SE, Campbell KL (2014) Breast cancer survivors’ perspectives on a weight loss and physical activity lifestyle intervention. Support Care Cancer 22(8):2057–2065. doi:10.1007/s00520-014-2185-4
Emslie C, Whyte F, Campbell A, Mutrie N, Lee L, Ritchie D, Kearney N (2007) I wouldn’t have been interested in just sitting round a table talking about cancer’; exploring the experiences of women with breast cancer in a group exercise trial. Health Educ Res 22(6):827–838. doi:10.1093/her/cyl159
Burke LE, Wang J, Sevick MA (2011) Self-monitoring in weight loss: a systematic review of the literature. J Am Diet Assoc 111(1):92–102. doi:10.1016/j.jada.2010.10.008
Wadden TA, Butryn ML, Wilson C (2007) Lifestyle modification for the management of obesity. Gastroenterology 132(6):2226–2238. doi:10.1053/j.gastro.2007.03.051
Akers JD, Cornett RA, Savla JS, Davy KP, Davy BM (2012) Daily self-monitoring of body weight, step count, fruit/vegetable intake, and water consumption: a feasible and effective long-term weight loss maintenance approach. J Acad Nutr Diet 112(5):685–692. doi:10.1016/j.jand.2012.01.022
Butryn ML, Phelan S, Hill JO, Wing RR (2007) Consistent self-monitoring of weight: a key component of successful weight loss maintenance. Obesity 15(12):3091–3096. doi:10.1038/oby.2007.368
Reyes NR, Oliver TL, Klotz AA, Lagrotte CA, Vander Veur SS, Virus A, Bailer BA, Foster GD (2012) Similarities and differences between weight loss maintainers and regainers: a qualitative analysis. J Acad Nutr Diet 112(4):499–505. doi:10.1016/j.jand.2011.11.014
Wadden TA, Crerand CE, Brock J (2005) Behavioral treatment of obesity. Psychiatr Clin North Am 28(1):151–170. doi:10.1016/j.psc.2004.09.008
Fazzino TL, Sporn NJ, Befort CA (2016) A qualitative evaluation of a group phone-based weight loss intervention for rural breast cancer survivors: themes and mechanisms of success. Support Care Cancer 24(7):3165–3173. doi:10.1007/s00520-016-3149-7
Kiernan M, Moore SD, Schoffman DE, Lee K, King AC, Taylor CB, Kiernan NE, Perri MG (2012) Social support for healthy behaviors: scale psychometrics and prediction of weight loss among women in a behavioral program. Obesity 20(4):756–764. doi:10.1038/oby.2011.293
Wing RR, Jeffery RW (1999) Benefits of recruiting participants with friends and increasing social support for weight loss and maintenance. J Consult Clin Psychol 67(1):132–138
Demark-Wahnefried W, Jones LW, Snyder DC, Sloane RJ, Kimmick GG, Hughes DC, Badr HJ, Miller PE, Burke LE, Lipkus IM (2014) Daughters and mothers against breast cancer (DAMES): main outcomes of a randomized controlled trial of weight loss in overweight mothers with breast cancer and their overweight daughters. Cancer 120(16):2522–2534. doi:10.1002/cncr.28761
Bennett WL, Gudzune KA, Appel LJ, Clark JM (2014) Insights from the POWER practice-based weight loss trial: a focus group study on the PCP’s role in weight management. J Gen Intern Med 29(1):50–58. doi:10.1007/s11606-013-2562-6
McArthur D, Dumas A, Woodend K, Beach S, Stacey D (2014) Factors influencing adherence to regular exercise in middle-aged women: a qualitative study to inform clinical practice. BMC Womens Health 14(1):49. doi:10.1186/1472-6874-14-49
Fletcher SM, Burley MB, Thomas KE, Mitchell EK (2014) Feeling supported and abandoned: mixed messages from attendance at a rural community cardiac rehabilitation program in Australia. J Cardiopulm Rehabil Prev 34(1):29–33. doi:10.1097/HCR.0b013e3182a52734
Coa KI, Smith KC, Klassen AC, Caulfield LE, Helzlsouer K, Peairs K, Shockney L (2014) Capitalizing on the "teachable moment" to promote healthy dietary changes among cancer survivors: the perspectives of health care providers. Support Care Cancer 23(3):679–686. doi:10.1007/s00520-014-2412-z
Wadden TA, Butryn ML, Byrne KJ (2004) Efficacy of lifestyle modification for long-term weight control. Obes Res 12(Suppl):S151–S162. doi:10.1038/oby.2004.282
Fallowfield L, Jenkins V (2015) Psychosocial/survivorship issues in breast cancer: are we doing better? J Natl Cancer Inst 107(1):335. doi:10.1093/jnci/dju335
Novick G (2008) Is there a bias against telephone interviews in qualitative research? Res Nurs Health 31(4):391–398. doi:10.1002/nur.20259
Australian Bureau of Statistics (2009) Household income and income distribution, Australia, 2007–08. ABS, Canberra
Acknowledgements
COT is supported by the University of Queensland Research Scholarships. EGE is supported by a National Health and Medical Research Council Senior Research Fellowship (APP1041789). MMR is supported by a National Breast Cancer Foundation Early Career Fellowship (ECF-13-09).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Rights and permissions
About this article
Cite this article
Terranova, C.O., Lawler, S., Spathonis, K. et al. Breast cancer survivors’ experience of making weight, dietary and physical activity changes during participation in a weight loss intervention. Support Care Cancer 25, 1455–1463 (2017). https://doi.org/10.1007/s00520-016-3542-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-016-3542-2