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Original Investigation
June 2018

Association of Survival With Adherence to the American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors After Colon Cancer DiagnosisThe CALGB 89803/Alliance Trial

Author Affiliations
  • 1Department of Epidemiology and Biostatistics, University of California, San Francisco
  • 2Department of Urology, University of California, San Francisco
  • 3Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
  • 4Alliance Statistics and Data Center, Duke University, Durham, North Carolina
  • 5Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
  • 6Memorial Sloan Kettering Cancer Center, New York, New York
  • 7Toledo Community Hospital Oncology Program, Toledo, Ohio
  • 8Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
  • 9Loyola University, Stritch School of Medicine, Naperville, Illinois
  • 10Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
  • 11Virginia Oncology Associates, Norfolk, Virginia
  • 12Southeast Clinical Oncology Research Consortium, Mission Hospitals Inc, Asheville, North Carolina
  • 13University of Chicago Comprehensive Cancer Center, Chicago, Illinois
  • 14Helen Diller Family Comprehensive Cancer Center, San Francisco, California
  • 15Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco
  • 16Program in Molecular Pathology Epidemiology (MPE), Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
  • 17Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • 18Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
  • 19Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
JAMA Oncol. 2018;4(6):783-790. doi:10.1001/jamaoncol.2018.0126
Key Points

Question  Do patients with colon cancer who follow the American Cancer Society’s Nutrition and Physical Activity Guidelines for Cancer Survivors (ACS guidelines) have better survival rates than those who do not follow these guidelines?

Findings  In this cohort study of 992 patients with colon cancer, a lifestyle consistent with the ACS guidelines was associated with a 42% lower risk of death during the study period. The 5-year survival probability was 85% for patients with high concordance with the guidelines and 76% for patients with low concordance with the guidelines, a 9% absolute reduction in risk of death at 5 years.

Meaning  Patients with colon cancer who follow the ACS guidelines during and after treatment may have a higher 5-year survival rate.

Abstract

Importance  The American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors (ACS guidelines) include maintaining (1) a healthy body weight; (2) physical activity; and (3) a diet that includes vegetables, fruits, and whole grains. It is not known whether patients with colon cancer who follow these guidelines have improved survival.

Objective  To examine whether a lifestyle consistent with the ACS guidelines is associated with improved survival rates after colon cancer.

Design, Setting, and Participants  This 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. Data for the present study were analyzed between November 2016 and December 2017.

Exposures  We assigned an ACS guidelines score for each included patient based on 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). Secondarily, we examined a score that also included alcohol intake in addition to the other factors (range, 0-8). Lifestyle was assessed during and 6 months after chemotherapy.

Main Outcomes and Measures  Hazard ratios (HRs) and 95% confidence intervals (CIs) for disease-free, recurrence-free, and overall survival.

Results  Of the 992 patients enrolled in the study, 430 (43%) were women, and the mean (SD) age was 59.6 (11.2) years (range, 21-85 years). Over a 7-year median follow-up, we observed 335 recurrences and 299 deaths (43 deaths without recurrence). Compared with patients with a 0 to 1 ACS guidelines score (n = 262; 26%), patients with a 5 to 6 score (n = 91; 9%) had a 42% lower risk of death during the study period (HR, 0.58; 95% CI, 0.34-0.99; P = .01 for trend) and improved disease-free survival (HR, 0.69; 95% CI, 0.45-1.06; P = .03 for trend). When alcohol consumption was included in the score, the adjusted HRs comparing patients with scores of 6 to 8 (n = 162; 16%) vs those with scores of 0 to 2 (187; 91%) were 0.49 for overall survival (95% CI, 0.32-0.76; P = .002 for trend), 0.58 for disease-free survival (95% CI, 0.40, 0.84; P = .01 for trend), and 0.64 for recurrence-free survival (95% CI, 0.44-0.94; P = .05 for trend).

Conclusions and Relevance  Having a healthy body weight, being physically active, and eating a diet rich in vegetables, fruits, and whole grains after diagnosis of stage III colon cancer was associated with a longer survival.

Trial Registration  clinicaltrials.gov Identifier: NCT00003835

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