Feasibility and Acceptability of Time-Restricted Eating During Chemotherapy for Breast Cancer

Worldwide, breast cancer is the most frequently diagnosed cancer in females, leading to over 4 million women living with this disease. Within the United States (U.S.), one in eight women will receive a breast cancer diagnosis. Five- and ten-year survival rates have improved significantly over the years due to improvements in screening, early detection, and treatment. However, common treatments still come with side effects that decrease quality of life and may lead to factors that increase the risk of recurrence, cardiovascular disease and all-cause mortality. Additionally, social determinants of health may further increase these risks. This dissertation research examines community-level factors and diet interventions that may affect body weight and composition, treatment related outcomes, and patient-reported quality of life in women undergoing treatment for breast cancer. Presented within this dissertation is a progression aimed at addressing weight and body composition changes in patients with breast cancer, moving from community-level, social determinants of health to a targeted, individual-level diet intervention. First, we completed an analysis of patients diagnosed with breast cancer at University of Illinois Health and Hospital System (UI Health) who were followed 18-months to examine change in weight and body mass index (BMI) and the association with neighborhood area deprivation. This is followed by a review on individual level-interventions through a systematic review on current diet and lifestyle interventions for patients undergoing acute treatment for breast cancer that reported on outcomes specific to body weight and composition, treatment related outcomes and patient reported quality of life. Finally, informed by the systematic review, we narrowed our focus to one promising area of interventions, intermittent fasting. We report on of the feasibility and acceptability of time-restricted eating, a form of intermittent fasting, among women receiving chemotherapy treatment for breast cancer at UI Health. We also explored the preliminary effects of time restricted eating (TRE) on body weight and composition, treatment related outcomes, and patient-reported quality of life. The research within this dissertation highlights the importance of both community and individual-level factors as well as highlighting current lifestyle interventions that may impact a patient’s weight trajectory after a breast cancer diagnosis. We completed a single arm pilot trial demonstrating the feasibility and acceptability of a TRE intervention among women diagnosed with breast cancer, initiating chemotherapy. Although feasible and well accepted by participants, we were not able to recruit an adequate sample size indicating the need for multi-site collaborations. Patients following TRE were able to decrease overall weight and BMI while maintaining lean mass and reported increased emotional well-being. The preliminary data generated from this intervention will be used in the development of a fully powered, randomized controlled trial of TRE during chemotherapy for breast cancer.