Impact of Lifestyle Choices on Outcomes in Survivors of Gastrointestinal Cancers

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The dissemination and implementation of effective interventions to increase physical activity and decrease alcohol use after cancer diagnosis are warranted.
— Jennifer Steel, PhD

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Physical inactivity among adult survivors of gastrointestinal cancers was tied to poor health-related quality of life, according to researchers at the American Psychosocial Oncology Society (APOS) Annual Meeting.1 Also, physical inactivity (Chi-square = 5.605, P = .018) and alcohol use (Chi-square = 4.186, P = .042) after diagnosis of cancer were linked to poorer survival, reported Jennifer Steel, PhD, of the University of Pittsburgh School of Medicine.

“Health behaviors, such as substance abuse, diet, and physical activity, have been studied in relation to the development of cancer,” Dr. Steel said during her presentation. “There have been few longitudinal studies that have looked at these behaviors in regard to disease progression after diagnosis of cancer.”2

Study Details

Dr. Steel and colleagues set out to add to that data with a study that examined the link between health behavior and survival in patients diagnosed with gastrointestinal cancers. They enrolled 411 patients who responded to multiple questionnaires, including the International Physical Activity Questionnaire (IPAQ)3 and Rapid Eating Assessment (REAP).4

The mean age of all the patients at cancer diagnosis was 62; 61.7% were male and 91.1% were white. Hepatocellular and cholangiocarcinoma were the most common diagnoses (42.6%), followed by other primary cancer with liver metastases (37.5%). The mean number of lesions was 3.71, and the mean tumor size was 3.4 cm.

Key Findings

Dr. Steel stated that of the 411 patients, 28% reported they were physically inactive after diagnosis of advanced gastrointestinal cancer, and 20% said they used alcohol. In addition, 19% said they used tobacco, and 19% said they ate less fruits and vegetables than recommended by the Centers for Disease Control and Prevention.

Compared with patients who were moderately or vigorously physically active, patients who reported physical inactivity also reported a lower quality of life (P < .001), the authors stated. However, physical activity levels were not associated with pain in the past week (P = 0.770) or sleep quality (P = 0.524).

The analyses revealed the following factors were significantly associated with overall survival:

  • Gender: Chi-square = 38.59 (P < .001)
  • Diagnosis: Chi-square = 133.33 (P < .001)
  • Cirrhosis: Chi-square = 144.89 (P < .001)
  • Vascular invasion: Chi-square = 202.65 (P < .001)
  • Age at diagnosis: Standardized beta = 0.016 (P < .001)
  • Number of lesions: Standardized beta = –0.026 (P < .001)
  • Body mass index: Standardized beta= –0.0147 (P = .005)
  • Tumor size: Standardized beta = 0.104 (P < .001).

A multivariate analysis in which the authors adjusted for demographic factors, disease-specific factors, and depression showed that physical inactivity (Chi-square = 4.206, P = .043) and alcohol use after diagnosis (Chi-square = –5.324, P = .021) were associated with poorer overall survival.

Clinical Implications

The ASCO Post asked Dr. Steel about some of the potential barriers to physical activity in this patient population. She noted that patients often become more sedentary after a cancer diagnosis due to disease- and treatment-related fatigue, but at her institution, clinicians encourage patients to incorporate small amounts of exercise into their daily lives. This strategy could include getting up and walking around the house several times a day or by starting with walking for 10 minutes and increasing the duration each day. She explained that suggesting this type of physical activity may be more feasible than trying to convince patients to take on a full exercise regimen.


  • Adult survivors of gastrointestinal cancers who are physically inactive may see worse health-related quality of life.
  • Lack of physical activity and alcohol consumption were associated with worse survival.

She also pointed out that they have not yet analyzed the association between the amount of alcohol they consumed and survival and at this time only if they did or did not use alcohol.

The dissemination and implementation of effective interventions to increase physical activity and decrease alcohol use after cancer diagnosis are warranted, the authors concluded. ■

DISCLOSURE: Dr. Steel reported no conflicts of interest.


1. Steel J, Geller D, Miceli J, et al: Physical inactivity and alcohol use predict shorter survival after a diagnosis of gastrointestinal cancer. 2018 American Psychosocial Oncology Society Annual Meeting. Submission 30006253. Presented February 23, 2018.

2. Jeon J, Sato K, Niedzwiecki D, et al: Impact of physical activity after cancer diagnosis on survival in patients with recurrent colon cancer: Findings from CALGB 89803/Alliance. Clin Colorectal Cancer 12:233-238, 2013.

3. Craig CL, Marshall AL, Sjöström M, et al: International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35:1381-1395, 2003.

4. Segal-Isaacson CJ, Wylie-Rosett J, Gans K: Rapid Eating Assessment for Participants (REAP-S). Last modified March 1, 2018. Available at Accessed March 5, 2018.