Physical Activity, Healthy Diet Improve Survival in Colorectal Cancer: Study at ASCO

A collaborative study, conducted at various cancer institutions across the United States, evaluated the impact of following the 2012 American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors and concluded that patients with colon cancer who had a healthy body weight, who engaged in physical activity, and ate a healthy diet had longer overall and disease-free survival (OS and DFS, respectively). Results from the 7-year median follow-up will be presented at the annual meeting of the American Society of Clinical Oncology (ASCO), which kicks off on June 2 in Chicago, Illinois.

More than 1.3 million have been diagnosed with colorectal cancer (CRC) in the United States. While the ACS released its guidelines for CRC survivors, the authors were curious to find out if it did improve outcomes among patients who adhered to those guidelines. The prospective study included 992 stage III colon cancer patients who received adjuvant chemotherapy between 1999 and 2001. Researchers assessed lifestyle twice and assigned a score, known as the McCullough score, that quantified patient adherence to the guidelines in the context of their body mass index; physical activity; and a diet of vegetables, whole grains, and red or processed meats. While alcohol was included in the guideline for cancer prevention, it was not included in the survivor guide. Even so, the authors included alcohol in calculating the McCullough score.

Recommendation

Score

Achieve and maintain a healthy body weight

0: BMI ≥30 kg/m² (obese)

1: BMI ≥25- <30 kg/m² (overweight)

2: 0: BMI 18.5- < 25 kg/m² (normal weight)

Regular physical activity

0: <8.75 MET-hours/week

1: 8.75- <17.5 MET-hours/week

2: ≥17.5 MET-hours/week

Dietary pattern high in vegetables, fruits, and whole grains; low in red and processed meat

0: 0-2 diet points

1: 3-6 diet points

2: 7-9 diet points

Alcohol, up to 1/day (women) or 2/day (men)

0: >1/day 9w), >2/day (m)

1: non drinker

2: up to 1/day (w), 2/day (m)

BMI indicates body mass index; m, men; MET, metabolic equivalent of task; w, women.

The study documented 335 recurrences and 299 deaths (43 without recurrence) during the follow-up period. Patients who scored between 5 and 6 points (91, 9%) had a 42% lower risk of death (hazard ratio [HR], 0.58; 95% CI, 0.34-0.99) compared with those who scored between 0 and 1 (262, 26%). The higher-scoring group of patients also had a better DFS (HR, 0.69; 95% CI, 0.45-1.06) compared with their lower-scoring counterparts.

Including alcohol intake in the score further reduced the hazard if the patients were moderate consumers.

Based on their results, the authors concluded that patients with CRC with higher lifestyle scores had a lower risk of death. Meaning, those who had a healthy body weight; engaged in regular physical activity; ate a diet rich in fruits, vegetables, whole grains and low in processed and red meats; and drank small to moderate amounts of alcohol had longer DFS and OS compared to those patients who did not.

The abstract highlighted during the ASCO annual meeting presscast and will be presented on June 2nd at the meeting.