What question did this study set out to answer?

Evaluate differences in weight loss and intervention engagement among breast cancer patients by language and ethnicity.

February 19, 2026

Abstract PS4-09-29: Variation in weight loss and intervention engagement in the Breast Cancer Weight Loss (BWEL) trial by language and ethnicity (Alliance)

Key Result

Spanish-preferred Hispanic breast cancer patients lost 2.4% weight at 12 months, less than English-preferred Hispanics (3.3%) and non-Hispanics (5.1%), with lower intervention engagement.

Key Points

Evaluate differences in weight loss and intervention engagement among breast cancer patients by language and ethnicity.
Randomized trial comparing weight loss intervention plus health education (WLI + HE) to health education (HE) alone.
Patients received semi-structured telephone coaching in English or Spanish with additional resources.
Statistical tests assessed demographic and treatment factors; means and percent weight changes were compared by ethnicity and language.
Hispanic patients showed lower weight loss at 12 months compared to non-Hispanic patients.
Spanish-preferred Hispanic patients were younger and had lower BMI than English-preferred Hispanic and non-Hispanic patients.
Engagement metrics showed fewer calls and less activity monitor usage among Spanish-preferred Hispanic patients despite receiving interventions in their preferred language.

Structured PICO

Does language preference and ethnicity affect weight loss and intervention engagement in breast cancer patients undergoing a telephone-based weight loss intervention?

Population

1,591 patients with stage II-III HER2-negative breast cancer and a body mass index (BMI) > 27 kg/m2 randomized to the weight loss intervention arm (1,190 analyzed with 12-month weight and language data).

Intervention

2-year telephone-based weight loss intervention (WLI) + health education (HE), including semi-structured telephone-based health coaching in English or Spanish, access to an activity monitor, wireless scale, and meal replacement shakes.

Comparator

Health education (HE) alone (main trial); however, this analysis compared subgroups within the WLI arm (Spanish-preferred Hispanic vs. English-preferred Hispanic vs. non-Hispanic).

Outcome

Percent weight change and intervention engagement (intervention attrition, number of calls, call duration, number of shake shipments, and frequency of activity monitor use and weight tracking) over 12 months.surrogate

In a large phase III trial of breast cancer patients, engagement and weight loss were lower in Spanish-preferred Hispanic patients despite the provision of the intervention in Spanish, highlighting the need for improved accessibility.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract BACKGROUND: Obesity is prevalent in Hispanic patients (pts) with breast cancer (BC), but this population is often underrepresented in studies of weight loss interventions (WLIs). The BWEL trial (Alliance A011401; NCT02750826) is a phase III randomized trial testing the impact of a 2-year (yr) telephone-based WLI on invasive disease-free survival in pts with stage II-III HER2-negative BC and a body mass index (BMI) 27 kg/m2. At 12 months (mo), Hispanic pts lost less weight than White pts on the WLI. Here, we evaluate differences in intervention engagement over the first 12 mo by language preference and ethnicity among BWEL pts on the WLI. METHODS: BWEL randomized pts 1:1 to WLI + health education (HE) or HE alone. WLI +HE pts received semi-structured telephone-based health coaching in English or Spanish, in addition to access to an activity monitor, wireless scale and meal replacement shakes. Pts self-reported ethnicity and their preferred language for the WLI. Kruskal Wallis and chi-square tests were used to assess language and ethnicity differences in demographic and treatment factors for continuous and categorical variables, respectively. Percent weight change and mean values for intervention attrition, number of calls, call duration, number of shake shipments, and frequency of activity monitor use and weight tracking over 12 mo were compared between Spanish-preferred Hispanic pts (SH), English-preferred Hispanic (EH) pts and non-Hispanic (NH) pts using ANOVA. Pts with missing language, ethnicity or 12 mo weight data were excluded from analysis. RESULTS: 1591 pts were randomized to the WLI + HE from 08/2018 to 02/2021. 80.5% of pts were White, 12.8% Black and 7.1% Hispanic. 1190 pts had 12 mo weight and language available. Among the 87 WLI + HE pts who had available data and identified as Hispanic, 34% were SH and 66% EH. SH WLI pts were younger (in yrs: 49.5 SH, 51.1 EH, 53.9 NH, p=0.006) and had lower BMI (32.2 SH, 35.1 EH, 34.5 NH, p=0.007). At 12 mo, SH WLI pts lost 2.4% of baseline body weight vs 3.3% in EH and 5.1% in NH (p=0.051) (Table). Compared with EH and NH WLI pts, SH WLI pts participated in fewer calls (15.7 SH, 21.1 EH, 24.3 NH, p 0.0001), had fewer days of activity monitor use (134.2 SH, 177.3 EH, 205.3 NH, p=0.015) and fewer days of weight tracking (65.3 SH, 96.8 EH, 148.2 NH, p0.0001), but had more shake shipments (3.9 SH, 3.5 EH, 3.0 NH, p=0.015). There were no significant differences in attrition rate or call duration by language preference or ethnicity. CONCLUSIONS: In a large phase III WLI study in breast cancer patients, engagement with the WLI appeared lower in SH pts, despite provision of the intervention in Spanish. More work is needed to improve accessibility and efficacy of WLI studies among non-English speaking populations. Support: U10CA180821, U10CA180882, UG1CA189823; https://acknowledgments.alliancefound.org. Citation Format: A. Odai-Afotey, K. V. Ballman, L. M. McCall, C. Cao, C. Alfano, V. Bernstein, T. E. Crane, L. M. Delahanty, L. Frank, P. J. Goodwin, O. Hahn, D. L. Hershman, J. O. Hopkins, M. Irwin, E. L. Mayer, L. Minasian, L. Nebeling, M. Neuhouser, E. D. Paskett, P. A. Spears, V. Stearns, C. A. Thomson, T. A. Wadden, A. Weiss, J. White, C. Hudis, E. P. Winer, L. Carey, A. H. Partridge, J. Ligibel. Variation in weight loss and intervention engagement in the Breast Cancer Weight Loss (BWEL) trial by language and ethnicity (Alliance) abstract. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-09-29.

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