Increased Coffee Consumption Associated With Improved Outcomes in Patients With Advanced or Metastatic Colorectal Cancer

Study results published in JAMA Oncology demonstrated that coffee consumption may be linked to a reduced risk of disease progression and an improvement in survival outcomes in patients with advanced or metastatic colorectal cancer (CRC).

“Abundant experimental and epidemiological data support a link between dietary and other lifestyle factors and the incidence and mortality of this disease,” the study authors wrote. “One such factor that has garnered increasing interest is the consumption of coffee, which possesses antineoplastic properties in the laboratory and may play a role in CRC development and progression.”

Results from a recent study published in the Journal of Clinical Oncology, the authors noted, showed that drinking four or more cups of coffee per day may reduce the risk of disease recurrence and death in patients with stage 3 colon cancer.

However, according to the authors, there was no data on the association between consumption of coffee and survival of patients with advanced or metastatic CRC.

To identify a possible connection between coffee consumption and disease progression and death in patients with advanced or metastatic CRC, the authors conducted a prospective observational cohort study of 1,171 patients who were enrolled on the phase 3 Cancer and Leukemia Group B (Alliance)/SWOG 80405 trial. Now completed, the trial was originally designed to evaluate the efficacy of adding Erbitux (cetuximab) and/or Avastin (bevacizumab) to standard chemotherapy.

Patients were given the option to be included in a diet and lifestyle companion study at the time of trial enrollment. Those who agreed to participate in the companion study then completed a diet and lifestyle survey within the first month of being enrolled on the trial.

A food frequency questionnaire asked patients how often they consumed a specific food portion over the previous three months for 131 food items and vitamin/mineral supplements. A different survey asked patients for their consumption of caffeinated and decaffeinated coffee. There were 10 possible responses with at least six cups per day being the last option patients could select.

The primary goal of the retrospective study was overall survival (OS), or the time from randomization to death due to any cause. Additional secondary goals included progression-free survival (PFS), or time from randomization to first documented disease progression or death.

More than half of the patient population (1,171 patients) consisted of men (694 patients) and the median patient age was 59 years. Most of the patients (86%) were white. Of the patient population, 280 reported not consuming coffee during the previous three months prior to enrollment. The rest were pooled into less than one cup per day (301 patients), one cup per day (298 patients), two to three cups per day (229 patients) or four or more cups per day (63 patients).

Among living patients, average follow-up was 5.4 years. Ninety-three percent of patients had died or had disease progression. Higher coffee consumption, according to multivariable analyses, was associated with a significant improvement in OS and a decreased risk of disease progression.

Median OS for the patients were as follows:

• 31 months for patients who didn’t drink coffee;
• 30 months for those who drank one or less cup per day;
• 32 months for those who drank two to three cups per day, and
• 39 months for those who drank four or more cups per day.

The authors reviewed survival among those who drank any amount of coffee to remove any possible difference between those who did and did not drink coffee. In that analysis, higher coffee intake was still associated with improved OS and PFS.

“This large cohort study detected an association between increased consumption of coffee and improved CRC outcomes,” they wrote. “These findings are consistent with those of previous epidemiological studies, although this is the first such study, to our knowledge, to show a protective effect of coffee consumption in patients with advanced or metastatic CRC.”

The authors noted that there are limitations to the study. For instance, factors such as sleep habits, employment, physical activity not related to dedicated exercise, or coffee consumption following diagnosis were not captured during the trial or in the questionnaire.

“Furthermore, most patients who consume coffee while being treated for cancer likely consumed coffee before the cancer diagnosis, so these results do not allow us to discern whether the consumption of coffee acts directly on active tumors or whether coffee drinkers tend to develop less aggressive tumors,” they concluded. “In a population of patients with advanced cancer, we considered the possibility that coffee drinkers may be more robust or have a lesser burden of cancer; however, we did not find any significant differences in performance status or disease characteristics across categories of coffee consumption.”

More research, according to the authors, is needed to evaluate any underlying biological mechanisms that could be behind these associations.

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