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ESMO Breast Cancer Congress: Making the case for integrated care ahead of innovation

30 Apr 2019

Therapeutic innovations should go hand in hand with a multidisciplinary, fully integrated approach to patient care is the reminder issued by Prof Giuseppe Curigliano ahead of the ESMO Breast Cancer Congress, to take place in Berlin, Germany, 2-4 May.

Breast cancer is a multifaceted disease, the treatment of which can impact women’s lives in many different ways.

Chemotherapy, radiotherapy and targeted therapies are core components of the standard course of treatment for breast cancer. “Among the possible side-effects of these therapies, cardiovascular toxicity is one that needs to be monitored particularly closely,” said Curigliano. “The ESMO Clinical Practice Guidelines on treatment-induced cardiovascular toxicity, which were designed as a roadmap for managing cardiac risk in cancer patients, have made a significant contribution in this field."

Curigliano continued: “A cardiologist is one of several specialists who should have a permanent place on any breast cancer patient’s medical team, and a cardiac assessment should always be performed before the start of treatment to identify pre-existing conditions or risk factors.”

These risk factors are known to include pathologies like diabetes and hypertension, but also lifestyle factors, such as smoking or obesity.

“Being overweight or obese is a risk factor for developing cardiovascular disease – not just for cancer patients, but for the population as a whole. That’s why, when a woman diagnosed with breast cancer is also overweight, it is essential that in addition to consulting with a cardiologist, she also be immediately referred to a qualified dietitian who can help her to lose weight, adopt a healthy lifestyle and improve her overall fitness,” Curigliano emphasised.

Although tools like the ESPEN guidelines on nutrition in cancer patients have helped to standardise practices in this area of patient care, scientific evidence on the efficacy of nutritional intervention among breast cancer patients is still scarce.

A study, the preliminary results of which will be presented at the ESMO Breast Cancer Congress in Berlin, has documented the follow-up of 204 early breast cancer patients who received dietary guidelines from a nutritionist shortly after their initial diagnosis. 

Study author Luisa Carbognin from the University of Verona, Italy, commented: "We designed this prospective clinical trial with two main objectives: to assess early breast cancer patients’ adherence to dietary guidelines, and to evaluate the effectiveness of nutritional intervention for weight loss or weight maintenance while undergoing treatment."

In the studied patient sample, over 60 percent of women were overweight or obese, and presented dietary patterns high in fat and low in dietary fibre.

Moreover, almost half of trial participants had gained 5 percent or more of their usual bodyweight at the time of cancer diagnosis, and a majority reported suffering from nutritional impact symptoms like constipation or indigestion.

Neoadjuvant chemotherapy was prescribed to 56 patients, and 92 women received adjuvant chemotherapy.

Overall, about 80 percent of participants underwent endocrine therapy.

“The dietary intervention that patients received consisted of monthly contacts with the nutritionist. Nutritional assessments were performed at baseline and six months after enrolment – additional follow-ups are still ongoing,” Carbognin reported. “Our interim analyses showed a statistically significant correlation between high adherence to dietary guidelines and weight loss. Weight loss, in turn, appeared to correlate with lower rates of depression, which we assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30).”

According to Carbognin, the small sample size and different treatments administered to participants of the study constitute an obstacle to drawing conclusions from its results.

“As it is still ongoing, however, we hope to increase the sample size and eventually perform sub-group analyses to compare the different treatment settings and explore any potential differences between them,” she explained.

Carbognin further suggested: “These initial results indicate that adhering to dietary guidelines can be an effective tool for controlling bodyweight. For women with a normal baseline bodyweight, the goal is to maintain a healthy weight and fitness throughout their course of treatment – it therefore makes sense to offer them support from a nutritionist regardless of their weight at diagnosis.”

Commenting on the results, Curigliano stated: “The key message here is that a high adherence to dietary guidelines correlates with weight loss. We must warrant though that in the context of this study, the observed weight loss might actually have been conditioned by the toxicity of the chemotherapy that most of these women received.”

“Nutrition is an important aspect of patient care in oncology and further research in this area needs to be encouraged in order to ground clinical practice in scientific fact,” Curigliano concluded.

Source: ESMO