Association of survival with adherence to the American cancer society nutrition and physical activity guidelines for cancer survivors after colon cancer diagnosis the calgb 89803/alliance trial

Erin L. Van Blarigan*, Charles S. Fuchs, Donna Niedzwiecki, Sui Zhang, Leonard B. Saltz, Robert J. Mayer, Rex B. Mowat, Renaud Whittom, Alexander Hantel, Al B Benson III, Daniel Atienza, Michael Messino, Hedy Kindler, Alan Venook, Shuji Ogino, Edward L. Giovannucci, Kimmie Ng, Jeffrey A. Meyerhardt

*Corresponding author for this work

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

IMPORTANCE The American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors (ACS guidelines) include maintaining (1) a healthy body weight; (2) physical activity; and (3) a diet that includes vegetables, fruits, and whole grains. It is not known whether patients with colon cancer who follow these guidelines have improved survival. OBJECTIVE To examine whether a lifestyle consistent with the ACS guidelines is associated with improved survival rates after colon cancer. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included 992 patients with stage III colon cancer who were enrolled in the CALGB 89803 randomized adjuvant chemotherapy trial from 1999 through 2001. Data for the present study were analyzed between November 2016 and December 2017. EXPOSURES We assigned an ACS guidelines score for each included patient based on body mass index; physical activity; and intake of vegetables, fruits, whole grains, and red/processed meats (score range, 0-6, with higher score indicating healthier behaviors). Secondarily, we examined a score that also included alcohol intake in addition to the other factors (range, 0-8). Lifestyle was assessed during and 6 months after chemotherapy. MAIN OUTCOMES AND MEASURES Hazard ratios (HRs) and 95% confidence intervals (CIs) for disease-free, recurrence-free, and overall survival. RESULTS Of the 992 patients enrolled in the study, 430 (43%) were women, and the mean (SD) age was 59.6 (11.2) years (range, 21-85 years). Over a 7-year median follow-up, we observed 335 recurrences and 299 deaths (43 deaths without recurrence). Compared with patients with a 0 to 1 ACS guidelines score (n = 262; 26%), patients with a 5 to 6 score (n = 91; 9%) had a 42%lower risk of death during the study period (HR, 0.58; 95%CI, 0.34-0.99; P = .01 for trend) and improved disease-free survival (HR, 0.69; 95%CI, 0.45-1.06; P = .03 for trend). When alcohol consumption was included in the score, the adjusted HRs comparing patients with scores of 6 to 8 (n = 162; 16%) vs those with scores of 0 to 2 (187; 91%) were 0.49 for overall survival (95%CI, 0.32-0.76; P = .002 for trend), 0.58 for disease-free survival (95%CI, 0.40, 0.84; P = .01 for trend), and 0.64 for recurrence-free survival (95%CI, 0.44-0.94; P = .05 for trend). CONCLUSIONS AND RELEVANCE Having a healthy body weight, being physically active, and eating a diet rich in vegetables, fruits, and whole grains after diagnosis of stage III colon cancer was associated with a longer survival. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00003835.

Original languageEnglish (US)
Pages (from-to)783-790
Number of pages8
JournalJAMA Oncology
Volume4
Issue number6
DOIs
StatePublished - Jun 1 2018

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Colonic Neoplasms
Survivors
Guidelines
Exercise
Confidence Intervals
Survival
Neoplasms
Vegetables
Recurrence
Fruit
Disease-Free Survival
Life Style
Body Weight
Diet
Adjuvant Chemotherapy
Alcohol Drinking
Body Mass Index
Cohort Studies
Survival Rate
Eating

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Van Blarigan, Erin L. ; Fuchs, Charles S. ; Niedzwiecki, Donna ; Zhang, Sui ; Saltz, Leonard B. ; Mayer, Robert J. ; Mowat, Rex B. ; Whittom, Renaud ; Hantel, Alexander ; Benson III, Al B ; Atienza, Daniel ; Messino, Michael ; Kindler, Hedy ; Venook, Alan ; Ogino, Shuji ; Giovannucci, Edward L. ; Ng, Kimmie ; Meyerhardt, Jeffrey A. / Association of survival with adherence to the American cancer society nutrition and physical activity guidelines for cancer survivors after colon cancer diagnosis the calgb 89803/alliance trial. In: JAMA Oncology. 2018 ; Vol. 4, No. 6. pp. 783-790.
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title = "Association of survival with adherence to the American cancer society nutrition and physical activity guidelines for cancer survivors after colon cancer diagnosis the calgb 89803/alliance trial",
abstract = "IMPORTANCE The American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors (ACS guidelines) include maintaining (1) a healthy body weight; (2) physical activity; and (3) a diet that includes vegetables, fruits, and whole grains. It is not known whether patients with colon cancer who follow these guidelines have improved survival. OBJECTIVE To examine whether a lifestyle consistent with the ACS guidelines is associated with improved survival rates after colon cancer. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included 992 patients with stage III colon cancer who were enrolled in the CALGB 89803 randomized adjuvant chemotherapy trial from 1999 through 2001. Data for the present study were analyzed between November 2016 and December 2017. EXPOSURES We assigned an ACS guidelines score for each included patient based on body mass index; physical activity; and intake of vegetables, fruits, whole grains, and red/processed meats (score range, 0-6, with higher score indicating healthier behaviors). Secondarily, we examined a score that also included alcohol intake in addition to the other factors (range, 0-8). Lifestyle was assessed during and 6 months after chemotherapy. MAIN OUTCOMES AND MEASURES Hazard ratios (HRs) and 95{\%} confidence intervals (CIs) for disease-free, recurrence-free, and overall survival. RESULTS Of the 992 patients enrolled in the study, 430 (43{\%}) were women, and the mean (SD) age was 59.6 (11.2) years (range, 21-85 years). Over a 7-year median follow-up, we observed 335 recurrences and 299 deaths (43 deaths without recurrence). Compared with patients with a 0 to 1 ACS guidelines score (n = 262; 26{\%}), patients with a 5 to 6 score (n = 91; 9{\%}) had a 42{\%}lower risk of death during the study period (HR, 0.58; 95{\%}CI, 0.34-0.99; P = .01 for trend) and improved disease-free survival (HR, 0.69; 95{\%}CI, 0.45-1.06; P = .03 for trend). When alcohol consumption was included in the score, the adjusted HRs comparing patients with scores of 6 to 8 (n = 162; 16{\%}) vs those with scores of 0 to 2 (187; 91{\%}) were 0.49 for overall survival (95{\%}CI, 0.32-0.76; P = .002 for trend), 0.58 for disease-free survival (95{\%}CI, 0.40, 0.84; P = .01 for trend), and 0.64 for recurrence-free survival (95{\%}CI, 0.44-0.94; P = .05 for trend). CONCLUSIONS AND RELEVANCE Having a healthy body weight, being physically active, and eating a diet rich in vegetables, fruits, and whole grains after diagnosis of stage III colon cancer was associated with a longer survival. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00003835.",
author = "{Van Blarigan}, {Erin L.} and Fuchs, {Charles S.} and Donna Niedzwiecki and Sui Zhang and Saltz, {Leonard B.} and Mayer, {Robert J.} and Mowat, {Rex B.} and Renaud Whittom and Alexander Hantel and {Benson III}, {Al B} and Daniel Atienza and Michael Messino and Hedy Kindler and Alan Venook and Shuji Ogino and Giovannucci, {Edward L.} and Kimmie Ng and Meyerhardt, {Jeffrey A.}",
year = "2018",
month = "6",
day = "1",
doi = "10.1001/jamaoncol.2018.0126",
language = "English (US)",
volume = "4",
pages = "783--790",
journal = "JAMA oncology",
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Van Blarigan, EL, Fuchs, CS, Niedzwiecki, D, Zhang, S, Saltz, LB, Mayer, RJ, Mowat, RB, Whittom, R, Hantel, A, Benson III, AB, Atienza, D, Messino, M, Kindler, H, Venook, A, Ogino, S, Giovannucci, EL, Ng, K & Meyerhardt, JA 2018, 'Association of survival with adherence to the American cancer society nutrition and physical activity guidelines for cancer survivors after colon cancer diagnosis the calgb 89803/alliance trial', JAMA Oncology, vol. 4, no. 6, pp. 783-790. https://doi.org/10.1001/jamaoncol.2018.0126

Association of survival with adherence to the American cancer society nutrition and physical activity guidelines for cancer survivors after colon cancer diagnosis the calgb 89803/alliance trial. / Van Blarigan, Erin L.; Fuchs, Charles S.; Niedzwiecki, Donna; Zhang, Sui; Saltz, Leonard B.; Mayer, Robert J.; Mowat, Rex B.; Whittom, Renaud; Hantel, Alexander; Benson III, Al B; Atienza, Daniel; Messino, Michael; Kindler, Hedy; Venook, Alan; Ogino, Shuji; Giovannucci, Edward L.; Ng, Kimmie; Meyerhardt, Jeffrey A.

In: JAMA Oncology, Vol. 4, No. 6, 01.06.2018, p. 783-790.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association of survival with adherence to the American cancer society nutrition and physical activity guidelines for cancer survivors after colon cancer diagnosis the calgb 89803/alliance trial

AU - Van Blarigan, Erin L.

AU - Fuchs, Charles S.

AU - Niedzwiecki, Donna

AU - Zhang, Sui

AU - Saltz, Leonard B.

AU - Mayer, Robert J.

AU - Mowat, Rex B.

AU - Whittom, Renaud

AU - Hantel, Alexander

AU - Benson III, Al B

AU - Atienza, Daniel

AU - Messino, Michael

AU - Kindler, Hedy

AU - Venook, Alan

AU - Ogino, Shuji

AU - Giovannucci, Edward L.

AU - Ng, Kimmie

AU - Meyerhardt, Jeffrey A.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - IMPORTANCE The American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors (ACS guidelines) include maintaining (1) a healthy body weight; (2) physical activity; and (3) a diet that includes vegetables, fruits, and whole grains. It is not known whether patients with colon cancer who follow these guidelines have improved survival. OBJECTIVE To examine whether a lifestyle consistent with the ACS guidelines is associated with improved survival rates after colon cancer. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included 992 patients with stage III colon cancer who were enrolled in the CALGB 89803 randomized adjuvant chemotherapy trial from 1999 through 2001. Data for the present study were analyzed between November 2016 and December 2017. EXPOSURES We assigned an ACS guidelines score for each included patient based on body mass index; physical activity; and intake of vegetables, fruits, whole grains, and red/processed meats (score range, 0-6, with higher score indicating healthier behaviors). Secondarily, we examined a score that also included alcohol intake in addition to the other factors (range, 0-8). Lifestyle was assessed during and 6 months after chemotherapy. MAIN OUTCOMES AND MEASURES Hazard ratios (HRs) and 95% confidence intervals (CIs) for disease-free, recurrence-free, and overall survival. RESULTS Of the 992 patients enrolled in the study, 430 (43%) were women, and the mean (SD) age was 59.6 (11.2) years (range, 21-85 years). Over a 7-year median follow-up, we observed 335 recurrences and 299 deaths (43 deaths without recurrence). Compared with patients with a 0 to 1 ACS guidelines score (n = 262; 26%), patients with a 5 to 6 score (n = 91; 9%) had a 42%lower risk of death during the study period (HR, 0.58; 95%CI, 0.34-0.99; P = .01 for trend) and improved disease-free survival (HR, 0.69; 95%CI, 0.45-1.06; P = .03 for trend). When alcohol consumption was included in the score, the adjusted HRs comparing patients with scores of 6 to 8 (n = 162; 16%) vs those with scores of 0 to 2 (187; 91%) were 0.49 for overall survival (95%CI, 0.32-0.76; P = .002 for trend), 0.58 for disease-free survival (95%CI, 0.40, 0.84; P = .01 for trend), and 0.64 for recurrence-free survival (95%CI, 0.44-0.94; P = .05 for trend). CONCLUSIONS AND RELEVANCE Having a healthy body weight, being physically active, and eating a diet rich in vegetables, fruits, and whole grains after diagnosis of stage III colon cancer was associated with a longer survival. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00003835.

AB - IMPORTANCE The American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors (ACS guidelines) include maintaining (1) a healthy body weight; (2) physical activity; and (3) a diet that includes vegetables, fruits, and whole grains. It is not known whether patients with colon cancer who follow these guidelines have improved survival. OBJECTIVE To examine whether a lifestyle consistent with the ACS guidelines is associated with improved survival rates after colon cancer. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included 992 patients with stage III colon cancer who were enrolled in the CALGB 89803 randomized adjuvant chemotherapy trial from 1999 through 2001. Data for the present study were analyzed between November 2016 and December 2017. EXPOSURES We assigned an ACS guidelines score for each included patient based on body mass index; physical activity; and intake of vegetables, fruits, whole grains, and red/processed meats (score range, 0-6, with higher score indicating healthier behaviors). Secondarily, we examined a score that also included alcohol intake in addition to the other factors (range, 0-8). Lifestyle was assessed during and 6 months after chemotherapy. MAIN OUTCOMES AND MEASURES Hazard ratios (HRs) and 95% confidence intervals (CIs) for disease-free, recurrence-free, and overall survival. RESULTS Of the 992 patients enrolled in the study, 430 (43%) were women, and the mean (SD) age was 59.6 (11.2) years (range, 21-85 years). Over a 7-year median follow-up, we observed 335 recurrences and 299 deaths (43 deaths without recurrence). Compared with patients with a 0 to 1 ACS guidelines score (n = 262; 26%), patients with a 5 to 6 score (n = 91; 9%) had a 42%lower risk of death during the study period (HR, 0.58; 95%CI, 0.34-0.99; P = .01 for trend) and improved disease-free survival (HR, 0.69; 95%CI, 0.45-1.06; P = .03 for trend). When alcohol consumption was included in the score, the adjusted HRs comparing patients with scores of 6 to 8 (n = 162; 16%) vs those with scores of 0 to 2 (187; 91%) were 0.49 for overall survival (95%CI, 0.32-0.76; P = .002 for trend), 0.58 for disease-free survival (95%CI, 0.40, 0.84; P = .01 for trend), and 0.64 for recurrence-free survival (95%CI, 0.44-0.94; P = .05 for trend). CONCLUSIONS AND RELEVANCE Having a healthy body weight, being physically active, and eating a diet rich in vegetables, fruits, and whole grains after diagnosis of stage III colon cancer was associated with a longer survival. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00003835.

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