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Adherence to nutrition, physical activity guidelines reduces colon cancer mortality risk

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April 12, 2018

Following American Cancer Society’s exercise, weight and nutrition guidelines appeared associated with a reduced risk for death among patients with colon cancer, study data showed.

“In response to the need for improved survivorship care, the American Cancer Society published guidelines for nutrition during and after cancer treatment in 2001,” Erin L. Van Blarigan, ScD, assistant professor of epidemiology and biostatistics at University of California, San Diego, and colleagues wrote.

The guidelines recommend patients achieve and maintain a healthy body weight; engage in regular physical activity; and eat a diet high in vegetables, fruits and whole grains.

“It is not known, however, whether following the guidelines after colorectal cancer diagnosis is associated with reduced risk [for] recurrence or mortality,” the researchers wrote.

The researchers performed a prospective cohort study of 992 patients (mean age, 59.6 years; 43% women) with stage 3 colon cancer enrolled in the CALGB 89803 randomized trial of adjuvant chemotherapy from 1999 through 2001; data for the current study was collected between November 2016 and December 2017.

The researchers assigned each patient a score — which ranged from 0 to 6, with a higher number indicating a healthier lifestyle — based on adherence to American Cancer Society guidelines for BMI, physical activity and dietary intake. A secondary evaluation included a score from 0 to 8 that also factored in alcohol use.

Van Blarigan and colleagues assessed patients’ lifestyles during chemotherapy and 6 months after treatment. OS served as the primary outcome.

Median follow-up was 7 years.

Researchers observed 335 recurrences and 299 deaths; 43 deaths occurred without recurrence.

Patients who had American Cancer Society guidelines scores of 5 to 6 (n = 91; 9%) had a 42% lower risk for death during the study period than those who had scores of 0 to 1 (n = 262; 26%; HR = 0.58; 95% CI, 0.34-0.99). These patients also had improved DFS (HR = 0.69; 95% CI, 0.45-1.06).

When the researchers included alcohol consumption in patients’ scores, those with scores of 6 to 8 (n = 162; 16%) had improved OS (HR = 0.49; 95% CI, 0.32-0.67), DFS (HR = 0.58; 95% CI, 0.4-0.84) and RFS (HR = 0.64; 95% CI, 0.44-0.94) compared with patients with scores of 0 to 2 (n = 187; 19%).

Data show that a cancer diagnosis does not always prompt behavioral change and adherence to healthy lifestyle guidelines, Michael J. Fisch, MD, medical director of medical oncology at AIM Specialty Health in Chicago, and colleagues wrote in an accompanying editorial.

“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 of lifestyle change and how to use technology for learning,” they wrote. “Success for patients also includes avoidance of nihilism, fatalism and unproven approaches such as fad diets or detoxification programs. In addition to having guidelines, we need implementation research to investigate methods that promote systematic uptake of guidelines.” by Andy Polhamus

Disclosures: The CALGB trial was partially funded by Pharmacia and Upjohn Company (now Pfizer Oncology). The authors report no relevant financial disclosures. Fisch is an employee of AIM Specialty Health, a subsidiary of Anthem Inc.

itj+ Infographic

Patients who closely adhered to American Cancer Society guidelines had a 42% lower risk for death during the study period than those who did not.