Following healthy lifestyle guidelines may improve survival among colon cancer patients

Patients with stage III colon cancer who had high concordance with the American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors had a five-year survival probability of 85% versus 76% for those with low concordance.

Patients with stage III colon cancer who maintain a healthy body weight, engage in physical activity, and follow a diet that includes vegetables, fruits, and whole grains may have a higher five-year survival rate, a study found.

The prospective cohort study included 992 patients with stage III colon cancer who were enrolled in the CALGB 89803 randomized adjuvant chemotherapy trial from 1999 through 2001. Researchers assigned a score from the American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors (ACS guidelines) for each patient, based on his or her body mass index; physical activity; and intake of vegetables, fruits, whole grains, and red/processed meats (score range, 0-6, with higher score indicating healthier behaviors).

The researchers also scored patients' alcohol intake in addition to the other factors (range, 0-8). They assessed patients' lifestyles during and six months after chemotherapy. Results were published April 12 by JAMA Oncology.

Over a seven-year median follow-up of 992 patients, there were 335 recurrences and 299 deaths (43 deaths without recurrence). The five-year survival probability was 85% for patients with high concordance with the guidelines and 76% for patients with low concordance with the guidelines, for a 9% absolute reduction in risk of death.

Compared to patients with a 0 to 1 ACS guidelines score (n=262; 26%), patients with a score of 5 to 6 (n=91; 9%) had a significantly lower risk of death during the study period (hazard ratio [HR], 0.58; 95% CI, 0.34 to 0.99; P=0.01 for trend) and improved disease-free survival (HR, 0.69; 95% CI, 0.45 to 1.06; P=0.03 for trend). When alcohol consumption was considered, the adjusted HRs comparing patients with scores of 6 to 8 (n=162; 16%) to those with scores of 0 to 2 (n=187; 19%) were 0.49 for overall survival (95% CI, 0.32 to 0.76; P=0.002 for trend), 0.58 for disease-free survival (95% CI, 0.40 to 0.84; P=0.01 for trend), and 0.64 for recurrence-free survival (95% CI, 0.44 to 0.94; P=0.05 for trend).

An editorial stated that a cancer diagnosis does not necessarily lead patients to adhere to healthy-lifestyle guidelines. “Behavior change is notoriously difficult at the individual and population level, but the companion study data from CALGB 89803 further strengthen the call to take aim at extending and improving lives for cancer survivors through changing behaviors related to nutrition and physical activity,” the editorial said.