Healthy Lifestyle Improves Survival Outcomes in Colon Cancer

Following nutrition and physical activity guidelines will actually help improve survival outcomes among patients with colon cancer, according to findings recently published in JAMA Oncology.

As the number of cancer survivors continues to increase, the demand for survivorship care has also been on the rise. Because of these increases, the American Cancer Society (ACS) published guidelines for nutrition and physical activity among colon cancer survivors back in 2001.

The guidelines recommend for individuals to maintain a healthy body weight, physical activity and a diet that includes vegetables, fruits and whole grains.

However, since the guidelines were published, it is unknown whether patients with colon cancer who follow these guidelines have experienced improved survival or a reduced risk for recurrence.

In the prospective cohort study, 992 patients with stage 3 colon cancer — who were enrolled in the CALGB 89803 randomized adjuvant chemotherapy trial from 1999 through 2001 – were assigned an ACS guidelines score based on body mass index (BMI), physical activity and intake of vegetables, fruits, whole grains and red/processed meats. The score ranged from 0 to 6, with a higher score indicating healthier behaviors.

The researchers also evaluated a score that included alcohol intake in addition to the other factors that ranged from 0 to 8. Lifestyle was assessed during chemotherapy and six months after.

Forty-three percent of patients were women and the mean age was approximately 59 years.

Overall, 335 recurrences and 299 deaths, which included 43 deaths without recurrence, were observed over a seven-year median follow-up.

Patients with a higher ACS guidelines score (5 to 6; 9 percent) had a 42 percent lower risk of death, as well as improved disease-free survival compared with patients with a lower ACS guidelines score (0 to 1; 26 percent).

Similarly, when alcohol consumption was also taken in to consideration, those with higher scores (6 to 8; 16 percent) experienced improved overall, disease-free and recurrence-free survival compared with patients with low scores (0 to 2; 91 percent).

As a result, clinical trials of lifestyle change in colon cancer are necessary, the researchers wrote.

Following these findings, Michael J. Fisch, M.D., MPH, and colleagues from the University of Texas MD Anderson Cancer Center in Houston, added that implementation strategies must also be put in place.

“Patients and families often feel overwhelmed at the complexity surrounding these guidelines, such as deciding what to eat, how to shop, a safe way and safe place for exercise, how to decide on the scope and pace of lifestyle change, and how to use technology for learning,” they wrote in an accompanying editorial.

Some ways to address this include: health care systems developing effective, diverse educational curricula; communities organizing wide-ranging public health campaigns that reach diverse populations on a variety of platforms; and forming collaborations with employers, health insurance plans, health systems, community partners, and with the food, fitness and technology industries.

“Behavior change is notoriously difficult at the individual and population level, but the companion study data from CALGB 898032 further strengthen the call to take aim at extending and improving lives for cancer survivors through changing behaviors related to nutrition and physical activity,” Fisch and colleagues added.