4.7 Article

Lifestyle after colorectal cancer diagnosis in relation to recurrence and all-cause mortality

Journal

AMERICAN JOURNAL OF CLINICAL NUTRITION
Volume 113, Issue 6, Pages 1447-1457

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1093/ajcn/nqaa394

Keywords

colorectal cancer; survival; recurrence; lifestyle; body mass index; physical activity; diet; alcohol

Funding

  1. Wereld Kanker Onderzoek Fonds and World Cancer Research Fund International
  2. World Cancer Research Fund International Regular Grant Programme [2014/1179]
  3. Alpe d'Huzes/Dutch Cancer Society [UM 2012-5653, UW 2015-7946, UW 2013-5927]
  4. European Research Area Network (ERA-NET) on Translational Cancer Research (TRANSCAN: Dutch Cancer Society) [UW2013-6397, UW2014-6877]
  5. Netherlands Organization for Health Research and Development (ZonMw)
  6. Stichting Alpe d'Huzes within the research program Leven met kanker of the Dutch Cancer Society [UM 2010-4867, UM2012-5653]
  7. ERA-NET on Translational Cancer Research (TRANSCAN: Dutch Cancer Society) [UM 2014-6877]
  8. Kankeronderzoekfonds Limburg as part of Health Foundation Limburg [00005739]

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The study found that having a healthy lifestyle and improving lifestyle after a colorectal cancer diagnosis does not increase the risk of cancer recurrence, but significantly reduces the risk of all-cause mortality.
Background: An unhealthy lifestyle is associated with the risk of colorectal cancer (CRC), but it is unclear whether overall lifestyle after a CRC diagnosis is associated with risks of recurrence and mortality. Objectives: To examine associations between postdiagnosis lifestyle and changes in lifestyle after a CRC diagnosis with risks of CRC recurrence and all-cause mortality. Methods: The study population included 1425 newly diagnosed, stage I-III CRC patients from 2 prospective cohort studies enrolled between 2010 and 2016. Lifestyle, including BMI, physical activity, diet, and alcohol intake, was assessed at diagnosis and at 6 months postdiagnosis. We assigned lifestyle scores based on concordance with 2 sets of cancer prevention guidelines-from the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) and the American Cancer Society (ACS)-and national disease prevention guidelines. Higher scores indicate healthier lifestyles. We computed adjusted HRs and 95% CIs using Cox regression. Results: We observed 164 recurrences during a 2.8-year median follow-up and 171 deaths during a 4.4-year median follow-up. No associations were observed for CRC recurrence. A lifestyle more consistent with the ACS recommendations was associated with a lower all-cause mortality risk (HR per +1 SD, 0.85; 95% CI: 0.73-0.995). The same tendency was observed for higher WCRF/AICR (HR, 0.92; 95% CI: 0.78-1.08) and national (HR, 0.90; 95% CI: 0.77-1.05) lifestyle scores, although these associations were statistically nonsignificant. Generally, no statistically significant associations were observed for BMI, physical activity, diet, or alcohol. Improving one's lifestyle after diagnosis (+1 SD) was associated with a lower all-cause mortality risk for the ACS (HR, 0.80; 95% CI: 0.67-0.96) and national (HR, 0.84; 95% CI: 0.70-0.999) scores, yet was statistically nonsignificant for the WCRF/AICR score (HR, 0.94; 95% CI: 0.78-1.13). Conclusions: A healthy lifestyle after CRC diagnosis and improvements therein were not associated with the risk of CRC recurrence, but were associated with a decreased all-cause mortality risk.

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