Body Mass Index and patient-reported measures of function, quality of life and treatment toxicity in women receiving adjuvant chemotherapy for breast cancer

Body Mass Index and patient-reported measures of function, quality of life and treatment toxicity in women receiving adjuvant chemotherapy for breast cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Body Mass Index and patient-reported measures of function, quality of life and treatment toxicity in women receiving adjuvant chemotherapy for breast cancer Kirsten A. Nyrop, Jane Monaco, Sanah Vohra, Allison Deal, William A Wood, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1632995/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: This study investigates whether high body mass index (BMI) in women diagnosed with early breast cancer (BC) is associated with patient-reported symptom severity during chemotherapy. Methods : Women with Stage I-III BC completed toxicity reports for 17 side effects during regularly scheduled chemotherapy infusions. Toxicity reports were compared in women with obesity (BMI >=30) versus no obesity (BMI <30). Fisher’s exact tests and 2-sample t-tests compared baseline patient characteristics. Risk ratios (RR) for women with obesity as compared to no obesity were estimated for individual symptoms that were patient-rated as moderate, severe or very severe (MSVS) severity, adjusting for marital status and race. Results : In a sample of 286 patients, Black women comprised 23% of the sample. The obesity rate was 76% among Black patients and 31% among White patients (p<.0001). Women with obesity rated an average of 6.9 side effects (standard deviation, SD 4.2) as MSVS vs 5.5 side effects (SD 3.7) among women with no obesity (p=.003). In adjusted analysis, women with obesity had significantly greater risk for MSVS fatigue (RR 1.18, 95% CI 1.01-1.36), dyspnea (RR 1.71, 95% CI 1.09-2.69), arthralgia (RR 1.47, 95% CI 1.10-1.97), peripheral neuropathy (RR 1.45, 95% CI 1.01-2.08), edema of limbs (RR 1.84, 95% CI 1.18-2.88), and abdominal pain (RR 1.75, 95% CI 1.07-2.87). There were no inter-group differences in BC stage or phenotype, chemotherapy treatment modifications, or hospitalizations. Conclusions : Among women with early BC, patients with obesity reported higher chemotherapy toxicity as compared to patients without obesity; however, this did not result in differences in treatment completion. obesity breast cancer chemotherapy toxicities Figures Figure 1 Introduction A majority of women with breast cancer (BC) are overweight or have obesity at diagnosis 1 – 4 . Obesity is associated with higher incidence of more severe BC (Stage III/IV BC and grade 3–4 tumors) 5 , 6 and elevated risk for adverse BC outcomes 6 – 8 . These findings are of particular concern in Black women diagnosed with non-metastatic BC, where the rate of obesity can be twice as high (62%) as in White women (32%) 1,9 . High BMI also presents added challenges for chemotherapy dosing and efficacy 10 , 11 . Chemotherapy treatment completion without modification produces highest efficacy 12 with the current gold standard being least 85% completion 13,14 . Toxicity is an important consideration in chemotherapy treatment and is monitored using the National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE) 15 , 16 . Dose reduction or early treatment discontinuation due to symptom severity occurs in about 80% of women receiving chemotherapy for early BC 17 and can impact treatment efficacy 18 , 19 . In some studies, higher BMI has been associated with increased risk for unplanned changes in the treatment plan 20 , 21 . Some studies have reported lower or no risk for treatment toxicity in patients with high BMI or body surface area (BSA) 11 , 22 while other studies have reported higher risk for side effects, such as chemotherapy-induced peripheral neuropathy (CIPN) 23 , 24 . It is clear that the evidence is mixed regarding the impact of obesity on symptom severity and treatment completion. In a sample of women with non-metastatic BC (Stage I-III) seen in current clinical practice, we compared women with obesity (BMI ≥ 30) to no obesity (BMI < 30) with regard to self-reported treatment toxicity, treatment modifications and hospitalizations during chemotherapy administered with curative intent. Our aim was to identify inter-group differences (obesity vs. no obesity) that should be monitored and, if possible, addressed through early intervention. Methods Study Participants This is an ancillary analysis of data from three studies investigating moderate exercise during chemotherapy for early BC -- age 21–64 years (NCT02167932), age 65 or older (NCT02328313), and age 21 or older (NCT03761706). NCT02328313 was a multi-site study that included the University of North Carolina at Chapel Hill (UNC) N.C. Cancer Hospital, UNC Rex Healthcare, Duke University Medical Center, MD Anderson Cancer Center, and Ohio State University Comprehensive Cancer Center. The other two studies were conducted at the N.C. Cancer Hospital only. The studies were approved by the institutional review boards of participating sites and by the University of North Carolina Lineberger Comprehensive Cancer Center Protocol Review Committee. Enrollment into the studies was from February 2014 through February 2020. The protocols were identical between all three studies, as described in previous publications 25 – 28 . Daily clinic schedules were reviewed for potential study patients, and eligible patients were recruited and consented 1–2 weeks prior to the initiation of planned neoadjuvant or adjuvant chemotherapy. Measures Chemotherapy Regimens. Depending on tumor stage 29 and phenotype, chemotherapy regimens were determined by the treating oncologists in consultation with their patients. The most common regimens were (a) doxorubicin/cyclophosphamide before/after paclitaxel (AC-T), (b) docetaxel/cyclophosphamide plus/minus anti-HER-2 therapy (TC), (c) docetaxel/carboplatin plus anti-HER-2 therapy (TCH), and (d) doxorubicin/cyclophosphamide before/after paclitaxel/carboplatin (AC-TC) and comprised 81 percent of all regimens. Growth factors (pegfilgrastim) were used for docetaxel/cyclophosphamide and docetaxel/carboplatin regimens and for doxorubicin/cyclophosphamide when administrated every 2 weeks (dose dense). Assessments and Patient-Reported Outcome (PRO) Measures . Prior to the start of chemotherapy, research staff conducted three assessments: Short Physical Performance Battery (SPPB) 30 , Timed Up and Go (TUG) 31 , 32 , and Blessed Orientation Memory Concentration test (BOMC) 33 , 34 . Questionnaires completed by study patients were the following: Instrumental Activities of Daily Living (IADL) 35 , Mental Health (Mental Health Index/MHI) 36 (subscales Depression and Anxiety), Physical Function 37 , Social Activities 38 , Social Support (subscales Emotional and Tangible) 39 , Quality of Life (Functional Assessment of Cancer-General/FACT-G) 40 , and Fatigue (Functional Assessment of Chronic Illness Therapy/FACIT-Fatigue) 41 . Patient age, race, education, marital status, alcohol consumption, and engagement in rigorous physical activity were also self-reported. Patient-Reported Symptoms . Patients were queried about 17 commonly occurring side effects of (neo)adjuvant chemotherapy: fatigue, insomnia, anxiety, depression, dyspnea, peripheral neuropathy, joint pain/arthralgia, muscle pain/myalgia, abdominal pain, general pain, lymphedema/edema of the extremities, constipation, diarrhea, nausea, vomiting, mucositis, and hot flashes. Research staff collected symptom data prior to chemotherapy initiation (baseline) and then at infusion visits throughout chemotherapy treatment by asking the patients to rate their symptoms using paper or electronic tablet. Symptom reports were collected at every infusion visit for patients receiving chemotherapy every 2 or 3 weeks, and every other week for patients receiving weekly infusions. The reporting format for two studies (NCT02167932 andNCT02328313) was the patient-validated Patient-Reported Symptom Monitoring (PRSM) (Appendix 1) 42 . For the most recent study (NCT03761706), the NCI’s PRO-CTCAE was used, as it became publicly available in April 2016 (Appendix 2) 43 , 44 . The PRSM and PRO-CTCAE formats are similar and entail 7-day recall questions regarding symptom “severity” and symptom “interference with daily activities” using a 5-point Likert-type scale. “Severity” was dichotomized as “none/mild” versus “moderate/severe/very severe”, and “interference” was dichotomized as “not at all/a little bit” versus “somewhat/quite a bit/very much”. Our previously reported studies have similarly combined results collected from both instruments 25 – 28 . Electronic Medical Record (EMR) . Research staff extracted the following EMR data: height and weight for BMI, comorbidities, BC diagnosis and treatment, and adverse events during chemotherapy (dose delay, dose reduction, early treatment discontinuation, hospitalization). Statistical Considerations Descriptive statistics were computed at baseline. Comparisons of patients with and without obesity were conducted using Fisher’s exact tests and chi-square tests for categorical variables and two-sample t-tests for continuous variables. Multivariable analyses, adjusting for race and marital status, were performed with log-binomial models to compare the two BMI groups for the 17 side effect measures as outcomes. Two-sided p-values less than 0.05 were considered statistically significant. Analyses used SAS statistical software (V9.4 SAS Institute Inc, Cary, NC) Results Patient Characteristics In a sample of 286 patients, Black women comprised 23% of the sample (Table 1 ). Forty-one percent of the patients (N = 118) had obesity (BMI 30 or higher). The obesity rate was 31% among White patients and 76% among Black patients (p < .0001). The marriage rates was 62% among patients without obesity and 45% among patients with obesity (p = .008). Table 1 Participant Characteristics at Baseline (pre-chemotherapy initiation) Variable Overall N = 286 BMI = 30 N = 118 (41%) p-value Demographics Age – mean (SD) years 57.6 (13.1) Range 23–83 56.5 (13.4) Range 27–83 59.1 (12.6) Range 23–83 .11 Race White Black/AA 220 (77%) 66 (23%) 152 (90%) 16 (10%) 68 (58%) 50 (42%) < .0001 Education High school or less More than high school 44 (15%) 240 (85%) 20 (12%) 147 (88%) 24 (21%) 93 (79%) .07 Employed more than 32 hours/week No Yes 198 (70%) 85 (30%) 114 (69%) 52 (31%) 84 (72%) 33 (28%) .60 Married No Yes 127 (45%) 156 (55%) 63 (38%) 103 (62%) 64 (55%) 53 (45%) .008 Living alone No Yes 225 (80%) 58 (20%) 137 (83%) 29 (17%) 88 (75%) 29 (25%) .14 Comorbidities Overall BMI = 30 p-value Number of comorbidities -Mean (SD) 1.7 (1.6) Range 0–11 1.3 (1.4) Range 0–9 2.3 (1.7) Range 0–11 < .0001 Comorbidities by category 0 1–2 3–4 5 or more 69 (25% 139 (51%) 53 (19%) 13 (5%) 54 (33%) 86 (53%) 17 (10%) 5 (3%) 15 (13%) 53 (47%) 36 (32%) 8 (7%) < .0001 Hypertension 91 (33%) 32 (20%) 59 (53%) < .0001 Diabetes Mellitus 33 (12%) 7 (4%) 26 (24%) < .0001 Stomach or intestinal disorders 30 (11%) 17 (11%) 13 (12%) .84 Arthritis or rheumatism 97 (36%) 45 (28%) 52 (47%) .002 Heart disease 10 (4%) 4 (3%) 6 (5%) .33 Liver or kidney disease 7 (3%) 1 (1%) 6 (5%) .02 Circulation disorders 21 (8%) 8 (5%) 13 (12%) .06 Glaucoma 12 (4%) 1 (1%) 11 (10%) .0003 Emphysema, chronic bronchitis 9 (3%) 2 (1%) 7 (6%) .03 Osteoporosis 28 (10%) 20 (12%) 8 (7%) .22 Stroke 6 (2%) 1 (1%) 5 (4%) .04 Breast cancer diagnosis and treatment Overall BMI = 30 p-value Breast cancer stage, N (%) I II III 71 (25%) 145 (51%) 69 (24%) 44 (26%) 88 (52%) 36 (21%) 27 (23%) 57 (49%) 33 (28%) .43 HER2, N (%) Negative Positive 213 (75%) 71 (25%) 130 (77%) 38 (23%) 83 (72%) 33 (28%) .27 Hormone receptor (HR), N (%) Negative Positive 59 (38%) 96 (62%) 31 (35%) 57 (65%) 28 (42%) 39 (58%) .41 Triple negative, N (%) No Yes 112 (72%) 43 (28%) 62 (70%) 26 (30%) 50 (75%) 17 (25%) .59 Lymph node surgery Axillary Sentinel 80 (29%) 196 (71%) 41 (25%) 121 (75%) 39 (34%) 75 (66%) .14 Breast surgery None Lumpectomy Mastectomy 8 (3%) 132 (48%) 135 (49%) 3 (2%) 71 (44%) 87 (54%) 5 (4%) 61 (54%) 48 (42%) .09 Radiation No Yes 67 (26%) 187 (74%) 49 (33%) 100 (67%) 18 (17%) 87 (83%) .006 Chemotherapy timing Neoadjuvant Adjuvant Both 107 (38%) 173 (61%) 2 (1%) 63 (38%) 102 (61%) 1 (1%) 44 (38%) 71 (61%) 1 (1%) 1.00 Chemotherapy regimen Not anthracycline-based Anthracycline-based 158 (55%) 127 (45%) 95 (57%) 73 (43%) 63 (54%) 54 (46%) .72 Taxane regimen Docetaxel Paclitaxel/Nab-paclitaxel 128 (48%) 139 (52%) 84 (53%) 75 (47%) 44 (41%) 64 (59%) .06 Chemotherapy regimen – specific AC-T AC-TC TC TCH Other 86 (30%) 21 (7%) 78 (28%) 43 (15%) 55 (19%) 43 (26%) 18 (11%) 56 (33%) 26 (15%) 25 (15%) 43 (37%) 3 (3%) 22 (19%) 17 (15%) 30 (26%) .0008 Legend: AC-T (Doxorubicin/Cyclophosphamide plus Paclitaxel); AC-TC (Doxorubicin/Cyclophosphamide plus Paclitaxel/Carboplatin); TC (Docetaxel/Cyclophosphamide +/- HER-2); TCH (Docetaxel/Carboplatin/anti-HER-2) Mean number of comorbidities was 2.3 (SD 1.7) in women with obesity vs 1.3 (SD 1.4) in patients with no obesity (p < .0001). Patients with obesity had higher rates of the following comorbidities: hypertension 53% vs 20% (p < .0001), diabetes mellitus 24% vs 4% (p < .0001), arthritis or rheumatism 47% vs 28% (p = .002), liver of kidney disease 5% vs 1% (p = .03), glaucoma 10% vs 1% (p = .0003), emphysema or chronic bronchitis 6% vs 1% (p = .04), and stroke 4% vs 1% (p = .04). There were no significant differences in BC stage or phenotype between patients with and without obesity. However, the proportion of patients receiving radiation treatment was lower in women with no obesity (67%) as compared to obesity (83%) (p = .006). And women with no obesity included higher proportions of women receiving chemotherapy regimens AC-TC (11% vs 3%) and TC (33% vs 19%), but lower proportion of “Other” regimens (15% vs 26%) (p = .0008). Pre-Chemotherapy Measures of Function, Quality of Life and Symptoms Assessments Conducted by Research Staff . Mean scores on the Short Physical Performance Battery (SPPB) were worse among women with obesity as compared to no obesity (p = .002) (Table 2 ). A higher proportion of women with obesity scored “lower cognition” (BOMC > = 5) (28%) as compared to women with no obesity (17%) (p = .02). Table 2 Baseline (pre-chemotherapy) Assessments and Patient-Reported Outcome (PRO) Measures and Symptoms Baseline Assessments Overall BMI = 30 N = 118 (41%) p- value Timed Up and Go (TUG) – 14 seconds or more No Yes 237 (88%) 32 (12%) 140 (89%) 18 (11%) 97 (87%) 14 (13%) .85 Short Physical Performance Battery (SPPB) – range 0 = worst to 12 = best performance 10.5 (SD 1.8) Range 3–12 10.8 (SD 1.6) Range 3–12 10.1 (SD 2.1) Range 4–12 .002 Blessed Orientation Memory Concentration Test/BOMC -- lower cognition score > = 5 =5 219 (78%) 60 (22% 136 (83%) 27 (17%) 83 (72%) 33 (28%) .02 Patient-Reported Health Behavior BMI = 30 p- value History of falls in the past 6 months None 1 or more 241 (88%) 32 (12%) 149 (93%) 12 (7%) 92 (82%) 20 (18%) .01 Self-reported history of walking minutes per week – Average (SD) 127.1 (SD 136.7) 149 (SD 136) 95 (SD 131) .001 Vigorous physical activity Never, a few times a week 1–2 times a week 3 or more times a week 128 (48%) 57 (21%) 82 (31%) 57 (36%) 36 (23%) 67 (42%) 71 (66%) 21 (20%) 15 (14%) < .0001 Smoking history Never Past smoker Current smoker 163 (60%) 90 (33%) 19 (7%) 98 (61%) 52 (32%) 11 (7%) 65 (59%) 38 (34%) 8 (7%) .94 Alcohol Use No, almost never Yes 170 (62%) 104 (38%) 92 (57%) 70 (43%) 78 (70%) 34 (30%) .03 Patient-Reported Outcomes (PRO) Scales Overall BMI = 30 p- value Instrumental Activities of Daily Living/IADL – range 0–14 = 12 Not depressed Depressed 195 (74%) 68 (26%) 123 (79%) 33 (21%) 72 (67%) 35 (32%) .04 Mental Health Index/MHI – range 0–20 Anxious score > = 6 Not anxious Anxious 148 (54%) 125 (46%) 88 (54%) 74 (46%) 60 (54%) 51 (46%) 1.00 Physical Function – range 0–20 20 = high function =50 high support =50 high support < 50 low support 216 (94%) 13 (6%) 129 (97%) 4 (3%) 87 (91%) 9 (9%) .05 Functional Assessment of Cancer Therapy/FACT-General (higher score = higher wellbeing) Physical well-being (range 0–28) Social/family wellbeing (range 0–28) Emotional wellbeing (range 0–24) Functional wellbeing (range 0–28) 24.8 (SD 3.9) Range 8–28 24.7 (SD 4.6) Range 4–28 19.1 (SD 3.8) Range 1–24 20.9 (SD 5.7) Range 0–28 25.4 (SD 3.5) Range 11–28 25.3 (SD 3.8) Range 6–28 19.3 (SD 3.6) Range 4–24 21.5 (SD 5.1) Range 6–28 23.9 (SD 4.2) Range 8–28 23.7 (SD 5.4) Range 4–28 18.9 (SD 4.1) Range 1.2–24 19.9 (SD 6.3) Range 0–28 .001 .003 .46 .02 Functional Assessment of Chronic Illness Therapy/FACIT-Fatigue (reverse scored so that higher score = less fatigue) (range 0-160) 43.1 (SD 8.8) Range 5–52 44.2 (SD 7.8) Range 19–52 41.3 (SD 9.8) Range 5–52 .006 Carolina Frailty Index Frail Pre-frail Robust 8 (3%) 62 (22%) 210 (75%) 2 (1%) 23 (14%) 140 (85%) 6 (5%) 39 (34%) 70 (61%) < .0001 Symptoms rated moderate, severe or very severe (MSVS) prior to chemotherapy initiation Overall BMI = 30 p- value Fatigue 45 (19%) 18 (13%) 27 (27%) .007 Anxiety 67 (26%) 38 (25%) 29 (26%) 1.00 Depression 41 (16%) 22 (15%) 19 (17%) .61 Insomnia 81 (31%) 43 (29%) 38 (34%) .42 Hot flashes 25 (10%) 13 (9%) 12 (11%) .67 Dyspnea 8 (3%) 0 (0%) 8 (7%) .001 Aching joints/arthralgia 32 (12%) 12 (8%) 20 (18%) .02 Aching muscles/myalgia 21 (8%) 10 (7%) 11 (10%) .36 Peripheral neuropathy 9 (3%) 2 (1%) 7 (6%) .04 Edema limbs 8 (3%) 2 (1%) 6 (5%) .07 Abdominal pain 5 (2%) 4 (3%) 1 (1%) .40 General pain 40 (15%) 21 (14%) 19 (18%) .49 Constipation 31 (12%) 20 (13%) 11 (9%) .56 Diarrhea 27 (10%) 14 (9%) 13 (12%) .55 Nausea 5 (2%) 3 (2%) 2 (2%) 1.00 Vomiting 1 (.5%) 1 (1%) 0 (0%) 1.00 Mucositis oral 2 (1%) 2 (1%) 0 (0%) 0.51 Legend: Short Physical Performance Battery/SPPB, Blessed Orientation Memory Concentration Test/BOMC, Mental Health Index/MHI, Instrumental Activities of Daily Living/IADL, Functional Assessment of Cancer Therapy/FACT, Functional Assessment of Chronic Illness Therapy/FACIT Patient-Reported Health Behavior . A higher proportion of patients with obesity as compared to no obesity reported one or more falls in the past 6 months (18% vs 7%), p = .01), fewer walking minutes per week (average 95 vs 149 minutes, p = .001), and never or only a few times a week engaging in physical activity (66% vs 36%, p < .0001) (Table 2 ). A higher proportion of women with no obesity reported alcohol use (43%) as compared to women with obesity (30%) (p = .03). Patient-Reported Outcome (PRO) Measures. Limitations in Instrumental Activities of Daily Living (IADL) were more prevalent among women with obesity than without obesity (23% vs 10%, p = .006) (Table 2 ). A higher proportion of patients with Mental Health Index (MHI) scores indicating depression was observed in patients no obesity as compared to no obesity (32% vs 21%) (p = .04). Patients with obesity more frequently reported lower tangible social support as compared to patients with no obesity (9% vs 3%, p = .05). Patients with obesity scored lower quality of life for physical well-being (p = .001), social/family wellbeing (p = .003), and functional well-being (p = .02), as well as higher fatigue (p = .006). On the Carolina Frailty Index, a higher proportion of women with no obesity as compared to patients with obesity were rated “robust” (85% vs 61%) (p < .0001). Symptoms. Prior to the start of chemotherapy (Table 2 ), a higher proportion of women with obesity as compared to no obesity reported moderate, severe or very severe (MSVS) fatigue (27% vs 13%, p = .007), dyspnea (7% vs 0%), p = .001), arthralgia (18% vs 8%, p = .02), and peripheral neuropathy (6% vs 1%, p = .04). Symptom Reports During Chemotherapy Symptom Severity . At any time during chemotherapy treatment, patients with obesity rated 6.9 (SD 4.2, range 0–17) symptoms as moderate, severe or very severe (MSVS) severity as compared to 5.5 (SD 3.7, range 0–16) among patients with no obesity (p = .003). Higher proportions of women with obesity rated individual symptom severity as MSVS (Fig. 1 ): fatigue 79% vs 66% p = .03), arthralgia 50% vs 34% (p = .01), peripheral neuropathy 43% vs 27% (p = .005), edema of limbs 36% vs 17% (p = .0003), dyspnea 29% vs 18% (p = .04), and abdominal pain 26% vs 15% (p = .02). In Table 3 , we report Relative Risk (RR) for MSVS patient-reported symptom severity, with multivariable (MV) analyses adjusted for race and marital status. Women with obesity as compared to no obesity were more likely to report MSVS fatigue (RR 1.18, 95% CI 1.02,1.36), dyspnea (RR 1.71, 95% CI 1.09,2.69), arthralgia (RR 1.47, 95% CI 1.10,1.97), peripheral neuropathy (RR 1.45, 95% CI 1.01,2.08), edema of limbs (RR 1.84 (95% CI 1.18.2.88), and abdominal pain (RR 1.75, 95% CI 1.07,2.87). Table 3 Patient-reported symptoms during chemotherapy, Relative Risk (RR) unadjusted and adjusted for marital status and race (shown for associations significant at alpha = .05 level) Symptom Severity (% MSVS) Overall BMI = 30 N = 118 (41%) Unadjusted RR (95% Confidence Interval Adjusted RR 95% Confidence Interval Fatigue 203 (72%) 111 (67%) 92 (79%) 1.18 (1.02,1.36) 1.18 (1.01,1.36) Anxiety 128 (45%) 71 (43%) 57 (48%) Depression 85 (30%) 48 (29%) 37 (31%) Insomnia 171 (60%) 94 (56%) 77 (65%) Hot flashes 94 (33%) 54 (32%) 40 (34%) Dyspnea 64 (22%) 30 (18%) 34 (29%) 1.60 (1.04,2.47) 1.71 (1.09,2.69) Aching joints/arthralgia 116 (41%) 57 (34%) 59 (50%) 1.46 (1.11, 1.93) 1.47 (1.10, 1.97) Aching muscles/myalgia 112 (39%) 58 (35%) 54 (46%) Peripheral neuropathy 96 (34%) 45 (27%) 51 (43%) 1.60 (1.16, 2.22) 1.45 (1.01, 2.08) Edema limbs 71 (25%) 28 (17%) 43 (36%) 2.17 (1.44, 3.29) 1.84 (1.18, 2.88) Abdominal pain 56 (20%) 25 (15%) 31 (26%) 1.75 (1.10, 2.81) 1.75 (1.07, 2.87) General pain 114 (40%) 63 (38%) 51 (43%) Constipation 107 (38%) 66 (40%) 41 (35%) Diarrhea 128 (45%) 68 (41%) 60 (51%) Nausea 102 (36%) 54 (32%) 48 (41%) Vomiting 26 (9%) 14 (8%) 12 (10%) Mucositis oral 66 (23%) 36 (22%) 30 (25%) Symptom Interference with Daily Activities Overall BMI 30 Unadjusted RR (95% Confidence Interval Adjusted RR 95% Confidence Interval Fatigue 186 (65%) 98 (59%) 88 (75%) 1.27 (1.08, 1.50) 1.27 (1.07, 1.51) Anxiety 70 (25%) 40 (24%) 30 (25%) Depression 50 (18%) 23 (14%) 27 (23%) Insomnia 116 (41%) 62 (37%) 54 (46%) Hot flashes 58 (20%) 34 (20%) 24 (21%) Dyspnea 60 (21%) 27 (16%) 33 (28%) 1.74 (1.11, 2.74) 1.65 (1.01, 2.68) Aching joints/arthralgia 90 (32%) 40 (24%) 50 (43%) 1.78 (1.27, 2.51) 1.74 (1.22, 2.49) Aching muscles/myalgia 78 (27%) 36 (22%) 42 (36%) 1.67 (1.14, 2.43) 1.54 (1.03, 2.30) Peripheral neuropathy 58 (20%) 24 (14%) 34 (29%) 2.02 (1.27, 3.22) 1.53 (0.93, 2.51) Edema limbs 48 (17%) 18 (11%) 30 (26%) 2.38 (1.39, 4.06) 1.92 (1.08, 3.41) Abdominal pain 43 (15%) 16 (10%) 27 (23%) 2.41 (1.36, 4.27) 2.34 (1.27, 4.29) General pain 90 (32%) 44 (26%) 46 (39%) 1.48 (1.05, 2.08) 1.50 (1.05, 2.15) Constipation 58 (20%) 32 (19%) 26 (22%) Diarrhea 92 (32%) 42 (25%) 50 (42%) 1.68 (1.20, 2.36) 1.55 (1.08, 2.23) Nausea 94 (33%) 51 (31%) 43 (37%) Vomiting 31 (11%) 15 (9%) 16 (14%) Mucositis oral 36 (13%) 17 (10%) 19 (16%) Legend: RR values provided only for statistically significant associations. MSVS = moderate, severe or very severe rating at any time during chemotherapy. Interference is defined as patients with self reported ‘somewhat/quite a bit/very much’ interference. Symptom Interference with Daily Activity. Patients with obesity rated an average of 5.4 (SD 4.2, range 0–17) symptoms as “somewhat/quite a bit/very much” interfering with daily living as compared to an average of 3.7 (SD 3.3, range 0–16) symptoms interfering with this intensity among patients without obesity (p = .0002). In both BMI categories, symptom interference with daily living was rated lower than the symptom’s severity. Higher proportions of women with obesity as compared to no obesity reported greater symptom interference (Fig. 1 ): fatigue 75% vs 59% (p = .006), diarrhea 42% vs 25% (p = .003), myalgia 36% vs 22% (p = .01), arthralgia 43% vs 24% (p = .001), general pain 39% vs 26% (p = .002), peripheral neuropathy 29% vs 14% (p = .004), edema of the limbs 26% vs 11% (p = .001), dyspnea 28% vs 16% (p = .02), and abdominal pain 23% vs 10% (p = .002). In MV analyses adjusted for race and marital status (Table 3 ), patients with obesity were more likely to report greater interference for fatigue (RR 1.27, 95% CI 1.07,1.51), dyspnea (RR 1.65, 95% CI 1.01,2.68), arthralgia (RR 1.74 95% CI 1.22, 2.49), myalgia (RR 1.54, 95% CI 1.03, 2.30), edema of limbs (RR 1.92, 95% CI 1.08,3.41), abdominal pan (RR 2.34, 95% CI 1.27,4.29), general pain (RR 1.50 (95% CI 1.05,2.15), and diarrhea (RR 1.55, 95% CI 1.08,2.23). During Chemotherapy Adverse Events and Patient-Reported Symptoms Overall, 18% of patients were hospitalized, 33% had at least one chemotherapy dose reduction, 23% had an infusion delay, and 17% had their chemotherapy treatment terminated early. For all of these measures, there were no significant differences between patients with obesity and no obesity (Table 4 ). Table 4 Adverse Events during Chemotherapy Variable Overall BMI = 30 p-value Hospitalized No Yes 205 (82%) 45 (18%) 125 (86%) 21 (14%) 80 (77%) 24 (23%) .10 Dose reduction No Yes 168 (67%) 83 (33%) 100 (69%) 45 (31%) 68 (64%) 38 (36%) .50 Dose delay No Yes 194 (77%) 57 (23%) 113 (77%) 34 (23%) 81 (78%) 23 (22%) .88 Early treatment discontinuation No Yes 209 (83%) 42 (17%) 126 (86%) 20 (14%) 83 (79%) 22 (21%) .17 Discussion In this study, we examined whether women with early breast cancer and obesity have a different toxicity profile as compared to women without obesity when they receive chemotherapy with curative intent, and whether symptom experience impacts treatment completion. This is an important question because high BMI is common at BC diagnosis 4 and women often experience weight gain after diagnosis 1 , 2 which, in turn, can impact BC incidence, severity and outcomes 45 – 50 . The obesity-breast cancer link is of particular concern in states experiencing ever-rising obesity rates and within minoritized populations that have been especially burdened by the obesity epidemic 4 , 51 . In our sample of 286 patients, 41% had obesity at BC diagnosis, with more than twice the rate of obesity observed among Black patients as compared to White. Unmarried patients also had significantly higher rates of obesity compared to married patients. Patients with obesity had higher mean number of comorbidities, most of them obesity related. There were no significant differences between patients with and without obesity with regard to BC stage or phenotype, although there were significant differences in specific chemotherapy regimens. Prior to chemotherapy initiation, patients with obesity performed worse on the Short Physical Performance Battery and a higher proportion scored “lower cognition”. Patients with obesity reported more falls and being less physically active, but they also reported less alcohol consumption compared to patients with no obesity. Higher proportions of patients with obesity reported limitations in instrumental activities of daily living, more depression, lower tangible social support, and lower physical, social/family, and functional well-being. A higher proportion of women with no obesity as compared to patients with obesity were rated “robust” on the Carolina Frailty Index. Prior to start of chemotherapy, higher proportions of patients with obesity reported moderate, severe or very severe (MSVS) fatigue, dyspnea, arthralgia, and peripheral neuropathy. The findings would suggest a potential for patients with obesity to have greater difficulties with treatment toxicities as compared to patients without obesity. In multivariable (MV) analyses of symptom severity during chemotherapy treatment adjusted for race and marital status, patients with obesity in fact had significantly higher risk for MSVS fatigue, dyspnea, arthralgia, peripheral neuropathy, edema of arms and legs, and abdominal pain. Similarly, in MV analyses of symptom interference with daily activities adjusted for race and marital status, patients with obesity were more likely to report greater interference for symptoms related to dyspnea, arthralgia, myalgia, edema of the limbs, abdominal pain, general pain, diarrhea, and peripheral neuropathy. As an exploratory finding, we also report that unmarried patients were more likely to report MSVS symptom severity for dyspnea, peripheral neuropathy, and edema of the limbs, as well as greater interference with daily living with regard to arthralgia, myalgia, peripheral neuropathy, and general pain. Yet, despite higher risk for symptom severity and symptom interference with activities of daily living among patients with obesity, there were no significant inter-group differences in hospitalizations during chemotherapy or chemotherapy dose reductions, dose delays or early treatment discontinuation. This finding is corroborated by other studies showing no significant association between BMI and receipt of adjuvant chemotherapy 3 . This is a key finding, but does not detract from the overall caution that women with obesity reported greater sensitivity to chemotherapy side-effects. Our study has some limitations. Our sample was limited to patients who agreed to participate in a moderate exercise program during chemotherapy. As such, both the patients and their treating clinicians deemed the patients able to participate in a self-directed walking intervention. Our sample also includes a high proportion of women with more than a college education. These “fitness” and education characteristics limit the generalizability of our sample to the larger population of women with early breast cancer scheduled to receive chemotherapy. However, this does not limit the overall purpose of our analysis, which is a comparison of similarly “fit” patients with and without obesity. Our study contributes to the on-going exploration of the potential impact of obesity on cancer treatment. Because of the tradition of basing chemotherapy dosing on Body Surface Area 52 (BSA) and concerns that under-dosing may undermine the effectiveness of cytotoxic agents 53 – 55 , best practice is for patients with obesity to receive higher doses of chemotherapy as compared to patients with no obesity 10 , 56 , 57 . One would expect higher doses in women with obesity to be associated with greater symptom severity leading, in turn, to reduced treatment completion, but this was not found in our study. In our sample, there were no significant inter-group differences in breast cancer stage and phenotype. The proportion of patients receiving anthracycline-based regimens was somewhat higher in women with obesity (59%) compared to women without obesity (47%); however, the difference failed to reach statistical significance (p = 0.06). This may contribute to the higher rates of MSVS peripheral neuropathy reported among patients with obesity, along with their higher rate of peripheral neuropathy symptoms prior to chemotherapy initiation. Nevertheless, we found no significant differences in treatment completion between patients with or without obesity, nor in dose delays, dose reductions or hospitalizations during chemotherapy. Our overall observation that women with obesity had greater fatigue, dyspnea, arthralgia, peripheral neuropathy, edema of the limbs, and abdominal pain most likely reflects the higher doses of chemotherapy they are receiving. Greater symptom severity among patients with obesity during treatment may also be a function of their greater symptom reports prior to chemotherapy initiation. Our findings point to the need for extra vigilance in monitoring chemotherapy toxicities in women with obesity treated with weight-appropriate doses, with the aim of offering interventions that may help them maintain quality of life as they continue receiving treatment at full dosage. Declarations Competing Interest: The authors have not competing interests to report. Author contributions : All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Kirsten A. Nyrop, Jane Monaco, and Sanah Vohra. The first draft of the manuscript was written by Kirsten A. Nyrop and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Data Availability : The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Ethics Approval : This is an observational study and was approved by the University of North Carolina Institutional Review Board and the IRBs of participating study sites. Consent to Participate : Informed consent was obtained from all individual participants included in the study. Funding Support : Breast Cancer Research Foundation of New York (New York; Muss PI, BCRF-21-114); Kay Yow Foundation (Raleigh NC; Muss PI). References Nyrop KA, Deal AM, Shachar SS et al (2020) Weight trajectories in women receiving systemic adjuvant therapy for breast cancer. Breast Cancer Res Treat 179(3):709–720 Demark-Wahnefried W, Peterson B, McBride C, Lipkus I, Clipp E (2000) Current health behaviors and readiness to pursue life-style changes among men and women diagnosed with early stage prostate and breast carcinomas. Cancer 88(3):674–684 Brewster AM, Etzel C, Zhou R et al (2011) The impact of obesity on receipt of adjuvant chemotherapy for breast cancer in the National Comprehensive Cancer Network (NCCN) centers. Breast Cancer Res Treat Dec 130(3):897–904. doi: 10.1007/s10549-011-1516-0 Nyrop KA, Deal A, Carey L et al (2021) Obesity, comorbidities and treatment selection in black and white women with early breast cancer. Cancer 127(6):922–930 Blair CK, Wiggins CL (2019) Obesity and survival among a cohort of breast cancer patients is partially mediated by tumor characteristics. 5:33. 10.1038/s41523-019-0128-4 Kamineni A, Anderson ML, White E et al (2013) Body mass index, tumor characteristics, and prognosis following diagnosis of early-stage breast cancer in a mammographically screened population. Cancer Causes Control 24(2):305–312 Niraula S, Ocana A, Ennis M, Goodwin PJ (2012) Body size and breast cancer prognosis in relation to hormone receptor and menopausal status: a meta-analysis. 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J Natl Compr Canc Netw Jan 7(1):99–108 Yuan JQ, Wang SM, Tang LL et al (2015) Relative dose intensity and therapy efficacy in different breast cancer molecular subtypes: a retrospective study of early stage breast cancer patients treated with neoadjuvant chemotherapy. Breast Cancer Res Treat Jun 151(2):405–413. doi: 10.1007/s10549-015-3418-z Lyman GH, Dale DC, Crawford J (2003) Incidence and predictors of low dose-intensity in adjuvant breast cancer chemotherapy: a nationwide study of community practices. J Clin Oncol Dec 15(24):4524–4531. doi: 10.1200/jco.2003.05.002 Denduluri N, Chavez-MacGregor M, Telli ML et al (2018) Selection of Optimal Adjuvant Chemotherapy and Targeted Therapy for Early Breast Cancer: ASCO Clinical Practice Guideline Focused Update. J Clin Oncol May 22:Jco2018788604. doi: 10.1200/jco.2018.78.8604 Morrison VA, McCall L, Muss HB et al (2018) The impact of actual body weight-based chemotherapy dosing and body size on adverse events and outcome in older patients with breast cancer: Results from Cancer and Leukemia Group B (CALGB) trial 49907 (Alliance A151436). J geriatric Oncol May 9(3):228–234. doi: 10.1016/j.jgo.2017.11.007 Robertson J, Raizer J, Hodges JS, Gradishar W, Allen JA (2018) Risk factors for the development of paclitaxel-induced neuropathy in breast cancer patients. Jun 23(2):129–133. doi: 10.1111/jns.12271 Timmins HC, Li T, Goldstein D et al (2021) The impact of obesity on neuropathy outcomes for paclitaxel- and oxaliplatin-treated cancer survivors. J Cancer Surviv Feb 27. doi: 10.1007/s11764-021-01012-y Nyrop KA, Deal AM, Shachar SS et al (2019) Patient-Reported Toxicities During Chemotherapy Regimens in Current Clinical Practice for Early Breast Cancer. Oncologist Jun 24(6):762–771. doi: 10.1634/theoncologist.2018-0590 Nyrop KA, Deal AM, Reeder-Hayes KE et al (2019) Patient and clinician-reported chemotherapy-induced peripheral neuropathy (CIPN) in early breast cancer: current clinical practice. Cancer 127(7):2945–2954 Nyrop KA, Deal AM, Chen YT, Reeve BB (2021) Patient-reported symptom severity, interference with daily activities, and adverse events in older and younger women receiving chemotherapy for early breast cancer. Mar 15(6):957–967. doi: 10.1002/cncr.33329 Nyrop KA, Damone EM, Deal AM et al (2021) Patient-reported treatment toxicity and adverse events in Black and White women receiving chemotherapy for early breast cancer. Breast Cancer Res Treat Nov 5. doi: 10.1007/s10549-021-06439-6 Gradishar WJ, Anderson BO, Balassanian R et al (2018) Breast Cancer, Version 4.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw Mar 16(3):310–320. doi: 10.6004/jnccn.2018.0012 Guralnik L, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF (1994) e. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol Med Sci 49(2):M85–M94 Shumway-Cook A, Brauer S, Woollacott M(2000) 2000;80:896–903 Predicting the probability of falls in community-dwelling older adults using the Timed Up and Go Test. Physical Therapy . Not in File Podsiadlo D, Richardson S(1991) 1991;39:142–148 The timed "Up & Go": a test of functional mobility for frail elderly persons. J Am Geriatr Soc . Not in File Kawas C, Karagiozis H, Resau L, Corrada M, Brookmeyer R (1995) Reliability of the Blessed Telephone Information-Memory-Concentration Test. 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Duke University Press, pp 173–181 Sherbourne CD, Stewart AL(1991) 1991;32(6):705 – 14 The MOS Social Support Survey. Soc Sci & Med . Not in File Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E (1993) al. e. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol 11(3):570–579 Webster K, Cella D, Yost K (2003) The Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System: properties, applications, and interpretation. Health Qual Life Outcomes Dec 16:1:79. doi: 10.1186/1477-7525-1-79 Stover A, Irwin DE, Chen RC et al (2015) Integrating Patient-Reported Outcome Measures into Routine Cancer Care: Cancer Patients' and Clinicians' Perceptions of Acceptability and Value. EGEMS (Washington DC) 3(1):1169. doi: 10.13063/2327-9214.1169 Basch E, Reeve BB, Mitchell SA et al (2014) Development of the National Cancer Institute's patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE). J Natl Cancer Inst Sep 106(9). doi: 10.1093/jnci/dju244 Hay JL, Atkinson TM, Reeve BB et al (2014) Cognitive interviewing of the US National Cancer Institute's Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). Qual Life Res Feb 23(1):257–269. doi: 10.1007/s11136-013-0470-1 Cheraghi Z, Poorolajal J, Hashem T, Esmailnasab N, Doosti Irani A (2012) Effect of body mass index on breast cancer during premenopausal and postmenopausal periods: a meta-analysis. PLoS ONE 7(12):e51446. doi: 10.1371/journal.pone.0051446 Neuhouser ML, Aragaki AK, Prentice RL et al (2015) Overweight, Obesity, and Postmenopausal Invasive Breast Cancer Risk: A Secondary Analysis of the Women's Health Initiative Randomized Clinical Trials. JAMA Oncol Aug 1(5):611–621. doi: 10.1001/jamaoncol.2015.1546 Key TJ, Appleby PN, Reeves GK, Roddam A, Dorgan JF et al(2003) Body mass index, serum sex hormones, and breast cancer risk in postmenopausal women. N Natl Cancer Inst . ;95(16):1218–1226 Pierobon M, Frankenfeld CL (2013) Obesity as a risk factor for triple-negative breast cancers: a systematic review and meta-analysis. Breast Cancer Res Treat Jan 137(1):307–314. doi: 10.1007/s10549-012-2339-3 Bissell MCS, Kerlikowske K, Sprague BL (Oct 2020) Breast Cancer Population Attributable Risk Proportions Associated with Body Mass Index and Breast Density by Race/Ethnicity and Menopausal Status. 29:2048–2056. 10.1158/1055-9965.epi-20-0358 . 10 Shieh Y, Scott CG, Jensen MR et al (2019) Body mass index, mammographic density, and breast cancer risk by estrogen receptor subtype. Breast Cancer Res Apr 3(1):48. doi: 10.1186/s13058-019-1129-9 Ward ZJ, Bleich SN, Cradock AL et al (2019) Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity. New Engl J Med Dec 19(25):2440–2450. doi: 10.1056/NEJMsa1909301 Freireich EJ, Gehan EA, Rall DP, Schmidt LH, Skipper HE (1966) Quantitative comparison of toxicity of anticancer agents in mouse, rat, hamster, dog, monkey, and man. Cancer Chemother Rep May 50(4):219–244 Frei E 3, Canellos GP (1980) Dose: a critical factor in cancer chemotherapy. Am J Med Oct 69(4):585–594. doi: 10.1016/0002-9343(80)90472-6 Budman DR, Berry DA, Cirrincione CT et al (1998) Dose and dose intensity as determinants of outcome in the adjuvant treatment of breast cancer. The Cancer and Leukemia Group B. J Natl Cancer Inst Aug 19(16):1205–1211. doi: 10.1093/jnci/90.16.1205 Hunter RJ, Navo MA, Thaker PH, Bodurka DC, Wolf JK, Smith JA (2009) Dosing chemotherapy in obese patients: actual versus assigned body surface area (BSA). Cancer Treat reviews Feb 35(1):69–78. doi: 10.1016/j.ctrv.2008.07.005 Lyman GH (2011) Commentary: chemotherapy dosing in obese patients with cancer-the need for evidence-based clinical practice guidelines. J Oncol Pract / Am Soc Clin Oncol Jan 7(1):17–18. doi: 10.1200/jop.2010.000200 Greenman CG, Jagielski CH, Griggs JJ (2008) Breast cancer adjuvant chemotherapy dosing in obese patients: dissemination of information from clinical trials to clinical practice. Cancer May 15(10):2159–2165. doi: 10.1002/cncr.23416 Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1632995","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":108970726,"identity":"0a42b6c6-2fe9-4106-8f2d-06f24ad21995","order_by":0,"name":"Kirsten A. Nyrop","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyElEQVRIiWNgGAWjYBACCQhlA8QJUKEDxGlJI13LYRK0SM7uMfvwccf5aH72BDbpghoGOb4bCfi1SMucMZ4588zt3Jk9D9ikZxxjMJYkpEVOIseYmbftdu6GG0BbeBsYEjcQqeVc7n6olnqCWqQhWg7kbpCAaEkwIKRFckZaMePMM8m5M848bLbmOSZhOPPMA/xaJG4kb2b4uMMut789+eBtnhobeb7jBGxhYOAwYGBsADHApAQh5SDA/gCqZRSMglEwCkYBDgAAlJZCjVpwvUMAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-2974-480X","institution":"University of North Carolina at Chapel Hill","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Kirsten","middleName":"A.","lastName":"Nyrop","suffix":""},{"id":108970727,"identity":"8e0896c9-570a-4978-ae98-ec2af3b3ec39","order_by":1,"name":"Jane Monaco","email":"","orcid":"","institution":"University of North Carolina at Chapel 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Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Gretchen","middleName":"G","lastName":"Kimmick","suffix":""},{"id":108970734,"identity":"dcebc16b-20e8-417a-b853-88e428e0a130","order_by":8,"name":"JoEllen C Speca","email":"","orcid":"","institution":"University of North Carolina at Chapel Hill","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"JoEllen","middleName":"C","lastName":"Speca","suffix":""},{"id":108970735,"identity":"e5525a16-1932-4c45-b157-0bdb1e4c07aa","order_by":9,"name":"Hyman B Muss","email":"","orcid":"","institution":"University of North Carolina at Chapel Hill","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hyman","middleName":"B","lastName":"Muss","suffix":""}],"badges":[],"createdAt":"2022-05-07 12:16:58","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1632995/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1632995/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":21980951,"identity":"57d9d7d9-f1fa-4489-9270-1cd76422f4b6","added_by":"auto","created_at":"2022-05-27 20:22:13","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":56651,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePercent of patients with moderate, severe or very severe (MSVS) symptom severity (grey) or symptom interference with daily living (white) comparing patients with BMI ≥30 (striped) and BMI \u0026lt;30 (solid).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-1632995/v1/1bd9bc8d352f1334e654bdf5.png"},{"id":23446884,"identity":"ae85256f-2827-4eb5-a0a7-71a59844ca44","added_by":"auto","created_at":"2022-07-05 13:12:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":806192,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1632995/v1/b6ecc8f3-6269-4c5a-9167-77027913ac42.pdf"}],"financialInterests":"","formattedTitle":"Body Mass Index and patient-reported measures of function, quality of life and treatment toxicity in women receiving adjuvant chemotherapy for breast cancer","fulltext":[{"header":"Introduction","content":"\u003cp\u003eA majority of women with breast cancer (BC) are overweight or have obesity at diagnosis\u003csup\u003e\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Obesity is associated with higher incidence of more severe BC (Stage III/IV BC and grade 3\u0026ndash;4 tumors)\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e and elevated risk for adverse BC outcomes\u003csup\u003e\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. These findings are of particular concern in Black women diagnosed with non-metastatic BC, where the rate of obesity can be twice as high (62%) as in White women (32%)\u003csup\u003e1,9\u003c/sup\u003e. High BMI also presents added challenges for chemotherapy dosing and efficacy\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Chemotherapy treatment completion without modification produces highest efficacy\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e with the current gold standard being least 85% completion\u003csup\u003e13,14\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eToxicity is an important consideration in chemotherapy treatment and is monitored using the National Cancer Institute\u0026rsquo;s Common Terminology Criteria for Adverse Events (CTCAE)\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Dose reduction or early treatment discontinuation due to symptom severity occurs in about 80% of women receiving chemotherapy for early BC\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e and can impact treatment efficacy\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. In some studies, higher BMI has been associated with increased risk for unplanned changes in the treatment plan\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Some studies have reported lower or no risk for treatment toxicity in patients with high BMI or body surface area (BSA)\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e while other studies have reported higher risk for side effects, such as chemotherapy-induced peripheral neuropathy (CIPN)\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. It is clear that the evidence is mixed regarding the impact of obesity on symptom severity and treatment completion.\u003c/p\u003e \u003cp\u003eIn a sample of women with non-metastatic BC (Stage I-III) seen in current clinical practice, we compared women with obesity (BMI\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;30) to no obesity (BMI\u0026thinsp;\u0026lt;\u0026thinsp;30) with regard to self-reported treatment toxicity, treatment modifications and hospitalizations during chemotherapy administered with curative intent. Our aim was to identify inter-group differences (obesity vs. no obesity) that should be monitored and, if possible, addressed through early intervention.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Participants\u003c/h2\u003e \u003cp\u003eThis is an ancillary analysis of data from three studies investigating moderate exercise during chemotherapy for early BC -- age 21\u0026ndash;64 years (NCT02167932), age 65 or older (NCT02328313), and age 21 or older (NCT03761706). NCT02328313 was a multi-site study that included the University of North Carolina at Chapel Hill (UNC) N.C. Cancer Hospital, UNC Rex Healthcare, Duke University Medical Center, MD Anderson Cancer Center, and Ohio State University Comprehensive Cancer Center. The other two studies were conducted at the N.C. Cancer Hospital only. The studies were approved by the institutional review boards of participating sites and by the University of North Carolina Lineberger Comprehensive Cancer Center Protocol Review Committee.\u003c/p\u003e \u003cp\u003eEnrollment into the studies was from February 2014 through February 2020. The protocols were identical between all three studies, as described in previous publications\u003csup\u003e\u003cspan additionalcitationids=\"CR26 CR27\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Daily clinic schedules were reviewed for potential study patients, and eligible patients were recruited and consented 1\u0026ndash;2 weeks prior to the initiation of planned neoadjuvant or adjuvant chemotherapy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cp\u003e \u003cem\u003eChemotherapy Regimens.\u003c/em\u003e Depending on tumor stage\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e and phenotype, chemotherapy regimens were determined by the treating oncologists in consultation with their patients. The most common regimens were (a) doxorubicin/cyclophosphamide before/after paclitaxel (AC-T), (b) docetaxel/cyclophosphamide plus/minus anti-HER-2 therapy (TC), (c) docetaxel/carboplatin plus anti-HER-2 therapy (TCH), and (d) doxorubicin/cyclophosphamide before/after paclitaxel/carboplatin (AC-TC) and comprised 81 percent of all regimens. Growth factors (pegfilgrastim) were used for docetaxel/cyclophosphamide and docetaxel/carboplatin regimens and for doxorubicin/cyclophosphamide when administrated every 2 weeks (dose dense).\u003c/p\u003e \u003cp\u003e \u003cem\u003eAssessments and Patient-Reported Outcome (PRO) Measures\u003c/em\u003e. Prior to the start of chemotherapy, research staff conducted three assessments: Short Physical Performance Battery (SPPB)\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e, Timed Up and Go (TUG)\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e,\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e, and Blessed Orientation Memory Concentration test (BOMC)\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. Questionnaires completed by study patients were the following: Instrumental Activities of Daily Living (IADL)\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e, Mental Health (Mental Health Index/MHI)\u003csup\u003e36\u003c/sup\u003e (subscales Depression and Anxiety), Physical Function\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e, Social Activities\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e, Social Support (subscales Emotional and Tangible)\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e, Quality of Life (Functional Assessment of Cancer-General/FACT-G)\u003csup\u003e40\u003c/sup\u003e, and Fatigue (Functional Assessment of Chronic Illness Therapy/FACIT-Fatigue)\u003csup\u003e41\u003c/sup\u003e. Patient age, race, education, marital status, alcohol consumption, and engagement in rigorous physical activity were also self-reported.\u003c/p\u003e \u003cp\u003e \u003cem\u003ePatient-Reported Symptoms\u003c/em\u003e. Patients were queried about 17 commonly occurring side effects of (neo)adjuvant chemotherapy: fatigue, insomnia, anxiety, depression, dyspnea, peripheral neuropathy, joint pain/arthralgia, muscle pain/myalgia, abdominal pain, general pain, lymphedema/edema of the extremities, constipation, diarrhea, nausea, vomiting, mucositis, and hot flashes. Research staff collected symptom data prior to chemotherapy initiation (baseline) and then at infusion visits throughout chemotherapy treatment by asking the patients to rate their symptoms using paper or electronic tablet. Symptom reports were collected at every infusion visit for patients receiving chemotherapy every 2 or 3 weeks, and every other week for patients receiving weekly infusions. The reporting format for two studies (NCT02167932 andNCT02328313) was the patient-validated Patient-Reported Symptom Monitoring (PRSM) (Appendix 1)\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e. For the most recent study (NCT03761706), the NCI\u0026rsquo;s PRO-CTCAE was used, as it became publicly available in April 2016 (Appendix 2)\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e,\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e. The PRSM and PRO-CTCAE formats are similar and entail 7-day recall questions regarding symptom \u0026ldquo;severity\u0026rdquo; and symptom \u0026ldquo;interference with daily activities\u0026rdquo; using a 5-point Likert-type scale. \u0026ldquo;Severity\u0026rdquo; was dichotomized as \u0026ldquo;none/mild\u0026rdquo; versus \u0026ldquo;moderate/severe/very severe\u0026rdquo;, and \u0026ldquo;interference\u0026rdquo; was dichotomized as \u0026ldquo;not at all/a little bit\u0026rdquo; versus \u0026ldquo;somewhat/quite a bit/very much\u0026rdquo;. Our previously reported studies have similarly combined results collected from both instruments\u003csup\u003e\u003cspan additionalcitationids=\"CR26 CR27\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cem\u003eElectronic Medical Record (EMR)\u003c/em\u003e. Research staff extracted the following EMR data: height and weight for BMI, comorbidities, BC diagnosis and treatment, and adverse events during chemotherapy (dose delay, dose reduction, early treatment discontinuation, hospitalization).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Considerations\u003c/h2\u003e \u003cp\u003eDescriptive statistics were computed at baseline. Comparisons of patients with and without obesity were conducted using Fisher\u0026rsquo;s exact tests and chi-square tests for categorical variables and two-sample t-tests for continuous variables. Multivariable analyses, adjusting for race and marital status, were performed with log-binomial models to compare the two BMI groups for the 17 side effect measures as outcomes. Two-sided p-values less than 0.05 were considered statistically significant. Analyses used SAS statistical software (V9.4 SAS Institute Inc, Cary, NC)\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003ePatient Characteristics\u003c/h2\u003e \u003cp\u003eIn a sample of 286 patients, Black women comprised 23% of the sample (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Forty-one percent of the patients (N\u0026thinsp;=\u0026thinsp;118) had obesity (BMI 30 or higher). The obesity rate was 31% among White patients and 76% among Black patients (p\u0026thinsp;\u0026lt;\u0026thinsp;.0001). The marriage rates was 62% among patients without obesity and 45% among patients with obesity (p\u0026thinsp;=\u0026thinsp;.008).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipant Characteristics at Baseline (pre-chemotherapy initiation)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;286\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBMI\u0026thinsp;\u0026lt;\u0026thinsp;30\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;168 (59%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBMI\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;118 (41%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDemographics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge \u0026ndash; mean (SD) years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57.6 (13.1)\u003c/p\u003e \u003cp\u003eRange 23\u0026ndash;83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.5 (13.4)\u003c/p\u003e \u003cp\u003eRange 27\u0026ndash;83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.1 (12.6)\u003c/p\u003e \u003cp\u003eRange 23\u0026ndash;83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRace\u003c/p\u003e \u003cp\u003eWhite\u003c/p\u003e \u003cp\u003eBlack/AA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e220 (77%)\u003c/p\u003e \u003cp\u003e66 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e152 (90%)\u003c/p\u003e \u003cp\u003e16 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68 (58%)\u003c/p\u003e \u003cp\u003e50 (42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003cp\u003eHigh school or less\u003c/p\u003e \u003cp\u003eMore than high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (15%)\u003c/p\u003e \u003cp\u003e240 (85%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (12%)\u003c/p\u003e \u003cp\u003e147 (88%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (21%)\u003c/p\u003e \u003cp\u003e93 (79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed more than 32 hours/week\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e198 (70%)\u003c/p\u003e \u003cp\u003e85 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e114 (69%)\u003c/p\u003e \u003cp\u003e52 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84 (72%)\u003c/p\u003e \u003cp\u003e33 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e127 (45%)\u003c/p\u003e \u003cp\u003e156 (55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (38%)\u003c/p\u003e \u003cp\u003e103 (62%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64 (55%)\u003c/p\u003e \u003cp\u003e53 (45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.008\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving alone\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e225 (80%)\u003c/p\u003e \u003cp\u003e58 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e137 (83%)\u003c/p\u003e \u003cp\u003e29 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88 (75%)\u003c/p\u003e \u003cp\u003e29 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eOverall\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eBMI\u0026thinsp;\u0026lt;\u0026thinsp;30\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eBMI\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;30\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003ep-value\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of comorbidities -Mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.7 (1.6)\u003c/p\u003e \u003cp\u003eRange 0\u0026ndash;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.3 (1.4)\u003c/p\u003e \u003cp\u003eRange 0\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.3 (1.7)\u003c/p\u003e \u003cp\u003eRange 0\u0026ndash;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities by category\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e1\u0026ndash;2\u003c/p\u003e \u003cp\u003e3\u0026ndash;4\u003c/p\u003e \u003cp\u003e5 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69 (25%\u003c/p\u003e \u003cp\u003e139 (51%)\u003c/p\u003e \u003cp\u003e53 (19%)\u003c/p\u003e \u003cp\u003e13 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 (33%)\u003c/p\u003e \u003cp\u003e86 (53%)\u003c/p\u003e \u003cp\u003e17 (10%)\u003c/p\u003e \u003cp\u003e5 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (13%)\u003c/p\u003e \u003cp\u003e53 (47%)\u003c/p\u003e \u003cp\u003e36 (32%)\u003c/p\u003e \u003cp\u003e8 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59 (53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes Mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStomach or intestinal disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArthritis or rheumatism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52 (47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiver or kidney disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCirculation disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlaucoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.0003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmphysema, chronic bronchitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.03\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOsteoporosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.04\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBreast cancer diagnosis and treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eOverall\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eBMI\u0026thinsp;\u0026lt;\u0026thinsp;30\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eBMI\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;30\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003ep-value\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreast cancer stage, N (%)\u003c/p\u003e \u003cp\u003eI\u003c/p\u003e \u003cp\u003eII\u003c/p\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71 (25%)\u003c/p\u003e \u003cp\u003e145 (51%)\u003c/p\u003e \u003cp\u003e69 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (26%)\u003c/p\u003e \u003cp\u003e88 (52%)\u003c/p\u003e \u003cp\u003e36 (21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (23%)\u003c/p\u003e \u003cp\u003e57 (49%)\u003c/p\u003e \u003cp\u003e33 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHER2, N (%)\u003c/p\u003e \u003cp\u003eNegative\u003c/p\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e213 (75%)\u003c/p\u003e \u003cp\u003e71 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130 (77%)\u003c/p\u003e \u003cp\u003e38 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83 (72%)\u003c/p\u003e \u003cp\u003e33 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHormone receptor (HR), N (%)\u003c/p\u003e \u003cp\u003eNegative\u003c/p\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 (38%)\u003c/p\u003e \u003cp\u003e96 (62%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (35%)\u003c/p\u003e \u003cp\u003e57 (65%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (42%)\u003c/p\u003e \u003cp\u003e39 (58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriple negative, N (%)\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112 (72%)\u003c/p\u003e \u003cp\u003e43 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62 (70%)\u003c/p\u003e \u003cp\u003e26 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50 (75%)\u003c/p\u003e \u003cp\u003e17 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymph node surgery\u003c/p\u003e \u003cp\u003eAxillary\u003c/p\u003e \u003cp\u003eSentinel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (29%)\u003c/p\u003e \u003cp\u003e196 (71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (25%)\u003c/p\u003e \u003cp\u003e121 (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39 (34%)\u003c/p\u003e \u003cp\u003e75 (66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreast surgery\u003c/p\u003e \u003cp\u003eNone\u003c/p\u003e \u003cp\u003eLumpectomy\u003c/p\u003e \u003cp\u003eMastectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (3%)\u003c/p\u003e \u003cp\u003e132 (48%)\u003c/p\u003e \u003cp\u003e135 (49%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (2%)\u003c/p\u003e \u003cp\u003e71 (44%)\u003c/p\u003e \u003cp\u003e87 (54%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (4%)\u003c/p\u003e \u003cp\u003e61 (54%)\u003c/p\u003e \u003cp\u003e48 (42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRadiation\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (26%)\u003c/p\u003e \u003cp\u003e187 (74%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (33%)\u003c/p\u003e \u003cp\u003e100 (67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (17%)\u003c/p\u003e \u003cp\u003e87 (83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.006\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChemotherapy timing\u003c/p\u003e \u003cp\u003eNeoadjuvant\u003c/p\u003e \u003cp\u003eAdjuvant\u003c/p\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107 (38%)\u003c/p\u003e \u003cp\u003e173 (61%)\u003c/p\u003e \u003cp\u003e2 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (38%)\u003c/p\u003e \u003cp\u003e102 (61%)\u003c/p\u003e \u003cp\u003e1 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44 (38%)\u003c/p\u003e \u003cp\u003e71 (61%)\u003c/p\u003e \u003cp\u003e1 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChemotherapy regimen\u003c/p\u003e \u003cp\u003eNot anthracycline-based\u003c/p\u003e \u003cp\u003eAnthracycline-based\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e158 (55%)\u003c/p\u003e \u003cp\u003e127 (45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95 (57%)\u003c/p\u003e \u003cp\u003e73 (43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63 (54%)\u003c/p\u003e \u003cp\u003e54 (46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTaxane regimen\u003c/p\u003e \u003cp\u003eDocetaxel\u003c/p\u003e \u003cp\u003ePaclitaxel/Nab-paclitaxel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e128 (48%)\u003c/p\u003e \u003cp\u003e139 (52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84 (53%)\u003c/p\u003e \u003cp\u003e75 (47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44 (41%)\u003c/p\u003e \u003cp\u003e64 (59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChemotherapy regimen \u0026ndash; specific\u003c/p\u003e \u003cp\u003eAC-T\u003c/p\u003e \u003cp\u003eAC-TC\u003c/p\u003e \u003cp\u003eTC\u003c/p\u003e \u003cp\u003eTCH\u003c/p\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86 (30%)\u003c/p\u003e \u003cp\u003e21 (7%)\u003c/p\u003e \u003cp\u003e78 (28%)\u003c/p\u003e \u003cp\u003e43 (15%)\u003c/p\u003e \u003cp\u003e55 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (26%)\u003c/p\u003e \u003cp\u003e18 (11%)\u003c/p\u003e \u003cp\u003e56 (33%)\u003c/p\u003e \u003cp\u003e26 (15%)\u003c/p\u003e \u003cp\u003e25 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43 (37%)\u003c/p\u003e \u003cp\u003e3 (3%)\u003c/p\u003e \u003cp\u003e22 (19%)\u003c/p\u003e \u003cp\u003e17 (15%)\u003c/p\u003e \u003cp\u003e30 (26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.0008\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eLegend: AC-T (Doxorubicin/Cyclophosphamide plus Paclitaxel); AC-TC (Doxorubicin/Cyclophosphamide plus Paclitaxel/Carboplatin); TC (Docetaxel/Cyclophosphamide +/- HER-2); TCH (Docetaxel/Carboplatin/anti-HER-2)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMean number of comorbidities was 2.3 (SD 1.7) in women with obesity vs 1.3 (SD 1.4) in patients with no obesity (p\u0026thinsp;\u0026lt;\u0026thinsp;.0001). Patients with obesity had higher rates of the following comorbidities: hypertension 53% vs 20% (p\u0026thinsp;\u0026lt;\u0026thinsp;.0001), diabetes mellitus 24% vs 4% (p\u0026thinsp;\u0026lt;\u0026thinsp;.0001), arthritis or rheumatism 47% vs 28% (p\u0026thinsp;=\u0026thinsp;.002), liver of kidney disease 5% vs 1% (p\u0026thinsp;=\u0026thinsp;.03), glaucoma 10% vs 1% (p\u0026thinsp;=\u0026thinsp;.0003), emphysema or chronic bronchitis 6% vs 1% (p\u0026thinsp;=\u0026thinsp;.04), and stroke 4% vs 1% (p\u0026thinsp;=\u0026thinsp;.04).\u003c/p\u003e \u003cp\u003eThere were no significant differences in BC stage or phenotype between patients with and without obesity. However, the proportion of patients receiving radiation treatment was lower in women with no obesity (67%) as compared to obesity (83%) (p\u0026thinsp;=\u0026thinsp;.006). And women with no obesity included higher proportions of women receiving chemotherapy regimens AC-TC (11% vs 3%) and TC (33% vs 19%), but lower proportion of \u0026ldquo;Other\u0026rdquo; regimens (15% vs 26%) (p\u0026thinsp;=\u0026thinsp;.0008).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePre-Chemotherapy Measures of Function, Quality of Life and Symptoms\u003c/h2\u003e \u003cp\u003e \u003cem\u003eAssessments Conducted by Research Staff\u003c/em\u003e. Mean scores on the Short Physical Performance Battery (SPPB) were worse among women with obesity as compared to no obesity (p\u0026thinsp;=\u0026thinsp;.002) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). A higher proportion of women with obesity scored \u0026ldquo;lower cognition\u0026rdquo; (BOMC\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;5) (28%) as compared to women with no obesity (17%) (p\u0026thinsp;=\u0026thinsp;.02).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline (pre-chemotherapy) Assessments and Patient-Reported Outcome (PRO) Measures and Symptoms\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline Assessments\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBMI\u0026thinsp;\u0026lt;\u0026thinsp;30\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;168 (59%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBMI\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;118 (41%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTimed Up and Go (TUG) \u0026ndash; 14 seconds or more\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e237 (88%)\u003c/p\u003e \u003cp\u003e32 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e140 (89%)\u003c/p\u003e \u003cp\u003e18 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97 (87%)\u003c/p\u003e \u003cp\u003e14 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShort Physical Performance Battery (SPPB) \u0026ndash; range 0\u0026thinsp;=\u0026thinsp;worst to 12\u0026thinsp;=\u0026thinsp;best performance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.5 (SD 1.8)\u003c/p\u003e \u003cp\u003eRange 3\u0026ndash;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.8 (SD 1.6)\u003c/p\u003e \u003cp\u003eRange 3\u0026ndash;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.1 (SD 2.1)\u003c/p\u003e \u003cp\u003eRange 4\u0026ndash;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlessed Orientation Memory Concentration Test/BOMC -- lower cognition score\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;5\u003c/p\u003e \u003cp\u003e\u0026lt;5\u003c/p\u003e \u003cp\u003e\u0026gt;=5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e219 (78%)\u003c/p\u003e \u003cp\u003e60 (22%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e136 (83%)\u003c/p\u003e \u003cp\u003e27 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83 (72%)\u003c/p\u003e \u003cp\u003e33 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePatient-Reported Health Behavior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eBMI\u0026thinsp;\u0026lt;\u0026thinsp;30\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eBMI\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;30\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003ep-\u003c/span\u003e\u003cb\u003evalue\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of falls in the past 6 months\u003c/p\u003e \u003cp\u003eNone\u003c/p\u003e \u003cp\u003e1 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e241 (88%)\u003c/p\u003e \u003cp\u003e32 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e149 (93%)\u003c/p\u003e \u003cp\u003e12 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92 (82%)\u003c/p\u003e \u003cp\u003e20 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-reported history of walking minutes per week \u0026ndash; Average (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e127.1 (SD 136.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e149 (SD 136)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95 (SD 131)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVigorous physical activity\u003c/p\u003e \u003cp\u003eNever, a few times a week\u003c/p\u003e \u003cp\u003e1\u0026ndash;2 times a week\u003c/p\u003e \u003cp\u003e3 or more times a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e128 (48%)\u003c/p\u003e \u003cp\u003e57 (21%)\u003c/p\u003e \u003cp\u003e82 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (36%)\u003c/p\u003e \u003cp\u003e36 (23%)\u003c/p\u003e \u003cp\u003e67 (42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71 (66%)\u003c/p\u003e \u003cp\u003e21 (20%)\u003c/p\u003e \u003cp\u003e15 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking history\u003c/p\u003e \u003cp\u003eNever\u003c/p\u003e \u003cp\u003ePast smoker\u003c/p\u003e \u003cp\u003eCurrent smoker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e163 (60%)\u003c/p\u003e \u003cp\u003e90 (33%)\u003c/p\u003e \u003cp\u003e19 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98 (61%)\u003c/p\u003e \u003cp\u003e52 (32%)\u003c/p\u003e \u003cp\u003e11 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65 (59%)\u003c/p\u003e \u003cp\u003e38 (34%)\u003c/p\u003e \u003cp\u003e8 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol Use\u003c/p\u003e \u003cp\u003eNo, almost never\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e170 (62%)\u003c/p\u003e \u003cp\u003e104 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92 (57%)\u003c/p\u003e \u003cp\u003e70 (43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78 (70%)\u003c/p\u003e \u003cp\u003e34 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.03\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePatient-Reported Outcomes (PRO) Scales\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eOverall\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eBMI\u0026thinsp;\u0026lt;\u0026thinsp;30\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eBMI\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;30\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003ep-\u003c/span\u003e\u003cb\u003evalue\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInstrumental Activities of Daily Living/IADL \u0026ndash; range 0\u0026ndash;14\u003c/p\u003e \u003cp\u003e\u0026lt;14\u0026thinsp;=\u0026thinsp;limitations\u003c/p\u003e \u003cp\u003e14\u0026thinsp;=\u0026thinsp;no limitations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (15%)\u003c/p\u003e \u003cp\u003e232 (85%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (10%)\u003c/p\u003e \u003cp\u003e144 (90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (23%)\u003c/p\u003e \u003cp\u003e88 (77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.006\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMental Health Index/MHI \u0026ndash; range 0\u0026ndash;43\u003c/p\u003e \u003cp\u003eDepressed score\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;12\u003c/p\u003e \u003cp\u003eNot depressed\u003c/p\u003e \u003cp\u003eDepressed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e195 (74%)\u003c/p\u003e \u003cp\u003e68 (26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e123 (79%)\u003c/p\u003e \u003cp\u003e33 (21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72 (67%)\u003c/p\u003e \u003cp\u003e35 (32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.04\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMental Health Index/MHI \u0026ndash; range 0\u0026ndash;20\u003c/p\u003e \u003cp\u003eAnxious score\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;6\u003c/p\u003e \u003cp\u003eNot anxious\u003c/p\u003e \u003cp\u003eAnxious\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e148 (54%)\u003c/p\u003e \u003cp\u003e125 (46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88 (54%)\u003c/p\u003e \u003cp\u003e74 (46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 (54%)\u003c/p\u003e \u003cp\u003e51 (46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical Function \u0026ndash; range 0\u0026ndash;20\u003c/p\u003e \u003cp\u003e20\u0026thinsp;=\u0026thinsp;high function\u003c/p\u003e \u003cp\u003e\u0026lt;20\u0026thinsp;=\u0026thinsp;lower function\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77 (34%)\u003c/p\u003e \u003cp\u003e150 (66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (39%)\u003c/p\u003e \u003cp\u003e83 (61%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (26%)\u003c/p\u003e \u003cp\u003e67 (74%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial Support-Emotional -- range 0-100\u003c/p\u003e \u003cp\u003e\u0026gt;=50 high support\u003c/p\u003e \u003cp\u003e\u0026lt; 50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e218 (96%)\u003c/p\u003e \u003cp\u003e9 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e129 (98%)\u003c/p\u003e \u003cp\u003e3 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e89 (94%)\u003c/p\u003e \u003cp\u003e6 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial Support-Tangible (range 0-100)\u003c/p\u003e \u003cp\u003e\u0026gt;=50 high support\u003c/p\u003e \u003cp\u003e\u0026lt; 50 low support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e216 (94%)\u003c/p\u003e \u003cp\u003e13 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e129 (97%)\u003c/p\u003e \u003cp\u003e4 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87 (91%)\u003c/p\u003e \u003cp\u003e9 (9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFunctional Assessment of Cancer Therapy/FACT-General (higher score\u0026thinsp;=\u0026thinsp;higher wellbeing)\u003c/p\u003e \u003cp\u003ePhysical well-being (range 0\u0026ndash;28)\u003c/p\u003e \u003cp\u003eSocial/family wellbeing (range 0\u0026ndash;28)\u003c/p\u003e \u003cp\u003eEmotional wellbeing (range 0\u0026ndash;24)\u003c/p\u003e \u003cp\u003eFunctional wellbeing (range 0\u0026ndash;28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.8 (SD 3.9)\u003c/p\u003e \u003cp\u003eRange 8\u0026ndash;28\u003c/p\u003e \u003cp\u003e24.7 (SD 4.6)\u003c/p\u003e \u003cp\u003eRange 4\u0026ndash;28\u003c/p\u003e \u003cp\u003e19.1 (SD 3.8)\u003c/p\u003e \u003cp\u003eRange 1\u0026ndash;24\u003c/p\u003e \u003cp\u003e20.9 (SD 5.7)\u003c/p\u003e \u003cp\u003eRange 0\u0026ndash;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.4 (SD 3.5)\u003c/p\u003e \u003cp\u003eRange 11\u0026ndash;28\u003c/p\u003e \u003cp\u003e25.3 (SD 3.8)\u003c/p\u003e \u003cp\u003eRange 6\u0026ndash;28\u003c/p\u003e \u003cp\u003e19.3 (SD 3.6)\u003c/p\u003e \u003cp\u003eRange 4\u0026ndash;24\u003c/p\u003e \u003cp\u003e21.5 (SD 5.1)\u003c/p\u003e \u003cp\u003eRange 6\u0026ndash;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.9 (SD 4.2)\u003c/p\u003e \u003cp\u003eRange 8\u0026ndash;28\u003c/p\u003e \u003cp\u003e23.7 (SD 5.4)\u003c/p\u003e \u003cp\u003eRange 4\u0026ndash;28\u003c/p\u003e \u003cp\u003e18.9 (SD 4.1)\u003c/p\u003e \u003cp\u003eRange 1.2\u0026ndash;24\u003c/p\u003e \u003cp\u003e19.9 (SD 6.3)\u003c/p\u003e \u003cp\u003eRange 0\u0026ndash;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e.003\u003c/b\u003e\u003c/p\u003e \u003cp\u003e.46\u003c/p\u003e \u003cp\u003e\u003cb\u003e.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFunctional Assessment of Chronic Illness Therapy/FACIT-Fatigue (reverse scored so that higher score\u0026thinsp;=\u0026thinsp;less fatigue) (range 0-160)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.1 (SD 8.8)\u003c/p\u003e \u003cp\u003eRange 5\u0026ndash;52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.2 (SD 7.8)\u003c/p\u003e \u003cp\u003eRange 19\u0026ndash;52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.3 (SD 9.8)\u003c/p\u003e \u003cp\u003eRange 5\u0026ndash;52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.006\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCarolina Frailty Index\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFrail\u003c/p\u003e \u003cp\u003ePre-frail\u003c/p\u003e \u003cp\u003eRobust\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (3%)\u003c/p\u003e \u003cp\u003e62 (22%)\u003c/p\u003e \u003cp\u003e210 (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1%)\u003c/p\u003e \u003cp\u003e23 (14%)\u003c/p\u003e \u003cp\u003e140 (85%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (5%)\u003c/p\u003e \u003cp\u003e39 (34%)\u003c/p\u003e \u003cp\u003e70 (61%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSymptoms rated moderate, severe or very severe (MSVS) prior to chemotherapy initiation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eOverall\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eBMI\u0026thinsp;\u0026lt;\u0026thinsp;30\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eBMI\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;30\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003ep-\u003c/span\u003e\u003cb\u003evalue\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsomnia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHot flashes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAching joints/arthralgia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAching muscles/myalgia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeripheral neuropathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.04\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEdema limbs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdominal pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstipation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiarrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNausea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMucositis oral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eLegend: Short Physical Performance Battery/SPPB, Blessed Orientation Memory Concentration Test/BOMC, Mental Health Index/MHI, Instrumental Activities of Daily Living/IADL, Functional Assessment of Cancer Therapy/FACT, Functional Assessment of Chronic Illness Therapy/FACIT\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003ePatient-Reported Health Behavior\u003c/em\u003e. A higher proportion of patients with obesity as compared to no obesity reported one or more falls in the past 6 months (18% vs 7%), p\u0026thinsp;=\u0026thinsp;.01), fewer walking minutes per week (average 95 vs 149 minutes, p\u0026thinsp;=\u0026thinsp;.001), and never or only a few times a week engaging in physical activity (66% vs 36%, p\u0026thinsp;\u0026lt;\u0026thinsp;.0001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). A higher proportion of women with no obesity reported alcohol use (43%) as compared to women with obesity (30%) (p\u0026thinsp;=\u0026thinsp;.03).\u003c/p\u003e \u003cp\u003e \u003cem\u003ePatient-Reported Outcome (PRO) Measures.\u003c/em\u003e Limitations in Instrumental Activities of Daily Living (IADL) were more prevalent among women with obesity than without obesity (23% vs 10%, p\u0026thinsp;=\u0026thinsp;.006) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). A higher proportion of patients with Mental Health Index (MHI) scores indicating depression was observed in patients no obesity as compared to no obesity (32% vs 21%) (p\u0026thinsp;=\u0026thinsp;.04). Patients with obesity more frequently reported lower tangible social support as compared to patients with no obesity (9% vs 3%, p\u0026thinsp;=\u0026thinsp;.05). Patients with obesity scored lower quality of life for physical well-being (p\u0026thinsp;=\u0026thinsp;.001), social/family wellbeing (p\u0026thinsp;=\u0026thinsp;.003), and functional well-being (p\u0026thinsp;=\u0026thinsp;.02), as well as higher fatigue (p\u0026thinsp;=\u0026thinsp;.006). On the Carolina Frailty Index, a higher proportion of women with no obesity as compared to patients with obesity were rated \u0026ldquo;robust\u0026rdquo; (85% vs 61%) (p\u0026thinsp;\u0026lt;\u0026thinsp;.0001).\u003c/p\u003e \u003cp\u003e \u003cem\u003eSymptoms.\u003c/em\u003e Prior to the start of chemotherapy (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), a higher proportion of women with obesity as compared to no obesity reported moderate, severe or very severe (MSVS) fatigue (27% vs 13%, p\u0026thinsp;=\u0026thinsp;.007), dyspnea (7% vs 0%), p\u0026thinsp;=\u0026thinsp;.001), arthralgia (18% vs 8%, p\u0026thinsp;=\u0026thinsp;.02), and peripheral neuropathy (6% vs 1%, p\u0026thinsp;=\u0026thinsp;.04).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eSymptom Reports During Chemotherapy\u003c/h2\u003e \u003cp\u003e \u003cem\u003eSymptom Severity\u003c/em\u003e. At any time during chemotherapy treatment, patients with obesity rated 6.9 (SD 4.2, range 0\u0026ndash;17) symptoms as moderate, severe or very severe (MSVS) severity as compared to 5.5 (SD 3.7, range 0\u0026ndash;16) among patients with no obesity (p\u0026thinsp;=\u0026thinsp;.003). Higher proportions of women with obesity rated individual symptom severity as MSVS (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e): fatigue 79% vs 66% p\u0026thinsp;=\u0026thinsp;.03), arthralgia 50% vs 34% (p\u0026thinsp;=\u0026thinsp;.01), peripheral neuropathy 43% vs 27% (p\u0026thinsp;=\u0026thinsp;.005), edema of limbs 36% vs 17% (p\u0026thinsp;=\u0026thinsp;.0003), dyspnea 29% vs 18% (p\u0026thinsp;=\u0026thinsp;.04), and abdominal pain 26% vs 15% (p\u0026thinsp;=\u0026thinsp;.02).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, we report Relative Risk (RR) for MSVS patient-reported symptom severity, with multivariable (MV) analyses adjusted for race and marital status. Women with obesity as compared to no obesity were more likely to report MSVS fatigue (RR 1.18, 95% CI 1.02,1.36), dyspnea (RR 1.71, 95% CI 1.09,2.69), arthralgia (RR 1.47, 95% CI 1.10,1.97), peripheral neuropathy (RR 1.45, 95% CI 1.01,2.08), edema of limbs (RR 1.84 (95% CI 1.18.2.88), and abdominal pain (RR 1.75, 95% CI 1.07,2.87).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient-reported symptoms during chemotherapy, Relative Risk (RR) unadjusted and adjusted for marital status and race (shown for associations significant at alpha\u0026thinsp;=\u0026thinsp;.05 level)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSymptom Severity\u003c/p\u003e \u003cp\u003e(% MSVS)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBMI\u0026thinsp;\u0026lt;\u0026thinsp;30\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;168 (59%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBMI\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;118 (41%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUnadjusted RR\u003c/p\u003e \u003cp\u003e(95% Confidence Interval\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAdjusted RR\u003c/p\u003e \u003cp\u003e95% Confidence Interval\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e203 (72%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e111 (67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92 (79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.18 (1.02,1.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.18 (1.01,1.36)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e128 (45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57 (48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsomnia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e171 (60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94 (56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77 (65%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHot flashes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 (32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.60 (1.04,2.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.71 (1.09,2.69)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAching joints/arthralgia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116 (41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.46 (1.11, 1.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.47 (1.10, 1.97)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAching muscles/myalgia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112 (39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54 (46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeripheral neuropathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51 (43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.60 (1.16, 2.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.45 (1.01, 2.08)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEdema limbs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.17 (1.44, 3.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.84 (1.18, 2.88)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdominal pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.75 (1.10, 2.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.75 (1.07, 2.87)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51 (43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstipation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41 (35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiarrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e128 (45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 (51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNausea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 (32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48 (41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMucositis oral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSymptom Interference with Daily Activities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eOverall\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eBMI\u0026thinsp;\u0026lt;\u0026thinsp;30\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eBMI\u0026thinsp;\u0026gt;\u0026thinsp;30\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eUnadjusted RR\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(95% Confidence Interval\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eAdjusted RR\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e95% Confidence Interval\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e186 (65%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98 (59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88 (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.27 (1.08, 1.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.27 (1.07, 1.51)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsomnia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116 (41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62 (37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54 (46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHot flashes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.74 (1.11, 2.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.65 (1.01, 2.68)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAching joints/arthralgia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90 (32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50 (43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.78 (1.27, 2.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.74 (1.22, 2.49)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAching muscles/myalgia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78 (27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.67 (1.14, 2.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.54 (1.03, 2.30)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeripheral neuropathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.02 (1.27, 3.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.53 (0.93, 2.51)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEdema limbs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.38 (1.39, 4.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.92 (1.08, 3.41)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdominal pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.41 (1.36, 4.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.34 (1.27, 4.29)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90 (32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46 (39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.48 (1.05, 2.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.50 (1.05, 2.15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstipation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiarrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92 (32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50 (42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.68 (1.20, 2.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.55 (1.08, 2.23)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNausea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43 (37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMucositis oral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eLegend: RR values provided only for statistically significant associations. MSVS\u0026thinsp;=\u0026thinsp;moderate, severe or very severe rating at any time during chemotherapy.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eInterference is defined as patients with self reported \u0026lsquo;somewhat/quite a bit/very much\u0026rsquo; interference.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eSymptom Interference with Daily Activity.\u003c/em\u003e Patients with obesity rated an average of 5.4 (SD 4.2, range 0\u0026ndash;17) symptoms as \u0026ldquo;somewhat/quite a bit/very much\u0026rdquo; interfering with daily living as compared to an average of 3.7 (SD 3.3, range 0\u0026ndash;16) symptoms interfering with this intensity among patients without obesity (p\u0026thinsp;=\u0026thinsp;.0002). In both BMI categories, symptom interference with daily living was rated lower than the symptom\u0026rsquo;s severity. Higher proportions of women with obesity as compared to no obesity reported greater symptom interference (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e): fatigue 75% vs 59% (p\u0026thinsp;=\u0026thinsp;.006), diarrhea 42% vs 25% (p\u0026thinsp;=\u0026thinsp;.003), myalgia 36% vs 22% (p\u0026thinsp;=\u0026thinsp;.01), arthralgia 43% vs 24% (p\u0026thinsp;=\u0026thinsp;.001), general pain 39% vs 26% (p\u0026thinsp;=\u0026thinsp;.002), peripheral neuropathy 29% vs 14% (p\u0026thinsp;=\u0026thinsp;.004), edema of the limbs 26% vs 11% (p\u0026thinsp;=\u0026thinsp;.001), dyspnea 28% vs 16% (p\u0026thinsp;=\u0026thinsp;.02), and abdominal pain 23% vs 10% (p\u0026thinsp;=\u0026thinsp;.002). In MV analyses adjusted for race and marital status (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), patients with obesity were more likely to report greater interference for fatigue (RR 1.27, 95% CI 1.07,1.51), dyspnea (RR 1.65, 95% CI 1.01,2.68), arthralgia (RR 1.74 95% CI 1.22, 2.49), myalgia (RR 1.54, 95% CI 1.03, 2.30), edema of limbs (RR 1.92, 95% CI 1.08,3.41), abdominal pan (RR 2.34, 95% CI 1.27,4.29), general pain (RR 1.50 (95% CI 1.05,2.15), and diarrhea (RR 1.55, 95% CI 1.08,2.23).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eDuring Chemotherapy Adverse Events and Patient-Reported Symptoms\u003c/h2\u003e \u003cp\u003eOverall, 18% of patients were hospitalized, 33% had at least one chemotherapy dose reduction, 23% had an infusion delay, and 17% had their chemotherapy treatment terminated early. For all of these measures, there were no significant differences between patients with obesity and no obesity (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAdverse Events during Chemotherapy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBMI\u0026thinsp;\u0026lt;\u0026thinsp;30\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBMI\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospitalized\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e205 (82%)\u003c/p\u003e \u003cp\u003e45 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e125 (86%)\u003c/p\u003e \u003cp\u003e21 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80 (77%)\u003c/p\u003e \u003cp\u003e24 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDose reduction\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e168 (67%)\u003c/p\u003e \u003cp\u003e83 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100 (69%)\u003c/p\u003e \u003cp\u003e45 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68 (64%)\u003c/p\u003e \u003cp\u003e38 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDose delay\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e194 (77%)\u003c/p\u003e \u003cp\u003e57 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e113 (77%)\u003c/p\u003e \u003cp\u003e34 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81 (78%)\u003c/p\u003e \u003cp\u003e23 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEarly treatment discontinuation\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e209 (83%)\u003c/p\u003e \u003cp\u003e42 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126 (86%)\u003c/p\u003e \u003cp\u003e20 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83 (79%)\u003c/p\u003e \u003cp\u003e22 (21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we examined whether women with early breast cancer and obesity have a different toxicity profile as compared to women without obesity when they receive chemotherapy with curative intent, and whether symptom experience impacts treatment completion. This is an important question because high BMI is common at BC diagnosis\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e and women often experience weight gain after diagnosis\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e which, in turn, can impact BC incidence, severity and outcomes\u003csup\u003e\u003cspan additionalcitationids=\"CR46 CR47 CR48 CR49\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e. The obesity-breast cancer link is of particular concern in states experiencing ever-rising obesity rates and within minoritized populations that have been especially burdened by the obesity epidemic\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn our sample of 286 patients, 41% had obesity at BC diagnosis, with more than twice the rate of obesity observed among Black patients as compared to White. Unmarried patients also had significantly higher rates of obesity compared to married patients. Patients with obesity had higher mean number of comorbidities, most of them obesity related. There were no significant differences between patients with and without obesity with regard to BC stage or phenotype, although there were significant differences in specific chemotherapy regimens.\u003c/p\u003e \u003cp\u003ePrior to chemotherapy initiation, patients with obesity performed worse on the Short Physical Performance Battery and a higher proportion scored \u0026ldquo;lower cognition\u0026rdquo;. Patients with obesity reported more falls and being less physically active, but they also reported less alcohol consumption compared to patients with no obesity. Higher proportions of patients with obesity reported limitations in instrumental activities of daily living, more depression, lower tangible social support, and lower physical, social/family, and functional well-being. A higher proportion of women with no obesity as compared to patients with obesity were rated \u0026ldquo;robust\u0026rdquo; on the Carolina Frailty Index. Prior to start of chemotherapy, higher proportions of patients with obesity reported moderate, severe or very severe (MSVS) fatigue, dyspnea, arthralgia, and peripheral neuropathy. The findings would suggest a potential for patients with obesity to have greater difficulties with treatment toxicities as compared to patients without obesity.\u003c/p\u003e \u003cp\u003eIn multivariable (MV) analyses of symptom severity during chemotherapy treatment adjusted for race and marital status, patients with obesity in fact had significantly higher risk for MSVS fatigue, dyspnea, arthralgia, peripheral neuropathy, edema of arms and legs, and abdominal pain. Similarly, in MV analyses of symptom interference with daily activities adjusted for race and marital status, patients with obesity were more likely to report greater interference for symptoms related to dyspnea, arthralgia, myalgia, edema of the limbs, abdominal pain, general pain, diarrhea, and peripheral neuropathy. As an exploratory finding, we also report that unmarried patients were more likely to report MSVS symptom severity for dyspnea, peripheral neuropathy, and edema of the limbs, as well as greater interference with daily living with regard to arthralgia, myalgia, peripheral neuropathy, and general pain.\u003c/p\u003e \u003cp\u003eYet, despite higher risk for symptom severity and symptom interference with activities of daily living among patients with obesity, there were no significant inter-group differences in hospitalizations during chemotherapy or chemotherapy dose reductions, dose delays or early treatment discontinuation. This finding is corroborated by other studies showing no significant association between BMI and receipt of adjuvant chemotherapy\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. This is a key finding, but does not detract from the overall caution that women with obesity reported greater sensitivity to chemotherapy side-effects.\u003c/p\u003e \u003cp\u003eOur study has some limitations. Our sample was limited to patients who agreed to participate in a moderate exercise program during chemotherapy. As such, both the patients and their treating clinicians deemed the patients able to participate in a self-directed walking intervention. Our sample also includes a high proportion of women with more than a college education. These \u0026ldquo;fitness\u0026rdquo; and education characteristics limit the generalizability of our sample to the larger population of women with early breast cancer scheduled to receive chemotherapy. However, this does not limit the overall purpose of our analysis, which is a comparison of similarly \u0026ldquo;fit\u0026rdquo; patients with and without obesity.\u003c/p\u003e \u003cp\u003eOur study contributes to the on-going exploration of the potential impact of obesity on cancer treatment. Because of the tradition of basing chemotherapy dosing on Body Surface Area\u003csup\u003e\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e (BSA) and concerns that under-dosing may undermine the effectiveness of cytotoxic agents\u003csup\u003e\u003cspan additionalcitationids=\"CR54\" citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u003c/sup\u003e, best practice is for patients with obesity to receive higher doses of chemotherapy as compared to patients with no obesity\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e,\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u003c/sup\u003e. One would expect higher doses in women with obesity to be associated with greater symptom severity leading, in turn, to reduced treatment completion, but this was not found in our study.\u003c/p\u003e \u003cp\u003eIn our sample, there were no significant inter-group differences in breast cancer stage and phenotype. The proportion of patients receiving anthracycline-based regimens was somewhat higher in women with obesity (59%) compared to women without obesity (47%); however, the difference failed to reach statistical significance (p\u0026thinsp;=\u0026thinsp;0.06). This may contribute to the higher rates of MSVS peripheral neuropathy reported among patients with obesity, along with their higher rate of peripheral neuropathy symptoms prior to chemotherapy initiation. Nevertheless, we found no significant differences in treatment completion between patients with or without obesity, nor in dose delays, dose reductions or hospitalizations during chemotherapy.\u003c/p\u003e \u003cp\u003eOur overall observation that women with obesity had greater fatigue, dyspnea, arthralgia, peripheral neuropathy, edema of the limbs, and abdominal pain most likely reflects the higher doses of chemotherapy they are receiving. Greater symptom severity among patients with obesity during treatment may also be a function of their greater symptom reports prior to chemotherapy initiation. Our findings point to the need for extra vigilance in monitoring chemotherapy toxicities in women with obesity treated with weight-appropriate doses, with the aim of offering interventions that may help them maintain quality of life as they continue receiving treatment at full dosage.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting Interest:\u003c/strong\u003e The authors have not competing interests to report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e: \u003cem\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Kirsten A. Nyrop, Jane Monaco, and Sanah Vohra. The first draft of the manuscript was written by Kirsten A. Nyrop and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e:\u0026nbsp;\u003c/em\u003eThe datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e: This is an observational study and was approved by the University of North Carolina Institutional Review Board and the IRBs of participating study sites.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e: Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Support\u003c/strong\u003e: Breast Cancer Research Foundation of New York (New York; Muss PI, BCRF-21-114); Kay Yow Foundation (Raleigh NC; Muss PI).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNyrop KA, Deal AM, Shachar SS et al (2020) Weight trajectories in women receiving systemic adjuvant therapy for breast cancer. 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Cancer May 15(10):2159\u0026ndash;2165. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/cncr.23416\u003c/span\u003e\u003cspan address=\"10.1002/cncr.23416\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"obesity, breast cancer, chemotherapy, toxicities","lastPublishedDoi":"10.21203/rs.3.rs-1632995/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1632995/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e This study investigates whether high body mass index (BMI) in women diagnosed with early breast cancer (BC) is associated with patient-reported symptom severity during chemotherapy.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Women with Stage I-III BC completed toxicity reports for 17 side effects during regularly scheduled chemotherapy infusions. Toxicity reports were compared in women with obesity (BMI \u0026gt;=30) versus no obesity (BMI \u0026lt;30). Fisher’s exact tests and 2-sample t-tests compared baseline patient characteristics. Risk ratios (RR) for women with obesity as compared to no obesity were estimated for individual symptoms that were patient-rated as moderate, severe or very severe (MSVS) severity, adjusting for marital status and race. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: In a sample of 286 patients, Black women comprised 23% of the sample. The obesity rate was 76% among Black patients and 31% among White patients (p\u0026lt;.0001). Women with obesity rated an average of 6.9 side effects (standard deviation, SD 4.2) as MSVS vs 5.5 side effects (SD 3.7) among women with no obesity (p=.003). In adjusted analysis, women with obesity had significantly greater risk for MSVS fatigue (RR 1.18, 95% CI 1.01-1.36), dyspnea (RR 1.71, 95% CI 1.09-2.69), arthralgia (RR 1.47, 95% CI 1.10-1.97), peripheral neuropathy (RR 1.45, 95% CI 1.01-2.08), edema of limbs (RR 1.84, 95% CI 1.18-2.88), and abdominal pain (RR 1.75, 95% CI 1.07-2.87). There were no inter-group differences in BC stage or phenotype, chemotherapy treatment modifications, or hospitalizations.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: Among women with early BC, patients with obesity reported higher chemotherapy toxicity as compared to patients without obesity; however, this did not result in differences in treatment completion.\u003c/p\u003e","manuscriptTitle":"Body Mass Index and patient-reported measures of function, quality of life and treatment toxicity in women receiving adjuvant chemotherapy for breast cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-05-27 20:22:12","doi":"10.21203/rs.3.rs-1632995/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4cf17d2f-5adb-4390-ad86-dd4ebebeadbe","owner":[],"postedDate":"May 27th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-07-05T13:12:05+00:00","versionOfRecord":[],"versionCreatedAt":"2022-05-27 20:22:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1632995","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1632995","identity":"rs-1632995","version":["v1"]},"buildId":"369fNeqWncA4NS6XSWjrt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}