Colorectal cancer survivors only marginally change their overall lifestyle in the first 2 years following diagnosis

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Abstract

Purpose

A healthy lifestyle after colorectal cancer (CRC) diagnosis may improve prognosis. Data related to lifestyle change in CRC survivors are inconsistent and potential interrelated changes are unknown.

Methods

We assessed dietary intake, physical activity, body mass index (BMI), waist circumference, and smoking among 1072 patients diagnosed with stages I–III CRC at diagnosis, 6 months and 2 years post-diagnosis. An overall lifestyle score was constructed based on the 2018 World Cancer Research Fund/American Institute of Cancer Research recommendations (range 0–7). We used linear mixed models to analyze changes in lifestyle over time.

Results

Participants had a mean (± SD) age of 65 ± 9 years and 43% had stage III disease. In the 2 years following CRC diagnosis, largest changes were noted for sugary drinks (− 45 g/day) and red and processed meat intake (− 62 g/week). BMI (+ 0.4 kg/m ²), waist circumference (+ 2 cm), and dietary fiber intake (− 1 g/day) changed slightly. CRC survivors did not statistically significant change their mean intake of fruits and vegetables, alcohol, or ultra-processed foods nor did they change their physical activity or smoking behavior. Half of participants made simultaneous changes that resulted in improved concordance with one component as well as deteriorated concordance with another component of the lifestyle score. Overall lifestyle score changed from a mean 3.4 ± 0.9 at diagnosis to 3.5 ± 0.9 2 years post-diagnosis.

Conclusions

CRC survivors hardly improve their overall lifestyle after diagnosis.

Implications for Cancer Survivors

Given the importance of a healthy lifestyle, strategies to effectively support behavior changes in CRC survivors need to be identified.

Related collections

Most cited references 26

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The Dutch surgical colorectal audit.

Gea Gooiker, E Manusama, T Wiggers … (2013)

In 2009, the nationwide Dutch Surgical Colorectal Audit (DSCA) was initiated by the Association of Surgeons of the Netherlands (ASN) to monitor, evaluate and improve colorectal cancer care. The DSCA is currently widely used as a blueprint for the initiation of other audits, coordinated by the Dutch Institute for Clinical Auditing (DICA). This article illustrates key elements of the DSCA and results of three years of auditing. Key elements include: a leading role of the professional association with integration of the audit in the national quality assurance policy; web-based registration by medical specialists; weekly updated online feedback to participants; annual external data verification with other data sources; improvement projects. In two years, all Dutch hospitals participated in the audit. Case-ascertainment was 92% in 2010 and 95% in 2011. External data verification by comparison with the Netherlands Cancer Registry (NCR) showed high concordance of data items. Within three years, guideline compliance for diagnostics, preoperative multidisciplinary meetings and standardised reporting increased; complication-, re-intervention and postoperative mortality rates decreased significantly. The success of the DSCA is the result of effective surgical collaboration. The leading role of the ASN in conducting the audit resulted in full participation of all colorectal surgeons in the Netherlands. By integrating the audit into the ASNs' quality assurance policy, it could be used to set national quality standards. Future challenges include reduction of administrative burden; expansion to a multidisciplinary registration; and addition of financial information and patient reported outcomes to the audit data. Copyright © 2013 Elsevier Ltd. All rights reserved.

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An overview of 25 years of incidence, treatment and outcome of colorectal cancer patients

Nelleke P.M. Brouwer, Amanda Bos, Valery E.P.P. Lemmens … (2018)

Regarding the continuous changes in the diagnostic process and treatment of colorectal cancer (CRC), it is important to evaluate long‐term trends which are relevant in giving direction for further research and innovations in cancer patient care. The aim of this study was to analyze developments in incidence, treatment and survival for patients diagnosed with CRC in the Netherlands. For this population‐based retrospective cohort study, all patients diagnosed with CRC between 1989 and 2014 in the Netherlands were identified using data of the nationwide population‐based Netherlands Cancer Registry (n = 267,765), with follow‐up until January 1, 2016. Analyses were performed for trends in incidence, mortality, stage distribution, treatment and relative survival measured from the time of diagnosis. The incidence of both colon and rectal cancer has risen. The use of postoperative chemotherapy for Stage III colon cancer increased (14–60%), as well as the use of preoperative (chemo)radiotherapy for rectal cancer (2–66%). The administration of systemic therapy and metastasectomy increased for Stage IV disease patients. The 5‐year relative survival increased significantly from 53 to 62% for colon cancer and from 51 to 65% for rectal cancer. Ongoing advancements in treatment, and also improvement in other factors in the care of CRC patients—such as diagnostics, dedicated surgery and pre‐ and postoperative care—lead to a continuous improvement in the relative survival of CRC patients. The increasing incidence of CRC favors the implementation of the screening program, of which the effects should be monitored closely.

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Operationalizing the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention Recommendations: A Standardized Scoring System

Marissa Shams-White, Nigel Brockton, Panagiota Mitrou … (2019)

Background: Following the publication of the 2018 World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) Third Expert Report, a collaborative group was formed to develop a standardized scoring system and provide guidance for research applications. Methods: The 2018 WCRF/AICR Cancer Prevention Recommendations, goals, and statements of advice were examined to define components of the new Score. Cut-points for scoring were based on quantitative guidance in the 2018 Recommendations and other guidelines, past research that operationalized 2007 WCRF/AICR Recommendations, and advice from the Continuous Update Project Expert Panel. Results: Eight of the ten 2018 WCRF/AICR Recommendations concerning weight, physical activity, diet, and breastfeeding (optional), were selected for inclusion. Each component is worth one point: 1, 0.5, and 0 points for fully, partially, and not meeting each recommendation, respectively (Score: 0 to 7–8 points). Two recommendations on dietary supplement use and for cancer survivors are not included due to operational redundancy. Additional guidance stresses the importance of accounting for other risk factors (e.g., smoking) in relevant models. Conclusions: The proposed 2018 WCRF/AICR Score is a practical tool for researchers to examine how adherence to the 2018 WCRF/AICR Recommendations relates to cancer risk and mortality in various adult populations.

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Author and article information

Contributors

Moniek van Zutphen:

ORCID: http://orcid.org/0000-0002-2368-0606

+31 317 480 959 , moniek.vanzutphen@wur.nl

Journal

Journal ID (nlm-ta): J Cancer Surviv

Journal ID (iso-abbrev): J Cancer Surviv

Title: Journal of Cancer Survivorship

Publisher: Springer US (New York )

ISSN (Print): 1932-2259

ISSN (Electronic): 1932-2267

Publication date (Electronic): 23 October 2019

Publication date PMC-release: 23 October 2019

Publication date (Print): 2019

Volume: 13

Issue: 6

Pages: 956-967

Affiliations

[1 ]GRID grid.4818.5, ISNI 0000 0001 0791 5666, Division of Human Nutrition and Health, , Wageningen University & Research, ; Stippeneng 4, PO Box 17 6708, WE Wageningen, the Netherlands

[2 ]GRID grid.29857.31, ISNI 0000 0001 2097 4281, Department Public Health Sciences, College of Medicine, , Penn State University, ; 500 University Drive, Hershey, PA 17033 USA

[3 ]GRID grid.440200.2, ISNI 0000 0004 0474 0639, Department of Internal Medicine, , Admiraal de Ruyter Ziekenhuis, ; ‘s-Gravenpolderseweg 114, 4462 RA Goes, the Netherlands

[4 ]GRID grid.10417.33, ISNI 0000 0004 0444 9382, Department of Surgery, , Radboud University Medical Centre, ; Geert Grooteplein-Zuid 22, 6525 GA Nijmegen, the Netherlands

Author information

Moniek van Zutphen http://orcid.org/0000-0002-2368-0606

Article

Publisher ID: 812

DOI: 10.1007/s11764-019-00812-7

PMC ID: 6881417

PubMed ID: 31646463

SO-VID: a4eec3a8-ccb8-41f1-8a46-6260718afa96

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 4 July 2019

Date accepted : 25 September 2019