From the Journals

Healthy lifestyle linked to better colon cancer survival


Key clinical point: Closely following ACS guidelines on nutrition, physical activity, and BMI correlated with significantly improved 5-year survival in colon cancer patients.

Major finding: Five-year survival probability was 85% for highly guideline-adherent patients and 76% for patients with low adherence (absolute risk reduction, 9%).

Study details: Prospective cohort study of 992 patients with stage III colon cancer.

Disclosures: The National Cancer Institute funded the study. Pharmacia and Upjohn Company (now Pfizer Oncology) partially funded the CALGB 89803/Alliance trial. Dr. Van Blarigan and several of the other investigators were supported by National Cancer Institute awards. No other disclosures were reported.

Source: Van Blarigan EL et al. JAMA Oncol. 2018 Apr 12. doi: 10.1001/jamaoncol.2018.0126.

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Findings help pinpoint recommendations

“If you previously gave [colorectal cancer survivors] vague recommendations about diet and exercise, now you can be more precise and recommend five to six servings per day of fruits and vegetables and 150 minutes per week of exercise,” Michael J. Fisch, MD, MPH; Lorna H. McNeill, PhD, MPH; and Karen M. Basen-Engquist, PhD, MPH, wrote in an accompanying editorial in JAMA Oncology.

Although this was an observational study, the size of the association between survival and high adherence to American Cancer Society Nutrition and Physical Activity Guidelines was “certainly striking,” they wrote.

However, few study patients were younger than 50 years, were nonwhite, or had poor performance status, they noted. Additionally, contemporary adjuvant regimens (FOLFOX and CAPEOX) include oxaliplatin, which can cause chronic neurotoxicities that undermine physical activity.

Nonetheless, the data “strengthen the call to focus on lifestyle changes to extend and improve the lives of cancer survivors,” the editorialists concluded. Although making such changes is “notoriously difficult,” clues may come from six ongoing trials of weight control and physical activity in cancer survivors.

Dr. Fisch, Dr. McNeill, and Dr. Basen-Engquist all are at the University of Texas MD Anderson Cancer Center, Houston. Dr. Fisch also is with AIM Specialty Health, Chicago, Ill.; AIM is a subsidiary of Anthem. No other disclosures were reported. This editorial accompanied the article by Van Blanigan et al. (JAMA Oncology. 2018 Apr 12. doi: 10.1001/jamaoncol.2018.0124 ).



Having a normal body mass index, being physically active, and eating abundant vegetables, fruits, and whole grains was linked to a significantly reduced risk of death during a prospective cohort study of 992 patients with stage III colon cancer.

After 7 years of median follow-up, patients who most closely followed American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors had a 5-year survival probability of 85%, compared with 76% for patients who were least adherent (absolute risk reduction, 9%). After adjustment for multiple potential confounders, high guideline concordance was associated with a 42% lower risk of death during follow-up, compared with low guideline concordance (hazard ratio, 0.58; 95% confidence interval, 0.34-0.99; P = .01).

Courtesy National Cancer Institute
“Clinical trials of lifestyle change in colon cancer are needed,” Erin L. Van Blarigan, ScD, of the University of California, San Francisco, and her associates wrote online April 12 in JAMA Oncology.

The cohort study included individuals with stage 3 colon cancer enrolled in the Cancer and Leukemia Group B (CALGB) 89803 randomized adjuvant chemotherapy trial, which ran from 1999 through 2001. Dr. Van Blarigan and her coinvestigators surveyed and scored each patient according to the ACS guidelines for cancer survivors. Scores ranged from 0 to 6 and increased with healthier behavior. The survival analysis compared individuals scoring 5 or 6 (highest guideline concordance) with those scoring 0 or 1 (lowest guideline concordance).

The 91 patients with the highest guideline concordance typically had a BMI of 23 kg/m2 or less, exercised more than 30 metabolic equivalent task hours per week, consumed more than three daily servings of fruits and vegetables, and ate mostly whole (versus refined) grains. In contrast, the 262 patients with the lowest guideline concordance had a median BMI of 33 kg/m2, exercised a median of 2 metabolic equivalent task hours per week, consumed less than two daily servings of fruits and vegetables, and ate mostly refined grains.

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