Lifestyle after Colorectal Cancer Diagnosis in Relation to Survival and Recurrence: A Review of the Literature

Zutphen, Moniek van; Kampman, Ellen; Giovannucci, Edward; Duijnhoven, Fränzel J.B. van

doi:10.1007/s11888-017-0386-1

Cited by 62 publications

(61 citation statements)

References 95 publications

(267 reference statements)

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“…Confounding by unmeasured factors is also a possibility as we did not have information on diet and exercise. However, the degree to which these factors may be related to recurrence of colon cancer is unclear . If recurrence risk factors were more common in antidepressant users, then our risk estimates would be falsely high (that is, the true HRs may be closer to the null or less than one).…”

Section: Discussionmentioning

confidence: 93%

“…However, the degree to which these factors may be related to recurrence of colon cancer is unclear. 19,20 If recurrence risk factors were more common in antidepressant users, then our risk estimates would be falsely high (that is, the true HRs may be closer to the null or less than one). We also had limited power, which resulted in a lack of precision to some degree in our HRs, especially those associated with individual classes of antidepressants.…”

Section: Study Limitationsmentioning

confidence: 98%

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Use of antidepressants after colon cancer diagnosis and risk of recurrence

Pocobelli

Ziebell

et al. 2019

Psycho-Oncology

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Objective Prior research examining the association between use of antidepressants after colon cancer diagnosis and risk of recurrence is scant. We evaluated this association among colon cancer patients diagnosed at two integrated health care delivery systems in the United States. Methods We conducted a cohort study of stage I to IIIA colon cancer patients diagnosed at greater than or equal to 18 years of age at Kaiser Permanente Colorado and Kaiser Permanente Washington during 1995 to 2014. We used pharmacy records to identify dispensings for antidepressants and tumor registry records and patients' medical charts to identify cancer recurrences. Using Cox proportional hazards models, we estimated the adjusted hazard ratio (HR) of colon cancer recurrence comparing patients who used antidepressants after diagnosis to those who did not. We also evaluated the risk associated with use of selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) separately. Results Among the 1923 eligible colon cancer patients, 807 (42%) used an antidepressant after diagnosis and 139 had a colon cancer recurrence during an average 5.6 years of follow‐up. Use of antidepressants after colon cancer diagnosis was not associated with risk of recurrence (HR: 1.14; 95% confidence interval [CI], 0.69‐1.87). The HR for use of SSRIs was 1.22 (95% CI, 0.64‐2.30), and for TCAs, it was 1.18 (95% CI, 0.68‐2.07). Conclusions Our findings suggest that use of antidepressants after colon cancer diagnosis was common and not associated with risk of recurrence. Future larger studies with greater power to examine risk associated with individual antidepressants would be valuable additions to the evidence base.

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Section: Discussionmentioning

confidence: 93%

Section: Study Limitationsmentioning

confidence: 98%

Use of antidepressants after colon cancer diagnosis and risk of recurrence

Pocobelli

Ziebell

et al. 2019

Psycho-Oncology

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“…Given the prognostic significance of weight loss in CRC ( 7 ) and its potential to confound associations between BMI and patient outcome, we also conducted analyses of weight change prior to study entry. Weight change data were captured using a self-reported questionnaire completed within 4 weeks after initiating trial therapy, soliciting weight at questionnaire completion and 6 months prior.…”

Section: Methodsmentioning

confidence: 99%

“…Obesity, defined as body mass index (BMI) no less than 30 kg/m 2 , is a risk factor for colorectal cancer (CRC), the second leading cause of cancer-related death in the United States ( 1–6 ). However, the relationship between BMI and patient outcome after CRC diagnosis is less clear ( 7 ). A growing body of evidence suggests that the association between BMI and nonmetastatic CRC survival is U- or J-shaped, wherein overweight and class I obese patients (BMI 25–35 kg/m 2 ) experience the most favorable outcomes ( 8–12 ).…”

mentioning

confidence: 99%

“…The association of high BMI with both increased CRC risk and improved nonmetastatic CRC outcome is referred to as the BMI paradox ( 13 ) and runs contrary to a large body of literature suggesting that factors associated with energy excess increase CRC mortality and disease recurrence ( 14–19 ). The influence of BMI on patients with advanced and metastatic colorectal cancer (mCRC) is relatively unexplored ( 7 ).…”

mentioning

confidence: 99%

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Body Mass Index and Weight Loss in Metastatic Colorectal Cancer in CALGB (Alliance)/SWOG 80405

Guercio

Zhang

Venook

et al. 2020

JNCI Cancer Spectrum

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Background In nonmetastatic colorectal cancer, overweight and mild-to-moderately obese patients experience improved outcomes compared with other patients. Obesity’s influence on advanced or metastatic colorectal cancer (mCRC) is relatively unexplored. Methods We conducted a prospective body mass index (BMI) companion study in Cancer and Leukemia Group B (now Alliance)/SWOG 80405, a phase III metastatic colorectal cancer (mCRC) treatment trial. BMI was measured at trial registration. Primary and secondary endpoints were overall and progression-free survival, respectively. To minimize confounding by poor and rapidly declining health, we used Cox proportional hazards regression to adjust for known prognostic factors, comorbidities, physical activity, and weight loss during the 6 months prior to study entry. We also examined weight loss prior to enrollment as an independent predictor of patient outcome. All statistical tests were two-sided. Results Among 2323 patients with mCRC, there were no statistically significant associations between BMI and overall or progression-free survival (adjusted Ptrend = .12 and .40, respectively). Weight loss during the 6 months prior to study entry was associated with shorter overall and progression-free survival; compared with individuals with stable weight ±4.9%, individuals with weight loss greater than 15% experienced an adjusted hazard ratio of 1.52 for all-cause mortality (95% confidence interval [CI] = 1.26 to 1.84; Ptrend < .001) and of 1.23 for disease progression or death (95% CI = 1.02 to 1.47; Ptrend = .006). Conclusions In this prospective study of patients with mCRC, BMI at time of first-line chemotherapy initiation was not associated with patient outcome. Weight loss prior to study entry was associated with increased risk of patient mortality and disease progression.

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Associations Between Unprocessed Red Meat and Processed Meat With Risk of Recurrence and Mortality in Patients With Stage III Colon Cancer

Blarigan

Bainter

et al. 2022

JAMA Netw Open

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IMPORTANCEThe American Cancer Society and American Institute for Cancer Research recommend that cancer survivors limit intake of red and processed meats. This recommendation is based on consistent associations between red and processed meat intake and cancer risk, particularly risk of colorectal cancer, but fewer data are available on red and processed meat intake after cancer diagnosis.OBJECTIVES To examine whether intake of unprocessed red meat or processed meat is associated with risk of cancer recurrence or mortality in patients with colon cancer. DESIGN, SETTING, AND PARTICIPANTSThis prospective cohort study used data from participants with stage III colon cancer enrolled in the Cancer and Leukemia Group B (CALGB 89803/Alliance) trial between 1999 and 2001. The clinical database for this analysis was frozen on November 9, 2009; the current data analyses were finalized in December 2021.EXPOSURES Quartiles of unprocessed red meat and processed meat intake assessed using a validated food frequency questionnaire during and 6 months after chemotherapy. MAIN OUTCOMES AND MEASURESHazard ratios (HRs) and 95% CIs for risk of cancer recurrence or death and all-cause mortality. RESULTSThis study was conducted among 1011 patients with stage III colon cancer. The median (IQR) age at enrollment was 60 (51-69) years, 442 patients (44%) were women, and 899 patients (89%) were White. Over a median (IQR) follow-up period of 6.6 (1.9-7.5) years, we observed 305 deaths and 81 recurrences without death during follow-up (386 events combined). Intake of unprocessed red meat or processed meat after colon cancer diagnosis was not associated with risk of recurrence or mortality. The multivariable HRs comparing the highest vs lowest quartiles for cancer recurrence or death were 0.84 (95% CI, 0.58-1.23) for unprocessed red meat and 1.05 (95% CI, 0.75-1.47) for processed meat. For all-cause mortality, the corresponding HRs were 0.71 (95% CI, 0.47-1.07) for unprocessed red meat and 1.04 (95% CI, 0.72-1.51) for processed meat. CONCLUSIONS AND RELEVANCEIn this cohort study, postdiagnosis intake of unprocessed red meat or processed meat was not associated with risk of recurrence or death among patients with stage III colon cancer.

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Lifestyle after Colorectal Cancer Diagnosis in Relation to Survival and Recurrence: A Review of the Literature

Cited by 62 publications

References 95 publications

Use of antidepressants after colon cancer diagnosis and risk of recurrence

Use of antidepressants after colon cancer diagnosis and risk of recurrence

Body Mass Index and Weight Loss in Metastatic Colorectal Cancer in CALGB (Alliance)/SWOG 80405

Associations Between Unprocessed Red Meat and Processed Meat With Risk of Recurrence and Mortality in Patients With Stage III Colon Cancer

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