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 "Colon cancer patients who followed the American Cancer Society
guidelines on nutrition and physical activity had a marked reduction
in risk of death and recurrence," lead author Erin Van Blarigan of
the University of California at San Francisco said in a telephone
interview.
"The magnitude of benefit was on par with what you might expect from
an invasive treatment, if not larger."
The ACS first released Nutrition and Physical Activity Guidelines
for Cancer Survivors in 2001, the study authors note in the journal
JAMA Oncology. Healthy people who follow these guidelines may reduce
their cancer risk, they add, and adhering to the guidelines has been
linked to a better quality of life in colon cancer survivors.
To investigate whether ACS guideline adherence might extend colon
cancer survival, the authors looked at 992 people participating in a
clinical trial of treatment for advanced colon cancer who reported
on their diet and physical activity during and after chemotherapy.
Each person was assigned a score from 0 to 6 based on their
adherence to the ACS guidelines, which included recommended ranges
for body mass index (BMI), physical activity, and consumption of
vegetables, fruit, whole and refined grains and red or processed
meat.
During an average seven years of follow-up, 335 patients had
recurrence of their cancer and 299 died, including 256 who died from
cancer recurrence. Twenty-six percent of the study participants had
an ACS guideline score of 0-1, while only 9 percent scored 5 to 6.
Patients who followed the guidelines most closely were 42 percent
less likely to die during follow up than those with the worst
adherence, and had better disease-free and recurrence-free survival.
Overall, the authors found, people who adhered well to the
guidelines were 9 percent more likely to survive for five years
after diagnosis than those with worse adherence.
Patients who logged 150 minutes or more of moderate physical
activity each week, such as brisk walking; ate at least five
servings of fruits and vegetables a day; and chose whole over
refined grains lived longer and were less likely to have cancer
recurrence, the study found. Those with BMIs of 23 to 29.9, somewhat
higher than the ACS guidelines recommend, also had improved survival
compared to those with higher BMIs.
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Low-to-moderate consumption of alcohol (no more than one drink a day
for women, two a day for men) was not associated with worse survival
or disease recurrence, but heavier drinking was.
Eating more red and processed meat was not associated with survival
or cancer recurrence. Paying attention to carbs appears more
important for colon cancer survivors, Van Blarigan noted, because
sugar-sweetened drinks, foods with a high glycemic load and other
less-healthy carbs have been linked to worse outcomes.
"The question is, if you added those types of recommendations
(avoiding sugar-sweetened beverages, etc.) to the general guidelines
would they have an even bigger benefit," she said.
Making lifestyle changes is "a big challenge," she added, noting
that research has shown that advice from their oncologist is the
most powerful motivator for cancer survivors.
The research team is also investigating strategies for supporting
cancer survivors in building healthier habits, including apps,
websites and text messaging. "So far it seems that people do like
these tools and find them useful so it is encouraging, but whether
it's going to be effective at changing behavior we don't know yet,"
Van Blarigan said.
The new study is especially valuable because it yields specifics
that doctors can discuss with colorectal cancer survivors, said Dr.
Michael J. Fisch of AIM Specialty Health in Chicago, who co-wrote an
editorial accompanying the study.
Strategies for supporting people in following healthier lifestyles
also need to include improving access to affordable, healthy foods
and opportunities for physical activity, he said in a telephone
interview.
SOURCE: https://bit.ly/2Hp7KcO and https://bit.ly/2HGLd8S JAMA
Oncology, online April 12, 2018.
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