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Evidence-Based Oncology July 2017
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Physical Activity, Healthy Diet Improve Survival in Colorectal Cancer: Study at ASCO

Surabhi Dangi-Garimella, PhD
Results from a collaborative study across the United States indicate that patients with colon cancer who had a healthy body weight, engaged in physical activity, and ate a healthy diet had longer survival.
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 Guidelines1 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 (OS) and disease-free survival (DFS). Results from the 7-year median follow-up were presented at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago.2

More than 1.3 million individuals in the United States have been diagnosed with colorectal cancer (CRC). With the ACS’ release of its guidelines for CRC survivors, the authors were curious to find out if they improved outcomes among patients who adhered to them. The prospective study included 992 patients with stage III colon cancer 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 (Table) 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. However, the authors included it in calculating the McCullough score.

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 (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 with those patients who did not.
REFERENCES

1. Nutrition and physical activity guidelines for cancer survivors. American Cancer Society website. cancer.org/health-care-professionals/american-cancer-society-prevention-early-detection-guidelines/nupa-guidelines-for-cancer- survivors.html. Accessed May 31, 2017.

2. Van Blarigan E, Fuchs CS, Niedzwiecki D, et al. American Cancer Society (ACS) Nutrition and Physical Activity Guidelines after colon cancer diagnosis and disease-free (DFS), recurrence-free (RFS), and overall survival (OS) in CALGB 89803 (Alliance). J Clin Oncol. 2017;35(suppl; abstract 10006).
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