Lifestyle after colorectal cancer diagnosis in relation to recurrence and all-cause mortality. Issue 6 (1st March 2021)

• Record Type: Journal Article
• Authors: van Zutphen, Moniek; Boshuizen, Hendriek C; Kenkhuis, Marlou-Floor; Wesselink, Evertine; Geijsen, Anne J M R; de Wilt, Johannes H W; van Halteren, Henk K; Spillenaar Bilgen, Ernst Jan; Keulen, Eric T P; Janssen-Heijnen, Maryska L G; Breukink, Stéphanie O; Bours, Martijn J L; Kok, Dieuwertje E; Winkels, Renate M; Weijenberg, Matty P; Kampman, Ellen; van Duijnhoven, Fränzel J B
• Is Part Of: American journal of clinical nutrition. Volume 113:Issue 6(2021)
• Page Start: 1447
• Page End: 1457
• Publication Date: 2021-03-01
• Subjects: colorectal cancer -- survival -- recurrence -- lifestyle -- body mass index -- physical activity -- diet -- alcohol; Diet therapy -- Periodicals; Nutrition -- Periodicals; Dietetics -- Periodicals; 613.205
• DOI: 10.1093/ajcn/nqaa394
• Languages: English
• ISSNs: 0002-9165

Abstract

ABSTRACT: 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.