Utilization of weight management treatment and subsequent cardiovascular events among patients with breast cancer.

PURPOSE

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.

METHODS

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.

RESULTS

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).

CONCLUSION

In patients with BC, WMT has increased over time, and most markedly weight loss medication use. WMT is associated with lower incidence of CVE.