Behavioral Interventions May Promote Weight Loss in Breast Cancer Survivors

Episodic future thinking (EFT), a behavioral strategy that directs individuals to mentally simulate positive, detailed, personal, and future-oriented events, may help breast cancer (BC) survivors lose weight, according to a study published at the 2024 American Society of Clinical Oncology Annual Meeting.

“EFT targets delay discounting (DD), a behavioral economic principle that measures valuation of long-term, future rewards. Higher DD correlates with bias of immediate gratification and maladaptive health behaviors. EFT can decrease impulsivity and improve body weight (BW) in those with obesity. However, EFT may impact cancer survivors differently,” the researchers noted.

This analysis consisted of 46 women with nonmetastatic BC who had a body mass index ≥25 kg/m² and completed BC treatment apart from endocrine therapy. Patients in the study population received lifestyle counseling, referral to a nutritionist, and logged exercise and diet in the MyFitnessPal app. Individuals were stratified based on DD and randomized 1:1 to 12 weeks of EFT versus episodic recent thinking (ERT), in which patients imagine events in the past (control). The primary outcome of interest was adherence to EFT. Secondary end points were 12-week change in BW and DD.

According to the results, there was a high average adherence to the interventions consistent with the 80% target (EFT, 77%; 95% CI, 0.69-0.85; ERT, 82%; 95% CI, 0.78-0.86). BW at 12 weeks was available in 74% of EFT patients and 83% of ERT patients. The results showed a significant 12-week change in BW in all patients (−4.0 pounds; 95% CI, −6.08 to −1.79; P<.001; −2.03 pounds; 95% CI, −3.15 to −0.91; P<.001) but no significant difference between groups (pounds, −2.28 EFT vs −5.42 ERT; 95% CI, −7.41 to 1.14; P=.1; −1.07 EFT vs −5.20 ERT; 95% CI, −4.01 to 0.37; P=.1).

“The high adherence supports the feasibility of implementing EFT and engaging digital health for remotely delivered weight loss in BC survivors. BW loss was globally observed, despite low baseline DD in the majority,” the researchers concluded. They added that “further investigation of EFT in combination with lifestyle intervention is needed to formally assess efficacy in this population.”