ASCO 2017: Healthy Lifestyle After Colon Cancer Diagnosis Helps Extend Survival

Key Points

  • The 91 survivors who had the highest healthy lifestyle scores had a 42% lower risk of death and a trend for reduced chance of recurrence than the 262 survivors with the lowest lifestyle scores.
  • When drinking alcohol was included in the score, the 162 survivors with the highest lifestyle score had a 51% lower chance of death and a 36% lower chance of cancer recurrence than the 187 survivors who had the lowest healthy lifestyle scores.
  • The associations were not driven by any particular lifestyle factor; body weight, regular physical activity, and a healthy diet were all important. 

A study of 992 patients with stage III colon cancer found that those who reported a healthy lifestyle during and following adjuvant treatment had a 42% lower chance of death and a trend for lower chance of cancer recurrence than those who had less healthy lifestyles. The study will be presented by Van Blarigan et al at the upcoming 2017 ASCO Annual Meeting in Chicago (Abstract 10006).

“There are over 1.3 million colorectal cancer survivors in the United States. These patients need survivorship care, including guidance on what they can do to lower their risk of recurrence,” said lead study author Erin Van Blarigan, ScD, Assistant Professor of Epidemiology and Biostatistics, University of California, San Francisco. “In response to patient interest and need, the American Cancer Society (ACS) published ‘Nutrition and Physical Activity Guidelines for Cancer Survivors’ in 2012, but it is not known if following the guidelines after cancer diagnosis is associated with improved outcomes.”

This study found that colon cancer patients whose lifestyle matched the ACS guidelines had longer disease-free survival and overall survival.

ACS Guidelines Study

The patients were enrolled from 1999 to 2001 as part of the CALGB 89803 (Alliance) clinical trial, which looked at the effect of two types of adjuvant chemotherapy for colon cancer on cancer recurrence and death. Lifestyle was assessed twice as part of the trial using validated surveys. Patients were assigned a score from 0 to 6 that measured the degree to which their lifestyle matched the ACS guidelines for cancer survivors. A score of 0 indicated no healthy behaviors, whereas a score of 6 indicated that the patients observed all of the healthy behaviors. Specifically, researchers assessed individuals based on recommendations for:

  • Maintaining a healthy body weight
  • Engaging in regular physical activity
  • Eating a diet rich in whole grains, vegetables, and fruits and low in red and processed meat

Each of the healthy behaviors was equally weighted, but assessing dietary components was a bit more complex, as the researchers had to score red and processed meat, whole grains, and vegetables and fruits individually and then build an overall dietary score.

Key Findings

Over a median follow-up of 7 years, the 91 survivors who had the highest healthy lifestyle scores (5–6 points) had a 42% lower risk of death and a trend for reduced chance of recurrence than the 262 survivors with the lowest lifestyle scores (0–1 points). When drinking alcohol was included in the score, the 162 survivors with the highest lifestyle score (6–8 points) had a 51% lower chance of death and a 36% lower chance of cancer recurrence than the 187 survivors who had the lowest healthy lifestyle scores (0–2 points). The associations were not driven by any particular lifestyle factor; body weight, regular physical activity, and a healthy diet were all important.

The researchers note that many cancer survivors have ongoing health problems, such as diabetes or heart disease, and a healthy lifestyle can help improve overall health. They further emphasize that their study’s novel findings indicate that a healthy lifestyle may improve colon cancer–specific outcomes as well.

Commentary

“Our research team is conducting clinical trials to evaluate the feasibility and acceptability of digital health lifestyle interventions such as Fitbit for colorectal cancer patients,” said Dr. Van Blarigan. “If our interventions are acceptable and useful to patients, we will test their impact on the risk of cancer recurrence and mortality in future studies.”

“This study clearly shows that in addition to good, standard cancer treatment, which has reduced mortality due to colorectal cancer substantially, what patients eat, drink, and do afterward can make a difference,” said ASCO President Daniel F. Hayes, MD, FACP, FASCO. “Patients often ask what else they can do in addition to chemotherapy to prevent their cancer from coming back, and the good news is that we have some information to point them to from a fairly large dataset.”

“It should be emphasized that the authors are not suggesting that a healthy lifestyle alone should be considered a substitute for standard chemotherapy and other treatments for colon cancer, which have dramatically improved survival. Rather, patients with colon cancer should be optimistic, and they should eat a healthy diet and exercise regularly, which may not only keep them healthier, but may also further decrease the chances of the cancer coming back,” concluded Dr. Hayes.

This study received funding from the National Cancer Institute.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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