ACS Survivorship Guidelines for Healthy Behaviors Beneficial for Colon Cancer Survivors

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Maintaining a healthy body weight and regular physical activity can improve colon cancer survival.
Maintaining a healthy body weight and regular physical activity can improve colon cancer survival.
The following article features coverage from the 2017 American Society of Clinical Oncology Annual Meeting in Chicago, Illinois. Click here to read more of Oncology Nurse Advisor's conference coverage. 

Maintaining healthy lifestyle habits after adjuvant chemotherapy for stage III colon cancer results in lower risk of death and a trend toward lower risk of cancer recurrence, according to a study to be presented at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting.1,2

“There are over 1.3 million colorectal cancer survivors in the United States. These patients need survivorship care, including guidance on what they can do to lower their risk of recurrence,” said Erin Van Blarigan, ScD, assistant professor of Epidemiology and Biostatistics, University of California San Francisco.2

In 2012, the American Cancer Society (ACS) published “Nutrition and Physical Activity Guidelines for Cancer Survivors.” The guidelines recommend maintaining a healthy body weight, engaging in regular physical activity, and eating a diet high in vegetables, fruits, and whole grains. However, whether following these guidelines improves outcomes is not known.

Therefore, Dr Van Blarigan and colleagues conducted a prospective study involving 992 patients with stage III colon cancer who were enrolled in an adjuvant chemotherapy trial (Combination Chemotherapy in Treating Patients with Stage III Colon Cancer [ClinicalTrials.gov Identifier: NCT00003835]) to investigate the effects of following the ACS guidelines.

For the study, adherence to the ACS guidelines was quantified by assigning a score of 0 to 6 points to patients based on body mass index (BMI); physical activity; and dietary intake of vegetables, fruits, whole grains, and red/processed meats. A score of 0 indicated no healthy behaviors were practiced, and a score of 6 indicated all healthy behaviors were practiced.

Although alcohol is included in the ACS guidelines for cancer prevention, it is not included in the guidelines for cancer survivorship. Therefore, the researchers applied scores without and with alcohol consumption using the cut points: 0 points for more than 1 drink per day for women and more than 2 drinks per day for men; 1 point for no alcohol consumption; 2 points for 0 to 1 drink per day for women and 0 to 2 drinks per day for men. Hazard ratio (HR) and 95% confidence interval (CI) were estimated for disease-free survival, recurrence-free survival, and overall survival, adjusting for clinical, demographic, and lifestyle factors.

Over a median follow-up of 7 years, 335 recurrences and 299 deaths, 43 without recurrence, were observed.

Scores that did not include alcohol consumption showed that patients who scored 5 to 6 points (91 [9%]) had a 42% lower risk of death (HR, 0.58; 95% CI, 0.34, 0.99; Ptrend =.01) and a trend toward improved DFS (HR, 0.69; 95% CI, 0.45, 1.06; Ptrend =.03), compared with those patients who scored 0 to 1 point (262 [26%]).

When alcohol consumption was included in the score, patients who scored 6 to 8 points (162 [16%]) had a 51% lower chance of death (HR, 0.49; 95% CI, 0.32-0.76; Ptrend =.002) and a 36% lower chance of cancer recurrence (adjusted HR, 0.49, 95% CI, 0.40-0.84; Ptrend =.01) than those who scored 0 to 2 points (187 [91%]).

These findings demonstrate that patients who maintained a healthy body weight, engaged in physical activity, and ate a diet high in whole grains, vegetables, and fruits and low in red/processed meats, and limited their alcohol consumption had longer disease-free survival and overall survival than patients who did not engage in these behaviors. 

Read more of Oncology Nurse Advisor's coverage of the 2017 American Society of Clinical Oncology Annual Meeting by visiting the conference page.

References

1. 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), recurrent-free (RFS), and overall survival (OS) in CALGB 89803 (Alliance). Oral presentation at: 2017 American Society of Clinical Oncology Annual Meeting; June 2-6, 2017; Chicago, IL. Abstract 10006.

2. Healthy lifestyle after colon cancer diagnosis helps patients live longer [news release]. Alexandria, VA: American Society of Clinical Oncology; May 17, 2017. 
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