Lifestyle and quality of life in colorectal cancer survivors

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Abstract

As cancer survival rates improve, there is growing interest in the role of lifestyle in longer-term health and quality of life (QoL). This study examined the prevalence of health-related behaviours, and the associations between health behaviours and QoL, in colorectal cancer survivors. Patients diagnosed with colorectal cancer within the last 5 years identified from five London (UK) hospitals (N = 495) completed a survey that included measures of fruit and vegetable (F&V) intake, physical activity, smoking status and alcohol consumption. The EORTC-QLQ-C30 questionnaire was used to index QoL. The majority of respondents were overweight/obese (58%), not physically active (<5 bouts of moderate activity per week; 82%) and ate fewer than five portions of F&V a day (57%). Few were smokers (6%) or heavy drinkers (weekly alcohol units >21 for men and >14 for women; 8%). Physical activity showed the strongest association with functional QoL and was also associated with lower fatigue, pain and insomnia (P < 0.05). F&V intake was associated with higher global QoL and physical, role and cognitive function (P < 0.05). Using a total health behaviour score (calculated by assigning one point for each of the following behaviours: not smoking, consuming ≥5 portions of F&V a day, being physically active and having moderate alcohol consumption), there was a linear relationship with global QoL, physical function and fatigue (P < 0.05). A high proportion of colorectal cancer survivors in the UK have suboptimal health behaviours, and this is associated with poorer QoL.

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Most cited references 37

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Overweight, Obesity, and Mortality from Cancer in a Prospectively Studied Cohort of U.S. Adults

Eugenia E Calle, Carmen Rodríguez, Kimberly Walker-Thurmond … (2003)

The influence of excess body weight on the risk of death from cancer has not been fully characterized. In a prospectively studied population of more than 900,000 U.S. adults (404,576 men and 495,477 women) who were free of cancer at enrollment in 1982, there were 57,145 deaths from cancer during 16 years of follow-up. We examined the relation in men and women between the body-mass index in 1982 and the risk of death from all cancers and from cancers at individual sites, while controlling for other risk factors in multivariate proportional-hazards models. We calculated the proportion of all deaths from cancer that was attributable to overweight and obesity in the U.S. population on the basis of risk estimates from the current study and national estimates of the prevalence of overweight and obesity in the U.S. adult population. The heaviest members of this cohort (those with a body-mass index [the weight in kilograms divided by the square of the height in meters] of at least 40) had death rates from all cancers combined that were 52 percent higher (for men) and 62 percent higher (for women) than the rates in men and women of normal weight. For men, the relative risk of death was 1.52 (95 percent confidence interval, 1.13 to 2.05); for women, the relative risk was 1.62 (95 percent confidence interval, 1.40 to 1.87). In both men and women, body-mass index was also significantly associated with higher rates of death due to cancer of the esophagus, colon and rectum, liver, gallbladder, pancreas, and kidney; the same was true for death due to non-Hodgkin's lymphoma and multiple myeloma. Significant trends of increasing risk with higher body-mass-index values were observed for death from cancers of the stomach and prostate in men and for death from cancers of the breast, uterus, cervix, and ovary in women. On the basis of associations observed in this study, we estimate that current patterns of overweight and obesity in the United States could account for 14 percent of all deaths from cancer in men and 20 percent of those in women. Increased body weight was associated with increased death rates for all cancers combined and for cancers at multiple specific sites. Copyright 2003 Massachusetts Medical Society

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Physical activity and survival after colorectal cancer diagnosis.

Jeffrey A. Meyerhardt, Edward L. Giovannucci, Michelle Holmes … (2006)

Physically active individuals have a lower risk of developing colorectal cancer but the influence of exercise on cancer survival is unknown. By a prospective, observational study of 573 women with stage I to III colorectal cancer, we studied colorectal cancer-specific and overall mortality according to predefined physical activity categories before and after diagnosis and by change in activity after diagnosis. To minimize bias by occult recurrences, we excluded women who died within 6 months of their postdiagnosis physical activity assessment. Increasing levels of exercise after diagnosis of nonmetastatic colorectal cancer reduced cancer-specific mortality (P for trend = .008) and overall mortality (P for trend = .003). Compared with women who engaged in less than 3 metabolic equivalent task [MET] -hours per week of physical activity, those engaging in at least 18 MET-hours per week had an adjusted hazard ratio for colorectal cancer-specific mortality of 0.39 (95% CI, 0.18 to 0.82) and an adjusted hazard ratio for overall mortality of 0.43 (95% CI, 0.25 to 0.74). These results remained unchanged even after excluding women who died within 12 and 24 months of activity assessment. Prediagnosis physical activity was not predictive of mortality. Women who increased their activity (when comparing prediagnosis to postdiagnosis values) had a hazard ratio of 0.48 (95% CI, 0.24 to 0.97) for colorectal cancer deaths and a hazard ratio of 0.51 (95% CI, 0.30 to 0.85) for any-cause death, compared with those with no change in activity. Recreational physical activity after the diagnosis of stages I to III colorectal cancer may reduce the risk of colorectal cancer-specific and overall mortality.