Understanding the association between body mass index and chemotherapy dose reductions in women treated for stage I-IIIA breast cancer
Historically, breast cancer patients with obesity have been more likely than normal-weight patients to receive dose-reduced chemotherapy, although contemporary dosing practices of patients with obesity remain unclear. Among 9708 women treated with adjuvant chemotherapy for stage I-IIIA breast cancer at two integrated healthcare delivery systems (2005-2019), we used generalized linear models to estimate adjusted prevalence ratios between body mass index (BMI) and comorbidity and chemotherapy dosing (first cycle dose reduction (FCDR), dose proportion < 90%) and average relative dose intensity (ARDI) < 90%). A strong, independent association was observed between BMI and FCDR (PR<sub>BMI:40+ vs 18.5-<25</sub>: 9.74; 95% CI: 7.43-12.8; p-trend < 0.001) and ARDI < 90% (PR<sub>BMI:40+ vs 18.5-<25</sub>: 2.69; 95% CI: 2.35-3.09; p-trend < 0.001). This association weakened over time, although remained significant, particularly in the heaviest patients. Charlson Comorbidity Index (CCI) was associated with FCDR (PR<sub>CCI:3+ vs 0</sub>: 1.58; 95% CI: 1.19-2.11; p-trend = 0.009) and ARDI < 90% (p-trend < 0.001), as were individual comorbidities. Understanding dose reductions and their impact will be critical to optimizing care and improving survivorship.
Authors
- Elisa V. Bandera (ORCID: https://orcid.org/0000-0002-8789-2755)
- Emily Valice (ORCID: https://orcid.org/0000-0003-2408-9727)
- Jenna Bhimani (ORCID: https://orcid.org/0000-0002-9962-7019)
- Kanichi G. Nakata (ORCID: https://orcid.org/0000-0001-6730-6045)
- Isaac Joshua Ergas (ORCID: https://orcid.org/0000-0002-3187-9754)
- Tatjana Kolevska
- Kelli O’Connell (ORCID: https://orcid.org/0000-0002-4021-0788)
- Raymond Liu (ORCID: https://orcid.org/0000-0002-4667-9632)
- Lawrence H. Kushi (ORCID: https://orcid.org/0000-0001-9136-1175)
- Rachael Burganowski
- Sara Tabatabai (ORCID: https://orcid.org/0000-0002-5498-7176)
- Erin J. Aiello Bowles (ORCID: https://orcid.org/0000-0001-6287-7391)
- Sonia Persaud (ORCID: https://orcid.org/0009-0008-5666-7994)
- Yuriy Kotsurovskyy (ORCID: https://orcid.org/0000-0002-1288-518X)
- Grace B Gallagher
- Janise M. Roh (ORCID: https://orcid.org/0000-0002-8615-4320)
- Narre Heon (ORCID: https://orcid.org/0009-0003-5239-0821)
- Candyce H. Kroenke (ORCID: https://orcid.org/0000-0002-6128-3118)
- Jennifer J. Griggs (ORCID: https://orcid.org/0000-0002-9587-5621)
- Elizabeth D. Kantor (ORCID: https://orcid.org/0000-0002-9124-5323)
- Victoria Blinder (ORCID: https://orcid.org/0000-0002-1448-8671)
- Cecile A. Laurent (ORCID: https://orcid.org/0000-0001-9332-6971)
- Sankeerth Jinna (ORCID: https://orcid.org/0000-0001-8478-5017)
- Peng Wang (ORCID: https://orcid.org/0000-0003-4303-6081)
Institutions
- Rutgers, The State University of New Jersey (US)
- Memorial Sloan Kettering Cancer Center (US)
- Kaiser Permanente (US)
- Kaiser Permanente Washington Health Research Institute (US)
- University of Michigan (US)
- Kaiser Permanente Vallejo Medical Center (US)
- Kaiser Permanente San Francisco Medical Center (US)
- Rutgers Cancer Institute (US)
Publication Details
- Journal
- npj Breast Cancer
- Published
- 2025-10-29
- DOI
- https://doi.org/10.1038/s41523-025-00833-9
- Primary Topic
- Cancer Risks and Factors
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Memorial Sloan-Kettering Cancer Center
- Geoffrey Beene Cancer Research Center
- National Institutes of Health
- National Cancer Institute