American Cancer Society (ACS) Nutrition and Physical Activity Guidelines after colon cancer diagnosis and disease-free (DFS), recurrence-free (RFS), and overall survival (OS) in CALGB 89803 (Alliance).

10006 Background: The ACS Nutrition and Physical Activity Guidelines for Cancer Survivors include: 1) healthy body weight; 2) physical activity; and 3) a diet high in vegetables, fruits, and whole grains. It is not known whether colon cancer patients who follow these guidelines have improved DFS, RFS, or OS. Methods: We conducted a prospective study among 992 stage III colon cancer patients enrolled in an adjuvant chemotherapy trial in 1999-2001. Lifestyle was assessed twice. We applied a score developed by McCullough ML et al. to quantify adherence to the ACS guidelines based on BMI; physical activity; and intake of vegetables, fruits, whole grains, and red/processed meats (range: 0-6; higher = more healthy behaviors). Alcohol is included in the ACS guidelines for cancer prevention, but not cancer survivors; we tested the score without and with alcohol using McCullough et al.’s cut points: 0 pts = >1/d for women, >2/d for men; 1 pt = no alcohol; 2 pts = >0-1/d for women, >0-2/d for men. We estimated hazard ratios (HR) and 95% confidence intervals (CI) for DFS, RFS, and OS adjusting for clinical, demographic, and lifestyle factors. Results: Over 7 y median follow-up, we observed 335 recurrences and 299 deaths (43 without recurrence). Compared to patients with 0-1 pt (262, 26%), patients with 5-6 pts (91, 9%) had 42% lower risk of death (HR: 0.58; 95% CI: 0.34, 0.99; p-trend: 0.01) and a trend toward improved DFS (HR: 0.69; 95% CI: 0.45, 1.06; p-trend: 0.03). When including alcohol in the score, the adjusted HR’s comparing patients with 6-8 pts (162; 16%) to 0-2 pts (187; 91%) were: 0.49 for OS (95% CI: 0.32, 0.76; p-trend: 0.002), 0.58 for DFS (95% CI: 0.40, 0.84; p-trend: 0.01), and 0.64 for RFS (95% CI: 0.44, 0.94; p-trend: 0.05). Conclusions: Colon cancer patients with a healthy body weight who engaged in physical activity, ate a diet high in whole grains, vegetables, and fruits and low in red/processed meats, and drank moderate alcohol had longer DFS and OS than patients who did not engage in these behaviors. Support: U10CA180821, U10CA180882, U10CA180820, K07CA197077, R01CA118553, P50CA127003, R35CA197735. ClinicalTrials.gov:NCT00003835.

Duke Scholars

Author Donna Niedzwiecki Biostatistics & Bioinformatics, Division of Biostatistics