Breast Cancer Research and Treatment 57: 285–290, 1999.
© 1999 Kluwer Academic Publishers. Printed in the Netherlands.
Changes in body composition during breast cancer chemotherapy with the
, and J.A. Levi
Center for In Vivo Body Composition,
Department of Clinical Oncology, Royal North Shore Hospital, St
Leonards, Sydney, Australia
Key words: breast cancer, chemotherapy, CMF, weight gain
Weight gain is a reported problem associated with adjuvant chemotherapy for breast cancer and often generates
psychosocial stress in women . It also may affect prognosis and survival. Changes in body composition and
weight during chemotherapy, particularly adjuvant treatment of breast carcinoma, have been previously reported
[1–3]. Multiple reasons for this weight gain have been suggested though few theories have been scientiﬁcally
The aim of this study was to investigate body composition and its relationship to weight change associated
with the CMF-based breast cancer chemotherapy protocols. Total body nitrogen (TBN), body fat, total body water
(TBW), and anthropometric measurements were conducted on 25 female out-patients (median age 47, range 26–
70 years) receiving adjuvant CMF-based chemotherapy for breast cancer. Total body nitrogen was measured using
the In Vivo Neutron Capture Analysis (IVNCA) technique (on day 1 of cycles 2–6) and TBP was calculated by
multiplying TBN by 6.25 . Nitrogen Index (NI) was calculated by expressing TBN as a percentage of normal.
There was a signiﬁcant increase in mean body weight during chemotherapy of 2.35kg (p<0.0001). Serial
measurementsshowed no signiﬁcant change in mean TBN, NI, or percentagebody fat. Break downof body weight
showed a signiﬁcant increase in mean TBW of 0.79kg (p = 0.003) and mean fat mass of 1.49kg (p = 0.008).
We conclude that weight gain observed during adjuvant chemotherapy for breast carcinoma is primarily due to
an increase in fat and TBW.
Adjuvant combination chemotherapy, such as 6
months of CMF (Cyclophosphamide, Methotrexate,
and 5-Fluorouracil), is now routinely recommended
for pre-menopausal women with stage II or poor pro-
gnosis stage I breast cancer, and for many post men-
opausal women with similar disease features who are
hormone receptor negative [6, 7]. Common toxicities
reported include nausea and vomiting, alopecia, mu-
cositis, and diarrhoea, while dose limiting toxicity is
myelosuppression [8–11]. Weight gain also has been
a common side effect in women receiving adjuvant
chemotherapyfor breastcancer. The magnitude of this
weight gain generally appears to be greater in pre-
menopausal women than in post menopausal women,
and greater in women receiving multi-agent rather
than single agent chemotherapy regimes [1, 3, 4, 12].
The addition of prednisone in some protocols appears
to contribute to the weight gain . There is con-
ﬂicting data in the literature on the impact of weight
gain on the survival beneﬁts obtained from chemo-
therapy, though it does affect psychosocialand general
well-being [1, 3, 4, 13].
Suggestedmechanismsfor thisweight gaininclude
reduced physical activity, reduction in metabolic rate,
dietary factors, and hormonal factors such as prema-
ture ovarian failure following chemotherapy, resulting
changes in fat distribution . However, there is very
little research in the contribution of each of these
factors to weight gain. Even less clear is the com-
position of this weight gain, though in one study