Wooster Margaux, Chen Ling, Accordino Melissa K, Sathe Claire, Wright Jason D, Hershman Dawn L
Department of Medicine, Division of Hematology and Oncology, Columbia University Irving Medical Center, New York, NY, USA.
Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA.
Breast Cancer Res Treat. 2025 May 13. doi: 10.1007/s10549-025-07714-6.
Overweight and obese breast cancer (BC) survivors face higher risks of recurrence and all-cause mortality, including from cardiovascular disease (CVD). Weight management therapy (WMT) may reduce cardiovascular events (CVE). We assessed trends in WMT in BC survivors and evaluated rates of CVE.
We conducted a retrospective cohort study using the MarketScan Database, including overweight and obese patients (18-95 years) with invasive BC (2009 -2021), who underwent breast surgery. Exclusions were prior bariatric surgery or secondary cancers. Patients were categorized by weight status and by WMT, including nutrition counseling, medications, and bariatric surgery. We utilized descriptive statistics, univariate analysis for factors associated with WMT receipt and rates of CVE, and a multivariable logistic regression model to determine WMT-associated factors.
We identified 35,206 patients: 18.8% overweight, 53.7% obese class I/II/unspecified, and 27.4% obese class III. WMT was utilized by 5.3%, 6.4%, and 9.6%, respectively (p < 0.001). Among 2,484 patients who received WMT, 72.7% had nutrition counseling, 26.7% received weight loss medication, and 4.9% underwent bariatric surgery. From 2009 to 2021, WMT use increased from 3.7% to 11.3% (p < 0.001), and use of weight loss medication increased from 0.3% to 5.1% (p < 0.001). Factors associated with receipt of WMT included younger age, greater degree of obesity, more recent year of surgery, lumpectomy, higher comorbidity score, and prior WMT. CVE incidence was lower in WMT recipients (0.8% vs.1.3%, p = 0.02).
In patients with BC, WMT has increased over time, and most markedly weight loss medication use. WMT is associated with lower incidence of CVE.
超重和肥胖的乳腺癌（BC）幸存者面临更高的复发风险和全因死亡率，包括心血管疾病（CVD）导致的死亡风险。体重管理治疗（WMT）可能会减少心血管事件（CVE）。我们评估了BC幸存者中WMT的趋势，并评估了CVE的发生率。
我们使用MarketScan数据库进行了一项回顾性队列研究，纳入了18至95岁接受乳房手术的超重和肥胖浸润性BC患者（2009年至2021年）。排除标准为既往接受过减肥手术或患有继发性癌症。患者根据体重状况和WMT进行分类，WMT包括营养咨询、药物治疗和减肥手术。我们使用描述性统计、对与接受WMT和CVE发生率相关的因素进行单变量分析，并使用多变量逻辑回归模型来确定与WMT相关的因素。
我们共纳入35206例患者：18.8%超重，53.7%为I/II级肥胖或未明确分级的肥胖，27.4%为III级肥胖。接受WMT的比例分别为5.3%、6.4%和9.6%（p<0.001）。在2484例接受WMT的患者中，72.7%接受了营养咨询，26.7%接受了减肥药物治疗,4.9%接受了减肥手术。从2009年到2021年，WMT的使用从3.7%增加到11.3%（p<0.001）,减肥药物治疗的使用从0.3%增加到5.1%（p<0.001）。与接受WMT相关的因素包括年龄较小、肥胖程度较高、手术年份较近、乳房肿块切除术、合并症评分较高以及既往接受过WMT治疗。接受WMT的患者CVE发生率较低（0.8%对1.3%，p=0.02）。
在BC患者中，WMT的使用随时间增加，减肥药物治疗的使用增加最为明显。WMT与较低的CVE发生率相关
