Health Literacy, Nutritional Knowledge, and Weight Trajectories During Endocrine Therapy in Breast Cancer Survivors: Educational Implications for Oncology Practice

Health Literacy, Nutritional Knowledge, and Weight Trajectories During Endocrine Therapy in Breast Cancer Survivors: Educational Implications for Oncology Practice | 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 Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Health Literacy, Nutritional Knowledge, and Weight Trajectories During Endocrine Therapy in Breast Cancer Survivors: Educational Implications for Oncology Practice Valeria Sanna, Alessandro Fancellu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8985805/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Purpose Weight gain during endocrine therapy is common among breast cancer survivors and may adversely affect long-term metabolic and oncologic outcomes. While obesity is a recognized prognostic factor, limited research has examined how nutritional knowledge and health literacy translate into real-world weight trajectories during endocrine therapy. This study evaluated the association between perceived nutritional knowledge, information sources, and weight trajectories, including exploratory analysis of patients receiving CDK4/6 inhibitors. Methods This single-center cross-sectional observational study was conducted in January 2023 at a tertiary oncology center (AOU Sassari, Italy). Consecutive women aged 35–85 years with luminal breast cancer receiving endocrine therapy for ≥ 4 months were invited to participate during routine follow-up visits. Of 112 eligible patients, 100 were included in the final analysis. Participants completed a structured questionnaire assessing anthropometric data, dietary habits, perceived nutritional knowledge, and communication patterns. Weight trajectories were categorized as gain, loss, or stable. Pearson’s chi-square test was used for categorical comparisons. Odds ratios (OR) with 95% confidence intervals (CI) were calculated. Statistical significance was set at p < 0.05. Results Sixty percent of participants were overweight or obese during therapy, compared with approximately 30% in the general female Italian population. Fifty-two percent gained weight (+ 7.2 kg), 32% lost weight (− 3 kg), and 16% remained stable. Forty-eight percent of patients in the weight-loss group mentioned fiber/vegetables in an open-ended dietary question compared to 8% in the weight-gain group. Fiber-oriented dietary awareness was strongly associated with weight loss (OR = 10.59; 95% CI 3.08–36.38; p < 0.001). Patients receiving CDK4/6 inhibitors (28%) were predominantly overweight but showed attenuated weight-gain patterns (exploratory observation). Conclusions Breast cancer survivors exhibit increased metabolic vulnerability during endocrine therapy. Applied nutritional literacy—rather than perceived knowledge alone—is strongly associated with favorable weight trajectories. Structured nutritional counseling may improve survivorship outcomes. Implications for Cancer Survivors Interactive health literacy represents a modifiable target for metabolic risk reduction in breast cancer survivorship. Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 07 Apr, 2026 Editor assigned by journal 07 Apr, 2026 Submission checks completed at journal 05 Mar, 2026 First submitted to journal 27 Feb, 2026 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. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board 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-8985805","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":620902008,"identity":"00d1c1df-527e-404b-8e88-12c0a749075b","order_by":0,"name":"Valeria Sanna","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYFAC5gYGBgMYpwJKJ+DVwois5QxMC149IC1wdhuMhUeLwfGDjY8rCuwY5NvPHnvwc56dnMH54w8YHv7Ao+VMYrPhGYNkICMv3bB3W7KxwY0cA7wOk2xIbJNsMGAGeifHTIJ3G3Pihhs8+P0i2f+w/WeDQT2DfP8bM8m/c+oTN4Achk8Lv0RiG2ODwWEGhhs5ZtK8DYcTNxxIwO8wfomHzUCHHecxuPHGTFrm2HFjSaBfDiSk4dbCxp988GPDn2o5+f4cM8k3NdVyfOePP3z4wwa3FhjgQeEdIKxhFIyCUTAKRgE+AABPX0/QX8lV8QAAAABJRU5ErkJggg==","orcid":"","institution":"Azienda Ospedaliero Universitaria di Sassari","correspondingAuthor":true,"prefix":"","firstName":"Valeria","middleName":"","lastName":"Sanna","suffix":""},{"id":620902009,"identity":"e7b87749-f161-49dc-83a7-bce1d17c11ba","order_by":1,"name":"Alessandro Fancellu","email":"","orcid":"","institution":"Azienda Ospedaliero Universitaria di Sassari","correspondingAuthor":false,"prefix":"","firstName":"Alessandro","middleName":"","lastName":"Fancellu","suffix":""}],"badges":[],"createdAt":"2026-02-27 09:09:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8985805/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8985805/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106927051,"identity":"58a8696b-5d24-4314-9a30-7df25bf1223e","added_by":"auto","created_at":"2026-04-14 23:40:31","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":684263,"visible":true,"origin":"","legend":"","description":"","filename":"HealthLiteracyNutritionalKnowledgeandWeightTrajectoriesDuringEndocrineTherapyinBreastCancerSurvivorsEducationalImplicationsforOncologyPractic.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8985805/v1_covered_2ac07514-2752-4bb7-a962-ab159856ed5b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Health Literacy, Nutritional Knowledge, and Weight Trajectories During Endocrine Therapy in Breast Cancer Survivors: Educational Implications for Oncology Practice","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8985805/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8985805/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWeight gain during endocrine therapy is common among breast cancer survivors and may adversely affect long-term metabolic and oncologic outcomes. While obesity is a recognized prognostic factor, limited research has examined how nutritional knowledge and health literacy translate into real-world weight trajectories during endocrine therapy. This study evaluated the association between perceived nutritional knowledge, information sources, and weight trajectories, including exploratory analysis of patients receiving CDK4/6 inhibitors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis single-center cross-sectional observational study was conducted in January 2023 at a tertiary oncology center (AOU Sassari, Italy). Consecutive women aged 35–85 years with luminal breast cancer receiving endocrine therapy for ≥ 4 months were invited to participate during routine follow-up visits. Of 112 eligible patients, 100 were included in the final analysis. 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Fiber-oriented dietary awareness was strongly associated with weight loss (OR = 10.59; 95% CI 3.08–36.38; p \u0026lt; 0.001). Patients receiving CDK4/6 inhibitors (28%) were predominantly overweight but showed attenuated weight-gain patterns (exploratory observation).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBreast cancer survivors exhibit increased metabolic vulnerability during endocrine therapy. Applied nutritional literacy—rather than perceived knowledge alone—is strongly associated with favorable weight trajectories. Structured nutritional counseling may improve survivorship outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications for Cancer Survivors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInteractive health literacy represents a modifiable target for metabolic risk reduction in breast cancer survivorship.\u003c/p\u003e","manuscriptTitle":"Health Literacy, Nutritional Knowledge, and Weight Trajectories During Endocrine Therapy in Breast Cancer Survivors: Educational Implications for Oncology Practice","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-14 23:40:16","doi":"10.21203/rs.3.rs-8985805/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-07T19:40:30+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-07T19:37:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-06T02:30:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2026-02-27T09:04:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"20a631ae-ecbc-4eae-92e0-34b7e106c134","owner":[],"postedDate":"April 14th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-14T23:40:16+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-14 23:40:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8985805","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8985805","identity":"rs-8985805","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}