Bridging the Miles between Rural Breast Cancer Survivors to Help Prevent Recurrence

Obesity is becoming a larger factor in the risk for cancer with the National Cancer Institute linking at least eight types of cancer to being overweight or obese. 

One of these cancers is breast cancer, particularly in postmenopausal women. Increased levels of estrogen in obese women have been shown to be a contributor to cancer cases, particularly tumors fueled by estrogen itself. 

Keeping one’s weight under control is not only important in preventing cancer, but also in keeping cancer from coming back. Christie Befort, Ph.D., co-leader of the Cancer Control and Population Health Research Program at The University of Kansas Cancer Center, is taking a look at an especially vulnerable population: breast cancer survivors living in rural America.

“This has been a hot topic over the past decade or so - obesity’s relationship to cancer and how it’s also been linked to cancer recurrence,” said Dr. Befort. “There’s been a lot of research into interventions to prevent both initial cancer as well as recurrences.”

Rural breast cancer survivors are especially in need of tailored weight loss help due to their unique circumstances.  Dr. Befort’s NCI-funded study involves group, phone-based intervention to help these breast cancer survivors lose weight and maintain the loss. 

 “These survivors are more likely to be isolated and have trouble dealing with their cancer,” said Dr. Befort. “They also don’t have as much access to support services as someone in a bigger city does.”

Her randomized controlled trial will look at the effects of a group phone-based treatment, which involves a conference call with other survivors to maintain weight loss. The researchers will compare this to an already-used method of mail-based education. 

Researchers will measure not only the weight loss and how it was maintained, but also the different approaches effects on quality of life, cancer biomarkers, exercise and diet. 

Dr. Befort is especially interested in how the added social interaction and community aspect of the conference call impacts how the women are able to continue with their weight loss and maintenance plan.

“During the call they receive a lot of information about cancer they wouldn’t normally be aware of,” said Dr. Befort. “Some of these women don’t know what stage of cancer they have or the effects of their treatment on their bodies. We have nurses who educate on menopause, nutrition, vitamin intake, and how alcohol affects their bodies. They’re also able to answer any questions the women might have, all within this community environment.”

Women are being recruited from rural areas of Kansas, Nebraska and Iowa. Some patients were recruited through the Midwest Cancer Alliance, the outreach arm of  KU Cancer Center that works heavily with rural populations in Kansas.

The initial weight loss goal for both groups was to lose 10 percent of their body weight. After six months, the conference calls and educational mailings would continue while measuring weight loss maintenance, along with the other quality of life data.

Weight gain is common in the six months immediately after weight loss. Coupling the risk for breast cancer recurrence with the other negative health effects of obesity, such as high blood pressure and diabetes, could cause a number of long-term health issues for these women.

“Keeping up with diet and physical activity plans when you don’t have much support around you can be really demotivating,” said Dr. Befort. “Every person isn’t going to be self-motivated enough to stick with their plan. We think having that support on the phone, along with the education aspect, will help significantly.”

Dr. Befort is also hoping this study will help educate the women about what they can control as far as risk of cancer recurrence goes. She said she doesn’t want the information about obesity and cancer to be seen as a scare tactic, but rather as a way for the women to regain control over their bodies.

“We want them to see the benefits of feeling healthy and in control of at least part of how they’re feeling,” said Dr. Befort. “We want them to feel strong, both physically and mentally. Hopefully, going through this with other women will have lasting, long-term effects.”

Funding sources

Relevant publications

  • Fazzino, T. L., Hunter, R. C., Sporn, N., Christifano, D. N., & Befort, C. A. (2015). Weight fluctuation during adulthood and weight gain since breast cancer diagnosis predict multiple dimensions of body image among rural breast cancer survivors. Psycho‐Oncology.
  • Gibbs, H. D., Ellerbeck, E. F., Befort, C., Gajewski, B., Kennett, A. R., Yu, Q., ... & Sullivan, D. K. (2015). Measuring Nutrition Literacy in Breast Cancer Patients: Development of a Novel Instrument. Journal of Cancer Education, 1-7.
  • Befort, C. A., Bennett, L., Christifano, D., Klemp, J. R., & Krebill, H. (2015). Effective recruitment of rural breast cancer survivors into a lifestyle intervention. Psycho‐Oncology, 24(4), 487-490.
  • Befort, C. A., Klemp, J. R., Fabian, C., Perri, M. G., Sullivan, D. K., Schmitz, K. H., ... & Shireman, T. (2014). Protocol and recruitment results from a randomized controlled trial comparing group phone-based versus newsletter interventions for weight loss maintenance among rural breast cancer survivors. Contemporary clinical trials, 37(2), 261-271.





Long-term Side Effects of Breast Cancer Treatment

The effects of breast cancer treatments, from chemotherapy to radiation, linger long after the treatments are through:

  • Fertility problems
    Chemotherapy can damage the ovaries, causing concern for many younger breast cancer patients. Certain medications can cause natural fertility to decline and can induce early menopause. Speaking with a fertility specialist before starting treatment can help determine options.
  • Cognitive and mental health issues
    Many women experience what is called “chemo-brain,” or a mental fogginess and difficulty remembering things or concentrating. These symptoms can last a year or two after treatment or even longer. Many women also deal with anxiety and depression.
  • Weight gain
    Studies suggest that chemotherapy changes the metabolism, and this - coupled with a likely less active lifestyle - can cause weight gain. Staying a healthy weight during and after treatment is important in managing cancer and potential recurrence.
  • Fear of recurrence
    After treatment, many people are fearful that their cancer will eventually return. There are things that are in the survivor’s power to prevent recurrence (eating healthy, exercising, going to doctor checkups) and those a doctor can monitor.

Source: Susan G. Komen Foundation