Lifestyle after colorectal cancer diagnosis in relation to recurrence and all-cause mortality

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.

Health-Promoting Lifestyle in Colorectal Cancer Survivors: A Qualitative Study on the Experiences and Perspectives of Colorectal Cancer Survivors and Healthcare Providers

“…[ 18 ] Overall lifestyle (including body weight, physical activity, diet, and alcohol intake) after diagnosis was not associated with CRC recurrence, while it was inversely associated with all-cause mortality. [ 89 ]…”

Modified WCRF/AICR Score and All-Cause, Digestive System, Cardiovascular, Cancer and Other-Cause-Related Mortality: A Competing Risk Analysis of Two Cohort Studies Conducted in Southern Italy

“…The lower risk of death associated with a higher consumption of fruits and vegetables may be the result of inverse associations with diseases of the circulatory, respiratory and digestive systems [56]. Emerging evidence has shown that lifestyle, including diet, after a Colorectal Cancer (CRC) diagnosis might affect all-cause and CRC-specific mortality risk, in particular, in terms of risk of relapse, mortality [57] and survival [58]. Other studies have highlighted that lifestyle and eating habits are associated with gastric adenocarcinoma [59].…”

Identification of Lifestyle Behaviors Associated with Recurrence and Survival in Colorectal Cancer Patients Using Random Survival Forests

“…Efforts to quantify overall lifestyle in CRC survivors have been limited to assessing adherence to lifestyle recommendations [ 14 , 23 , 24 ]. Previous studies among CRC survivors showed that an overall healthy lifestyle after CRC diagnosis was associated with improved survival [ 14 , 24 ], but not among long-term survivors [ 23 ]. The results regarding CRC recurrence were inconsistent [ 14 , 24 ].…”

“…Previous studies among CRC survivors showed that an overall healthy lifestyle after CRC diagnosis was associated with improved survival [ 14 , 24 ], but not among long-term survivors [ 23 ]. The results regarding CRC recurrence were inconsistent [ 14 , 24 ]. Our group reported that post-diagnosis lifestyle might be more important than lifestyle before diagnosis, as the summary lifestyle score before CRC diagnosis was not associated with all-cause mortality [ 24 ].…”

“…The results regarding CRC recurrence were inconsistent [ 14 , 24 ]. Our group reported that post-diagnosis lifestyle might be more important than lifestyle before diagnosis, as the summary lifestyle score before CRC diagnosis was not associated with all-cause mortality [ 24 ]. There have been no studies that have identified which post-diagnosis lifestyle behaviors are most important in relation to mortality or recurrence.…”