Lifestyle factors and health-related quality of life in colorectal cancer survivors

LASSO-based nomogram predicts the risk factors of low anterior resection syndrome for middle and low rectal cancer underwent robotic surgery

BACKGROUND

This study aims to analyze the influencing factors of postoperative Low Anterior Resection Syndrome (LARS) in patients with middle and low rectal cancer who underwent robotic surgery. It also seeks to predict the probability of LARS through a visual, quantitative, and graphical nomogram. This approach is expected to lower the risk of postoperative LARS in these patients and improve their quality of life through effective prevention and early intervention.

PATIENTS AND METHODS

This research involved patients with middle and low rectal cancer who underwent robotic surgery in the Department of Gastrointestinal Surgery at the First Affiliated Hospital of Nanchang University from January 2015 to October 2022. A series of intestinal dysfunction symptoms arising from postoperative rectal cancer were diagnosed and graded using LARS scoring criteria. After the initial screening of all variables related to LARS with Lasso regression, they were included in logistic regression for further univariate and multivariate analysis to identify independent risk factors for LARS. A prediction model was then constructed.

RESULTS

The study included 358 patients. The parameters identified by Lasso regression included obstruction, BMI, tumor localization, maximum tumor diameter, AJCC stage, stoma, neoadjuvant therapy (NAT), and postoperative adjuvant therapy (AT). Univariate and multivariate analyses indicated that a higher BMI, lower tumor localization, higher AJCC stage, neoadjuvant therapy, and postoperative adjuvant therapy were independent risk factors for total LARS. The AUC of the prediction nomogram was 0.834, with a sensitivity of 0.825 and specificity of 0.741. The calibration curve demonstrated excellent concordance with the nomogram, indicating the prediction curve fit the diagonal well.

CONCLUSION

Higher BMI, lower tumor localization, higher AJCC stage, neoadjuvant therapy, and adjuvant therapy were identified as independent risk factors for total LARS. A new predictive nomogram for postoperative LARS in patients with middle and low rectal cancer undergoing robotic surgery was developed, proving to be stable and reliable. This tool will assist clinicians in managing the postoperative treatment of these patients, facilitating better clinical decision-making and maximizing patient benefits.

Effects of Lifestyle Interventions on Health and Life Quality of Colorectal Cancer Survivors: A Systematic Review and Meta-analysis

BACKGROUND

The results of previous studies on the effects of lifestyle interventions on the quality of life (QoL) in colorectal cancer (CRC) survivors remain controversial, and there have been several new publications in this area in recent years.

OBJECTIVES

To assess whether lifestyle interventions can lead to favorable health outcomes and improved QoL in CRC survivors, we performed a meta-analysis.

METHODS

PubMed, EMBASE, Web of Science, and Cochrane Library were systematically searched to obtain relevant literature published from January 1, 1990, to November 1, 2021. The required data were extracted and summarized to compare the physical activity levels, QoL, mental health assessment, and anthropometric data between lifestyle interventions and routine nursing.

RESULTS

Twelve studies were included. Compared with the control group, lifestyle interventions could significantly increase the physical activity time (weighted mean difference [WMD], 9.84; 95% confidence interval [CI], 1.20-18.48; P = .026), metabolic equivalent task levels (WMD, 10.40; 95% CI, 5.30-15.49; P < .001), and Functional Assessment of Cancer Therapy Scale-Colorectal scores (WMD, 3.12; 95% CI, 0.24-5.99; P = .034). However, lifestyle interventions were not noticeably able to improve the fatigue, depression levels, anxiety levels, waist circumference, or body mass index in CRC survivors.

CONCLUSION

Lifestyle interventions could generate an increase in physical activity time, metabolic equivalent task levels, and QoL in CRC survivors.

IMPLICATIONS FOR PRACTICE

Lifestyle interventions in the future that include physical activity, diet, or comprehensive programs are needed to increase physical activity levels and improve QoL in CRC survivors.

Associations between modifiable lifestyle factors and health-related quality of life among endometrial carcinoma survivors - A cross-sectional study

OBJECTIVE

To explore possible associations between modifiable lifestyle factors and health-related quality of life (HRQoL) in endometrial carcinoma survivors by assessing differences in HRQoL between survivors meeting and not meeting the World Health Organization's (WHO) recommendations regarding physical activity, BMI, and smoking.

METHODS

This was a cross-sectional population-based study in women having undergone surgery for assumed early-stage endometrial carcinoma. Thresholds for clinical importance based on the EORTC QoL working group were used to interpret scores. Effect size (ES) was interpreted as small (d = 0.2-0.49), medium (d = 0.5-0.8), and large (d > 0.8).

RESULTS

In total, 1200 evaluable women were included. Meeting physical activity recommendations and BMI <25 kg/m2 was associated with significantly better global health status, (ES) = 0.18 and ES = -0.11, respectively. On multivariate analysis, women meeting physical activity recommendations had significantly higher scores on physical- (ES = 0.31), role- (ES = 0.15), and social functioning (ES = 0.15), and lower levels of fatigue (ES = -0.16), pain (ES = -0.10), and appetite loss (ES = -0.15) (all p < 0.05) compared to non-meeting survivors. Participants with BMI ≥25 kg/m2 had lower scores for social functioning (ES = -0.10), and higher levels of pain (ES = 0.13) and dyspnea (ES = 0.12) (all p < 0.05) compared to those with BMI <25 kg/m2. Smokers had lower scores for emotional functioning (ES = -0.09) and higher levels of diarrhea (ES = 0.10) (all p < 0.05) compared to non-smokers.

CONCLUSION

Meeting WHO recommendations for modifiable life-style factors is associated with better HRQoL among endometrial carcinoma survivors: Being sufficiently physical active and having a BMI <25 kg/m2 are significantly associated with better self-reported global health status. All modifiable factors are associated with better functioning, and reduced symptom-burden.

Information Provision, Decision Self-efficacy, and Decisional Conflict in Adopting Health Behaviors Among Patients Treated for Colorectal Cancer: A Cross-sectional Study

BACKGROUND

Health promotion is necessary to mitigate the negative consequences of colorectal cancer and its treatment. Rates of behavior modification are low in populations of cancer patients. Studies are needed to determine the factors, such as decisional conflict, which influence adoption of healthy behaviors following a cancer diagnosis.

OBJECTIVE

To examine the effects of information provision, decision self-efficacy, and decisional conflict on the adoption of healthy behaviors among patients with colorectal cancer.

METHODS

This cross-sectional study focused on 251 patients with colorectal cancer in South Korea. Information provision, decision self-efficacy, and decisional conflict were measured using validated instruments. Patients rated their decisional conflict related to the adoption of behaviors that include regular exercise and a balanced diet.

RESULTS

Most participants (73%) reported low satisfaction with the amount of information received. Of the participants, 64% had low decision self-efficacy, and 80% experienced decisional conflict. The perception of a higher level of information provision was associated with greater decision self-efficacy (odds ratio, 4.63; 95% confidence interval, 1.61-13.35). Higher decision self-efficacy was associated with lower decisional conflict (odds ratio, 5.19; 95% confidence interval, 2.33-11.59).

CONCLUSION

Receiving adequate information is important for promoting patients' confidence in making decisions about their health and reducing decisional conflict in the adoption of healthy lifestyle changes following a cancer diagnosis.

IMPLICATION FOR PRACTICE

Oncology nurses should assess patient information needs and promote decision self-efficacy, thus empowering patients diagnosed with colorectal cancer to make lifestyle decisions that improve their health and quality of life.

Change Toward Healthier Lifestyles Is Associated With Better Health-Related Quality of Life in Long-Term Colorectal Cancer Survivors

BACKGROUND

Little is known about how changes in a constellation of lifestyle factors affect health-related quality of life (HRQoL) in colorectal cancer (CRC) survivors. Our study aimed to investigate the association between changes in healthy lifestyle and HRQoL over time in survivors of stage I-IV CRC.

METHODS

We included 2,283 long-term (≥5 years postdiagnosis) survivors. A healthy lifestyle score (HLS) comprising smoking, alcohol consumption, diet, physical activity, and body fatness was derived at diagnosis and 5-year follow-up (5YFU) and categorized as low, moderate, or high. We assessed HRQoL with the EORTC Quality of Life Questionnaire-Core 30 at 5YFU and 10-year follow-up. We used multivariable linear regression and linear mixed models to explore associations between changes in HLS and HRQoL over follow-up.

RESULTS

A low baseline HLS was associated with poorer functioning and global health/QoL and a higher symptom burden at 5YFU compared with a high baseline HLS. An improved HLS from baseline to 5YFU was associated with better functioning, higher global health/QoL, and fewer symptoms at 5YFU than a maintained-high HLS. In longitudinal analyses, improved HLS was associated with better functioning at follow-up. Survivors with a maintained-high or an improved HLS reported generally less fatigue, pain, and dyspnea at follow-ups compared with survivors with a maintained-low or decreased HLS.

CONCLUSIONS

Change toward a healthier lifestyle since diagnosis was associated with better HRQoL in long-term CRC survivors. Our results support the importance of maintaining and/or promoting a healthier lifestyle among CRC survivors postdiagnosis.

Nutrition and physical activity in cancer patients: a survey on their information sources

BACKGROUND

Many cancer patients suffer from problems concerning nutrition and physical activity (PA) during and after their treatment. Forwarding reliable health information could help to alleviate severe symptoms. The present study aimed to examine cancer patients' commonly used information sources on nutrition and PA.

METHODS

An anonymous questionnaire was developed and distributed to German cancer patients in different settings. In total, 90 questionnaires have been completed between October 2021 and March 2022. For analysis, descriptive statistics were used and associations between information sources and patients' lifestyle behaviour explored utilising Spearman's Rho, Mann-Whitney U, and Pearson's Chi Square tests.

RESULTS

The cancer patients received information on nutrition and PA most frequently from physicians (70.9%), family and friends (68%) and browsing the internet (61.3%). Half of the patients (51.1%) had questions concerning these topics during the time of their disease. The majority of those patients (81.8%) reported that their questions were answered. The topics were addressed primarily with outpatient oncologists (60.0%) and in rehabilitation clinics (53.3%). Just about half of the patients (55.3%) felt satisfactorily informed on nutrition and PA in their cancer disease, more so if they talked to their oncologist or family physician (Z = - 2.450, p = 0.014 and Z = - 3.425, p = 0.001 resp.).

CONCLUSION

Cancer patients receive information on nutrition and PA predominantly after their initial treatment. Since they might be missing significant information to alleviate severe symptoms during their treatment, the importance of nutrition and PA should be emphasised by clinicians early on in treatment.

TRIAL REGISTRATION

Trial Registration Number (May 7, 2021): 2021-2149-Bef.

Prospective associations between coffee consumption and psychological well-being

Objective

Prior work indicates a robust relationship between coffee consumption and lower depression risk, yet no research has examined links with psychological well-being (e.g., happiness, optimism). This study tested whether coffee intake is prospectively associated with greater psychological well-being over time. Secondarily, associations in the reverse direction were also examined to determine whether initial levels of psychological well-being were related to subsequent coffee consumption.

Methods

Among women in the Nurses’ Health Study, coffee consumption was examined in 1990 and 2002 in relation to sustained levels of happiness reported across multiple assessments from 1992–2000 (N = 44,449) and sustained levels of optimism assessed from 2004–2012 (N = 36,729). Associations were tested using generalized estimating equations with a Poisson distribution adjusted for various relevant covariates. Bidirectional relationships were evaluated in secondary analyses of baseline happiness (1992) and optimism (2004) with sustained moderate coffee consumption across multiple assessments through 2010.

Results

Compared to minimal coffee consumption levels (<1 cup/day), moderate consumption (1–3 cups/day) was unrelated to happiness, whereas heavy consumption (≥4 cups/day) was associated with a 3% lower likelihood of sustained happiness (relative risk, RR = 0.97, 95% CI = 0.95–0.99). Only moderate coffee consumption was weakly associated with a greater likelihood of sustained optimism (RR_1-3cups/day = 1.03, 95% CI = 1.00–1.06). Secondary analyses showed high levels of optimism but not happiness levels were modestly associated with increased likelihood of sustained moderate coffee intake (RR_optimism = 1.06, 95% CI = 1.02–1.10; RR_happiness = 1.01, 95% CI = 0.99–1.04).

Conclusions

Associations between psychological well-being and coffee consumption over up to two decades were largely null or weak. Although coffee consumption may protect individuals against depression over time, it may have limited impact on facets of psychological well-being.

Influence of Exercise Intervention on the Quality of Life for Colon Cancer: A Meta-Analysis of Randomized Controlled Studies

Introduction The influence of exercise intervention for colon cancer remains controversial. We conduct a systematic review and meta-analysis to explore the effect of exercise intervention on the quality of life in patients with colon cancer.

Methods We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through September 2020 for randomized controlled trials (RCTs) assessing the effect of exercise intervention for colon cancer. This meta-analysis is performed using the random-effect model.

Results Five RCTs are included in the meta-analysis. In patients with colon cancer, exercise intervention is associated with improved health-related quality of life (SMD=2.79; 95% CI=1.66 to 3.92; P<0.00001) and reduced fatigue score (SMD=−2.21; 95% CI=−3.22 to −1.20; P<0.0001), but revealed no obvious impact on emotional functioning (SMD=0.51; 95% CI=−0.57 to 1.58; P=0.35), anxiety score (SMD=−0.93; 95% CI=−2.50 to 0.64; P=0.25) or weight (SMD=0.28; 95% CI=−0.19 to 0.75; P=0.24).

Conclusions Exercise intervention is effective to improve the quality of life in patients with colon cancer.

Berberine as a Potential Agent for the Treatment of Colorectal Cancer

Colorectal cancer (CRC) is one of the most commonly diagnosed and deadly malignancies worldwide. The incidence of CRC has been increasing, especially in young people. Although great advances have been made in managing CRC, the prognosis is unfavorable. Numerous studies have shown that berberine (BBR) is a safe and effective agent presenting significant antitumor effects. Nevertheless, the detailed underlying mechanism in treating CRC remains indistinct. In this review, we herein offer beneficial evidence for the utilization of BBR in the management and treatment of CRC, and describe the underlying mechanism(s). The review emphasizes several therapeutic effects of BBR and confirms that BBR could suppress CRC by modulating gene expression, the cell cycle, the inflammatory response, oxidative stress, and several signaling pathways. In addition, BBR also displays antitumor effects in CRC by regulating the gut microbiota and mucosal barrier function. This review emphasizes BBR as a potentially effective and safe drug for CRC therapy.

Comparison of surgical and oncologic outcomes in very elderly patients (≥ 80 years old) and elderly (65-79 years old) colorectal cancer patients: a propensity score matching

Purpose

The purpose of this study was to investigate the short-term outcomes and prognosis of elderly and very elderly colorectal cancer (CRC) patients after primary CRC surgery using propensity score matching (PSM).

Methods

This study retrospectively collected the medical records of CRC patients ≥ 65 years old undergoing primary CRC surgery from Jan 2011 to Jan 2020. Short-term outcomes, overall survival (OS) and disease-free survival (DFS) were compared between very elderly CRC patients (≥ 80 years old) and elderly CRC patients (65–79 years old).

Results

A total of 2084 patients were enrolled for analysis. After PSM, 331 very elderly patients were matched to 331 elderly patients. In terms of short-term outcomes, the very elderly patients had longer postoperative hospital stays (p = 0.007) after PSM. In terms of OS, it was found that age (p < 0.01, HR = 1.878, 95% CI 1.488–2.371), tumor stage (p < 0.01, HR = 1.865, 95% CI 1.603–2.170), overall complications (p < 0.01, HR = 1.514, 95% CI 1.224–1.872) and major complications (p = 0.001, HR = 2.012, 95% CI 1.319–3.069) were independent prognostic factors. For DFS, age (p < 0.01, HR = 1.816, 95% CI 1.579–2.088), tumor stage (p < 0.01, HR = 1.816, 95% CI 1.579–2.088), overall complications (p = 0.002, HR = 1.379, 95% CI 1.128–1.685) and major complications (p = 0.002, HR = 1.902, 95% CI 1.259–2.874) were found to be independent prognostic factors. Moreover, elderly patients had a better OS and DFS than very elderly patients.

Conclusion

Very elderly patients had a poorer prognosis than elderly patients after primary CRC surgery. Surgeons should be cautious when treating very elderly CRC patients.

Predictors of Quality of Life Six Years after Curative Colorectal Cancer Surgery: Results of the Prospective Multicenter Study

Background and objectives: Improving early diagnosis and advances in colorectal cancer (CRC) treatment leads to longer survival of these patients. The purpose of this study was to identify the main surgical factors affecting long-term Quality of life (QoL) among colorectal cancer patients after surgery. Materials and Methods: QoL was prospectively evaluated in patients undergoing elective colorectal cancer resection operations in three CRC surgery centers of Lithuania using EORTC generic (QLQC-30) and disease-specific (QLQ-CR29) questionnaires at the time of preoperative admission and 1, 24, and 72 months after surgery. QoL was evaluated among different patient groups, diagnostic and treatment modalities, disease, and postoperative complications. Non-parametric tests and multivariate logistic regression models were used for statistical analysis. Results: Eighty-eight consecutive CRC patients from three institutions were included in the study over a three-month inclusion period, 42 (47.73%) women and 46 (52.27%) men, mean age 64.2 ± 11.5 years. Most tumors were localized in the sigmoid colon and rectum. The largest number of patients had stage III cancer. Twenty-nine patients died—a 6-year survival rate was 67%. 50 of 59 live patients (84.8%) responded to the questionnaire 6 years after their operation. Evaluating changes in quality of life 72 months after surgery with assessments before surgery, both questionnaire responses revealed good long-term CRC surgical treatment results: improved general and functional scale estimates and decreased symptom scale ratings. The multivariate analysis found that age, stoma formation, and rectal cancer were independent risk factors for having worse QoL six years after surgical intervention. Conclusions: Six years after surgery, QoL returns to preoperative levels. Age, stoma formation, adjuvant treatment, and rectal cancer reduce long-term QoL.

Diet/Nutrition: Ready to Transition from a Cancer Recurrence/Prevention Strategy to a Chronic Pain Management Modality for Cancer Survivors?

Evidence for the relationship between chronic pain and nutrition is mounting, and chronic pain following cancer is gaining recognition as a significant area for improving health care in the cancer survivorship population. This review explains why nutrition should be considered to be an important component in chronic pain management in cancer survivors by exploring relevant evidence from the literature and how to translate this knowledge into clinical practice. This review was built on relevant evidence from both human and pre-clinical studies identified in PubMed, Web of Science and Embase databases. Given the relationship between chronic pain, inflammation, and metabolism found in the literature, it is advised to look for a strategic dietary intervention in cancer survivors. Dietary interventions may result in weight loss, a healthy body weight, good diet quality, systemic inflammation, and immune system regulations, and a healthy gut microbiota environment, all of which may alter the pain-related pathways and mechanisms. In addition to being a cancer recurrence or prevention strategy, nutrition may become a chronic pain management modality for cancer survivors. Although additional research is needed before implementing nutrition as an evidence-based management modality for chronic pain in cancer survivors, it is already critical to counsel and inform this patient population about the importance of a healthy diet based on the data available so far.

Longitudinal Associations of Adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Lifestyle Recommendations with Quality of Life and Symptoms in Colorectal Cancer Survivors up to 24 Months Post-Treatment

Simple Summary

Using data from 459 colorectal cancer (CRC) survivors, we described how participants adhered to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) lifestyle recommendations and how this adherence was related to quality of life, level of functioning, symptoms of fatigue, and neuropathy symptoms. We found that increases in a lifestyle score was associated with better physical functioning and less fatigue. No relations with neuropathy symptoms were found. In addition, we observed that physical activity played an important role in the lifestyle score with regards to quality of life. In contrast, we observed that body composition and alcohol recommendations had a counteractive influence within the lifestyle score. Our findings suggest that CRC survivors benefit from overall adherence to the WCRF/AICR lifestyle recommendations in terms of quality of life and fatigue. Specific recommendations have a varying influence on these associations, complicating the interpretation and requiring further study.

Abstract

Post-treatment adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) lifestyle recommendations were associated with health-related quality of life (HRQoL), fatigue, and chemotherapy-induced peripheral neuropathy (CIPN) in colorectal cancer (CRC) survivors. In a prospective cohort among CRC survivors (n = 459), repeated home-visits were performed at 6 weeks, 6, 12, and 24 months post-treatment. Dietary intake, body composition, sedentary behaviour, and physical activity were assessed to construct a lifestyle score based on adherence to seven 2018 WCRF/AICR recommendations. Longitudinal associations of the lifestyle score with HRQoL, fatigue, and CIPN were analysed by confounder-adjusted linear mixed models. A higher lifestyle score was associated with better physical functioning and less activity-related fatigue, but not with CIPN. Adjustment for physical activity substantially attenuated observed associations, indicating its importance in the lifestyle score with regards to HRQoL. In contrast, adjustment for body composition and alcohol inflated observed associations, indicating that both recommendations had a counteractive influence within the lifestyle score. Our findings suggest that CRC survivors benefit from an overall adherence to the WCRF/AICR lifestyle recommendations in terms of HRQoL and fatigue, but not CIPN. Specific recommendations have a varying influence on these associations, complicating the interpretation and requiring further study.

Colorectal Cancer Survivors' Receptivity toward Genomic Testing and Targeted Use of Non-Steroidal Anti-Inflammatory Drugs to Prevent Cancer Recurrence

Genomic testing and targeted use of non-steroidal anti-inflammatory drugs (NSAIDs) may mitigate cancer recurrence risks. This study examines colorectal cancer (CRC) survivors' interest and receptivity to these strategies. Patients diagnosed with stage I-III CRC in 2004-2012 were recruited through the New Mexico Cancer Registry to complete a cancer survivorship experiences survey. We assessed interest in genomic testing, daily aspirin (ASA) and NSAID use, and receptivity to future daily ASA/NSAIDs. Descriptive statistics and multivariable logistic regression models estimated factors associated with genomic testing interest. Receptivity to future ASA/NSAIDs use was estimated for non-users of ASA/NSAIDs. Among CRC survivors (n = 273), 83% endorsed interest in genomic testing, 25% were ASA users and 47% ASA/NSAIDs users. In our final model, genomic testing interest was associated with being uncoupled [OR = 4.11; 95% CI = 1.49-11.35], low income [OR = 0.35, 95% CI: 0.14-0.88], smoking history [OR = 0.35, 95% CI: 0.14-0.90], low [OR: 0.33, 95% CI: 0.07-1.43] and moderate [OR: 0.26, 95% CI: 0.11-0.61] health literacy, and personal CRC risk worry [OR: 2.86, 95% CI: 1.63-5.02, p = 0.0002]. In our final model, ASA use was associated with age [OR: 1.05, 95% CI: 1.01-1.10] and cardiovascular disease history [OR: 2.42, 95% CI: 1.23-4.73, p = 0.010]. Among non-users ASA/NSAIDs, 83% reported receptivity to ASA/NSAIDs to reduce cancer risks, and no significant correlates were identified. The majority of survivors' expressed genomic testing interest and endorsed receptivity toward ASA/NSAIDs use for cancer risk management. Further research to optimize ASA/NSAIDs use guided by genomic testing is warranted.

Health-Promoting Lifestyle in Colorectal Cancer Survivors: A Qualitative Study on the Experiences and Perspectives of Colorectal Cancer Survivors and Healthcare Providers

OBJECTIVE

Understanding the experiences of survivors and healthcare providers about health-promoting lifestyle (HPL) in colorectal cancer (CRC) survivors is important in planning for coping with the disease, managing treatment side effects, increasing survival, and improving quality of life (QOL). This study was conducted to explore the experiences and perspectives of CRC survivors and healthcare providers about HPL in CRC survivors.

METHODS

This descriptive qualitative study was performed in 2020 at Omid and Imam Reza Hospitals in Mashhad, Iran. Participants were CRC survivors (n = 12) and healthcare providers (n = 33) who were selected by purposive sampling. Data were collected using in-depth semi-structured interview by face to face and then analyzed by Zhang and Wildemuth content analysis method. MaxQDA software was used to organize the data.

RESULTS

Following the treatment of cancer, CRC survivors seek to make changes in lifestyle and they choose a HPL that maintains or improves their health. HPL in CRC survivors includes nutrition, activity and rest, health responsibility, interpersonal relations, spiritual growth, and psychological management. The results showed that HPL can lead to motivation, the ability to self-care and improve daily performance, reduce treatment complications, and increase the QOL.

CONCLUSIONS

CRC survivors can help change their lifestyle patterns with healthy eating, treatment adherence, regular physical activity, and good sleep habits. Furthermore, effective personal and social relationships, spiritual growth, and management of psychological disorders develop health-promoting behaviors in them. CRC survivors also face challenges and limitations in their life after treatment; identifying the components of a HPL in CRC survivors can lead to desirable care, treatment, education, and counseling services.

Risk factors for poor health-related quality of life in patients with colon cancer include stoma and smoking habits

Background

Previous studies have shown that health-related quality of life (HRQoL) is associated with the prognosis of cancer patients. The aim of this study was to investigate risk factors for poor HRQoL in patients with colon cancer.

Methods

This was a prospective population-based study of patients with colon cancer included between 2012 and 2016. HRQoL was measured using the cancer-specific European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30. Multiple linear regression analysis adjusted for age, sex, body mass index, smoking habits, American Society of Anesthesiologists physical status classification, emergency/elective surgery, resection with/without a stoma and tumour stage was used.

Results

A total of 67% (376/561) of all incident patients with colon cancer (196 [52.1%] females) was included. Mean (range) age was 73 (30–96) years. Patients with worse health (American Society of Anesthesiologists physical status 3 and 4), those with higher body mass index, smokers and those planned to undergo surgical treatment with a stoma were at a higher risk for poor HRQoL than the other included patients at baseline and 6-month follow-up.

Conclusions

Patient characteristics such as smoking, high body mass index and worse physical health as well as treatment with a stoma were associated with lower HRQoL. Health care for such patients should focus on social and lifestyle behavioural support and stoma closure, when possible.

Trial registration: ClinicalTrials.gov (NCT 03910894).

Psychological distress and lower health-related quality of life are associated with need for dietary support among colorectal cancer survivors with overweight or obesity

OBJECTIVE

Two-third of colorectal cancer (CRC) survivors are overweight or obese. Psychological distress and low health-related quality of life (HRQoL) may be barriers to improving diet. We aimed to assess associations between psychological distress and HRQoL and the need for dietary support in CRC survivors with overweight or obesity.

METHODS

All alive individuals diagnosed with CRC between 2000 and 2009, as registered by the Dutch population-based Eindhoven Cancer Registry, were eligible for participation and received a questionnaire. Multivariable logistic regression analyses were conducted to assess associations between HRQoL (EORTC QLQ-C30), symptoms of anxiety and depression (HADS), and self-reported need for dietary support (single-item).

RESULTS

A total of 1458 completed the questionnaire (response rate 82%), and 756 (43%) had a BMI of 25.0 or higher and complete data on "need for dietary support" and were included for analyses. BMI ranged between 25.0 and 60.6 (mean, 28.9; SD, 3.6). The majority (71.7%) was overweight (BMI ≥ 25), and 28.3% obese (BMI ≥ 30). Twenty-one percent reported a need for dietary support which was associated with more psychological distress and lower HRQoL. Those who experienced symptoms of anxiety or depression were more likely to report a need for dietary support (27.6% and 28.7%) than those who did not experience symptoms of anxiety (12.3%; OR 2.02; 95% CI 1.22-3.35) or depression (13.5%; OR 1.96; 95% CI 1.19-3.22).

CONCLUSIONS

Results suggest that psychological distress and lower HRQoL should be taken into account while promoting a healthy diet in overweight or obese CRC survivors since these factors may hinder adherence to a healthy diet.

Increases in adipose tissue and muscle function are longitudinally associated with better quality of life in colorectal cancer survivors

Colorectal cancer (CRC) survivors need evidence-based guidelines pertaining to post-treatment body composition, which could benefit health-related quality of life (HRQoL). We aimed to describe the course of several body composition measures, and to assess longitudinal associations of these measures with HRQoL, fatigue and chemotherapy-induced peripheral neuropathy (CIPN). In a prospective cohort among stage I–III CRC survivors (n = 459), five repeated home visits from diagnosis up to 24 months post-treatment were executed. Body mass index (BMI), waist circumference and fat percentage were assessed as measures of adiposity, and muscle arm circumference and handgrip strength as measures of muscle mass and function. We applied linear mixed-models to describe changes in body composition over time and to analyze overall longitudinal associations. Of included participants, 44% was overweight and 31% was obese at diagnosis. All body composition measures followed similar trends, decreasing from diagnosis to 6 weeks and then increasing up to 24 months post-treatment. In confounder-adjusted mixed models, increases in adipose tissue and muscle function were longitudinally associated with better HRQoL and less fatigue, regardless of pre-treatment body composition. With regards to improving HRQoL, decreasing fatigue and CIPN, clinical practice should also focus on restoring body tissues after CRC treatment.

Trial registration: NTR7099.

Associations of the dietary World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations with patient-reported outcomes in colorectal cancer survivors 2-10 years post-diagnosis: a cross-sectional analysis

The World Cancer Research Fund and American Institute for Cancer Research (WCRF/AICR) advise cancer survivors to follow their lifestyle recommendations for cancer prevention. Adhering to these recommendations may have beneficial effects on patient-reported outcomes after a cancer diagnosis, but evidence is scarce. We aimed to assess associations of the individual dietary WCRF/AICR recommendations regarding fruit and vegetables, fibre, fast foods, red and processed meat, sugar-sweetened drinks and alcohol consumption with patient-reported outcomes in colorectal cancer (CRC) survivors. Cross-sectional data of 150 stage I-III CRC survivors, 2-10 years post-diagnosis, were used. Dietary intake was measured by 7-d dietary records. Validated questionnaires were used to measure health-related quality of life (HRQoL), fatigue and neuropathy. Confounder-adjusted linear regression models were used to analyse associations of each WCRF/AICR dietary recommendation with patient-reported outcomes. Higher vegetable intake (per 50 g) was associated with better global QoL (β 2·6; 95 % CI 0·6, 4·7), better physical functioning (3·3; 1·2, 5·5) and lower levels of fatigue (-4·5; -7·6, -1·4). Higher fruit and vegetables intake (per 100 g) was associated with better physical functioning (3·2; 0·8, 5·5) and higher intake of energy-dense food (per 100 kJ/100 g) with worse physical functioning (-4·2; -7·1, -1·2). No associations of dietary recommendations with neuropathy were found. These findings suggest that adhering to specific dietary WCRF/AICR recommendations is associated with better HRQoL and less fatigue in CRC survivors. Although the recommendations regarding healthy dietary habits may be beneficial for the well-being of CRC survivors, longitudinal research is warranted to gain insight into the direction of associations.

Post-diagnostic reliance on plant-compared with animal-based foods and all-cause mortality in omnivorous long-term colorectal cancer survivors

BACKGROUND

Plant-rich diets are associated with lower cardiometabolic risks and longer survival in the general population, but their association with mortality in cancer survivors is still unclear.

OBJECTIVES

We aimed to examine the associations of 3 postdiagnostic plant-based diet indices with all-cause mortality in omnivorous long-term colorectal cancer (CRC) survivors.

METHODS

Diet was assessed with FFQs at a median of 6 years after diagnosis in 1404 CRC survivors (56% male; median age, 69 years) in a Northern German prospective cohort study. An overall, a healthful plant-based, and an unhealthful plant-based diet index were derived by scoring intakes of animal foods reversely and intakes of healthy (whole grains, vegetables, fruits, legumes, nuts, oils, tea/coffee) and less healthy plant foods (refined grains, fruit juices, sugar-sweetened beverages, potatoes, sweets/desserts) positively or reversely, depending on the index. Vital status follow-up was conducted via population registries. Cox proportional hazards regression was applied to estimate HRs for all-cause mortality according to plant-based diet adherence.

RESULTS

Within 7 years (median) after diet assessment, 204 deaths occurred. The overall plant-based diet index displayed a significant, inverse association with all-cause mortality (HR per 10-point increase in diet index, 0.72; 95% CI, 0.57-0.91). Although not statistically significant, higher healthful plant-based diet scores showed a strong tendency towards lower mortality (HR, 0.82; 95% CI, 0.67-1.01). The unhealthful plant-based diet index was associated with higher mortality, but lost statistical significance after multivariable adjustment (HR, 1.19; 95% CI, 0.96-1.48). A subgroup analysis revealed that the tendency towards a positive association of the unhealthful plant-based diet with mortality was restricted to less physically active individuals (<95 metabolic equivalent of task hours/week).

CONCLUSIONS

An overall plant-based diet was inversely associated with all-cause mortality in long-term CRC survivors. However, more research is needed to further disentangle the impacts of different qualities of plant-based diets on cancer survivors' health.

Associations between baseline demographic, clinical and lifestyle factors, and changes in fatigue, depression, and health-related quality of life in long-term cancer survivors: a cohort study

PURPOSE

To investigate the longitudinal associations between demographic, clinical and lifestyle factors, and changes in patient-reported outcomes (PROs) in cancer survivors 6-9 years post-diagnosis in Western Australia.

METHODS

A total of 290 individuals participated in this study. Three-quarters of participants were female, and 55%, 31%, and 14% were survivors of breast cancer, colon cancer, and non-Hodgkin lymphoma (NHL), respectively. PROs (fatigue, depression, and health-related quality of life (HRQOL)) were reported at two time points (2012-13 and 2017). Descriptive statistics were used to assess the overall changes over time and linear mixed models were used to identify factors associated with changes over time, after adjusting for confounders.

RESULTS

No significant changes were observed in PROs between time point 1 and follow-up at the population level, yet a notable proportion of participants (23% for fatigue, 10% for depression, and 39% for HRQOL) reported a negative minimal clinically important difference (MCID). Being non-Caucasian and having had NHL were associated with negative changes over time. Being obese and having had radiotherapy were related to improved outcomes.

CONCLUSION

Cancer survivors whose levels of fatigue, depression, and quality of life are compromised during cancer treatment may require intervention even 6-9 years post-treatment. Our results suggest particular attention should be paid to those who are non-Caucasian and who have had NHL. This is crucial for providing appropriate care and to support those who are at increased risk of deteriorating naturally over time.

Diet and cognitive function in cancer survivors with cancer-related cognitive impairment: A qualitative study

OBJECTIVE

To identify cancer survivors' perceptions of the role diet plays in their cognitive function, and how their cancer-related cognitive changes influence their diet.

METHODS

Cancer survivors diagnosed with cancer in the past 5 years, not on active treatment, and with self-reported cognitive changes since diagnosis were recruited from the general population. Semi-structured interviews were conducted with 15 Australian breast (n = 13) and colorectal (n = 2) survivors (mean time since diagnosed: 27.0 months ± SD=16.8). Questions related to how their diet and cognitive changes influenced each other. Interviews were recorded, and transcripts were analysed using thematic analysis.

RESULTS

Four themes related to how diet impacted cognition: (a) directly (e.g. healthy diet improves cognition), (b) indirectly (e.g. diet affects tiredness which affects cognition); (c) no impact; and (d) potentially (e.g. poorer diet quality would worsen cognition). Three themes emerged for how cognitive changes were thought to impact survivors' diets: (a) planning meals is harder; (b) cooking is more difficult and complex; and, (c) choosing healthy is more challenging.

CONCLUSIONS

Many cancer survivors perceived a bidirectional influence between diet and cognition that has cognitive and behavioural consequences. Diet could be investigated as a modifiable lifestyle behaviour to improve cancer-related cognitive impairment and fatigue. Survivors may benefit from dietary guidance with meal planning and preparing.

The Role of CT-Quantified Body Composition on Longitudinal Health-Related Quality of Life in Colorectal Cancer Patients: The Colocare Study

Background: Obesity, defined by body mass index (BMI), measured at colorectal cancer (CRC) diagnosis has been associated with postoperative complications and survival outcomes. However, BMI does not allow for a differentiation between fat and muscle mass. Computed tomography (CT)-defined body composition more accurately reflects different types of tissue and their associations with health-related quality of life (HRQoL) during the first year of disease, but this has not been investigated yet. We studied the role of visceral and subcutaneous fat area (VFA and SFA) and skeletal muscle mass (SMM) on longitudinally assessed HRQoL in CRC patients. Methods: A total of 138 newly diagnosed CRC patients underwent CT scans at diagnosis and completed questionnaires prior to and six and twelve months post-surgery. We investigated the associations of VFA, SFA, and SMM with HRQoL at multiple time points. Results: A higher VFA was associated with increased pain six and twelve months post-surgery (β = 0.06, p = 0.04 and β = 0.07, p = 0.01) and with worse social functioning six months post-surgery (β = −0.08, p = 0.01). Higher SMM was associated with increased pain twelve months post-surgery (β = 1.03, p < 0.01). Conclusions: CT-quantified body composition is associated with HRQoL scales post-surgery. Intervention strategies targeting a reduction in VFA and maintaining SMM might improve HRQoL in CRC patients during the first year post-surgery.

Correlates of poor adherence to a healthy lifestyle among a diverse group of colorectal cancer survivors

PURPOSE

Lifestyle factors may have a synergistic effect on health. We evaluated the correlates of poor adherence to a healthy lifestyle among a diverse sample of colorectal cancer (CRC) survivors to inform future lifestyle promotion programs.

METHODS

Lifestyle questions from a cross-sectional survey were completed by 283 CRC survivors (41% Hispanic, 40% rural, 33% low income). Adherence to recommendations (yes/no) for physical activity, fruit and vegetable servings/day, avoiding tobacco, and healthy weight was summed to create an overall lifestyle quality score. Polytomous logistic regression was used to evaluate correlates of good (reference group), moderate, and poor overall lifestyle quality. Potential correlates included sociodemographic characteristics, cancer-related factors, and indicators of health and well-being.

RESULTS

CRC survivors with poor adherence were 2- to 3.4-fold significantly more likely to report multiple comorbidities, poor physical functioning, fatigue, anxiety/depressive symptoms, and poor social participation. In multivariable analyses, poor physical functioning was the only significant correlate of poor adherence to lifestyle recommendations, compared to good adherence [OR (95% CI) 3.4 (1.8-6.4)]. The majority of survivors, 71% and 78%, indicated interest in receiving information on exercise and eating a healthy diet, respectively.

CONCLUSION

Future lifestyle promotion programs for CRC survivors should carefully consider indicators of physical and psychosocial health and well-being, especially poor physical functioning, in the design, recruitment, and implementation of these health programs.

Smoking, alcohol consumption, diet and physical activity following stoma formation surgery, stoma-related concerns, and desire for lifestyle advice: a United Kingdom survey

BACKGROUND

Adherence to smoking, alcohol consumption, diet and physical activity (PA) guidelines may improve outcomes for people with a stoma. A better understanding of these behaviours following stoma formation surgery and their experiences and attitudes towards receiving lifestyle advice, could help identify specific gaps and inform interventions going forward. The aim of this study was to describe changes in current lifestyle following stoma formation and to explore concerns, desire for lifestyle information, advice and support among people who have or have had a stoma.

METHODS

A sample of adults who currently had or in the past had a stoma for treatment for any medical condition was recruited online through relevant charities and companies, and invited to complete a cross-sectional, online survey. Consenting participants (n = 425) provided demographic information and completed brief, validated questionnaires about their lifestyle, alongside questions around their concerns regarding permanent stoma and experiences of lifestyle information and advice. Responses were summarised using descriptive statistics, and associations between reported concerns about stoma and changes in health behaviours were explored.

RESULTS

Most respondents (93%) still had a stoma at the time of completing the survey. The majority (80%) had not consumed at least 5 portions of fruit and vegetables on the previous day and 20% reported they had not participated in at least 30 min of physical activity on any day in the previous week. Most respondents were non-smokers (84%) and did not exceed recommendations for alcohol intake (60%). Most (56%) felt their PA had decreased following stoma formation. Frequencies of concerns about a permanent stoma were high, and appeared to be associated with reported decreases in PA. Of those reporting nausea, 40% felt their diet had worsened since having their stoma. A large proportion of respondents had not received PA (42%) or dietary (30%) advice, and of these > 90% would have liked guidance.

CONCLUSIONS

Few respondents to this survey were eating the recommended amount of fruit and vegetables, and most reported a decrease in their PA following stoma surgery. Lifestyle advice would be welcomed by this population, which professionals should take into account when addressing stoma- related concerns.

Adherence to the World Cancer Research Fund/American Institute for Cancer Research recommendations for cancer prevention is associated with better health-related quality of life among long-term colorectal cancer survivors: results of the PROFILES registry

Since colorectal cancer (CRC) survivors often suffer from long-term adverse health effects of the cancer and its treatment, having a negative impact on their health-related quality of life (HRQL), this study focuses on the association between adherence to WCRF/AICR recommendations and HRQL among CRC survivors. In a cross-sectional PROFILES registry study in 1096 CRC survivors (mean time since diagnosis 8.1 years), WCRF/AICR adherence scores (range 0–8, with a higher score for better adherence) were calculated, and HRQL was assessed using the EORTC QLQ-C30. Associations between adherence scores and HRQL scores were investigated using linear regression analyses. Additionally, associations with adherence to guidelines for body mass index (BMI) (normal weight, overweight and obese), physical activity (PA) (score 0/1) and diet (score < 3, 3– < 4 and > 4) were evaluated separately. Mean adherence score was 4.81 ± 1.04. Higher WCRF/AICR scores were associated with better global health status (β 1.64; 95%CI 0.69/2.59), physical functioning (β 2.71; 95%CI 1.73/3.68), role functioning (β 2.87; 95%CI 1.53/4.21), cognitive functioning (β 1.25; 95%CI 0.19/2.32), social functioning (β 2.01; 95%CI 0.85/3.16) and fatigue (β − 2.81; 95%CI − 4.02/− 1.60). Adherence versus non-adherence PA was significantly associated with better physical, role, emotional and social functioning, global health status and less fatigue. Except for the association between being obese and physical functioning (β − 4.15; 95%CI − 47.16/− 1.15), no statistically significant associations with physical functioning were observed comparing adherence to non-adherence to BMI and dietary recommendations. Better adherence to the WCRF/AICR recommendations was positively associated with global health status, most functioning scales and less fatigue among CRC survivors. PA seemed to be the main contributor.

Development and psychometric properties of the Healthy Aging Activity Engagement Scale (HAAE)

OBJECTIVES

Accumulating research indicates that engaging in healthy lifestyle behaviors (e.g. exercise, cognitive and social engagement, stress reduction) can prevent illness and disability as people age and improve mental health. The Healthy Aging Activity Engagement (HAAE) scale was developed to holistically assess an individual's level of engagement in healthy aging behaviors across multiple health domains.

METHODS

Participants were 275 healthy younger, midlife and older adults. Participants rated engagement in 38 healthy aging lifestyle behaviors over the past 7 days on a scale from 1 (strongly disagree) to 5 (strongly agree).

RESULTS

Traditional measurement analysis and Rasch modelling techniques resulted in a 32-item scale with three subscales representing biologic health, social and cognitive strategies, and health safeguard behaviors. With the exception of the health safeguard subscale, the HAAE total score and subscales demonstrated good internal consistency, test-retest reliability, convergent and discriminant validity, and responsiveness to a program designed to promote engagement in healthy brain aging behaviors.

DISCUSSION

With further validation, the HAAE may be useful for holistic clinical assessment of behaviors that promote healthy aging, support brain and mental health, and for treatment planning. Furthermore, the HAAE can be used to measure the outcome of multi-domain lifestyle interventions.

Health-related quality of life in long-term survivors of colorectal cancer and its association with all-cause mortality: a German cohort study

Background

The group of colorectal cancer (CRC) survivors continues to grow worldwide. Understanding health-related quality of life (HRQOL) determinants and consequences of HRQOL impairments in long-term CRC survivors may help to individualize survivorship care plans. We aimed to i) examine the HRQOL status of CRC long-term survivors, ii) identify cross-sectional sociodemographic and clinical correlates of HRQOL, and iii) investigate the prospective association of HRQOL after CRC diagnosis with all-cause mortality.

Methods

We assessed HRQOL within a Northern German cohort of 1294 CRC survivors at a median of 6 years after CRC diagnosis using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Cross-sectional correlates of different HRQOL dimensions were analyzed using multivariable-adjusted logistic regression models with HRQOL as a binary variable. With multivariable-adjusted Cox proportional hazards regression models, hazard ratios (HR) of all-cause mortality were estimated per 10-point-increments of an HRQOL summary score, a global quality of life scale, and HRQOL functioning and symptom domains.

Results

The median HRQOL summary score was 87 (interquartile range: 75–94). Sex, age, education, tumor location, metastases, other cancers, type of therapy, and current stoma were identified as correlates of different HRQOL scales. After a median follow-up time of 7 years after HRQOL assessment, 175 participants had died. Nearly all HRQOL domains, except for cognitive functioning and diarrhea, were significantly associated with all-cause mortality. A 10-point-increment in the summary score decreased the risk of death by 24% (HR: 0.76; 95% CI: 0.70–0.82).

Conclusions

HRQOL in CRC survivors appeared to be relatively high in the long term. Various clinical and sociodemographic factors were cross-sectionally associated with HRQOL in long-term CRC survivors. Lower HRQOL was associated with increased all-cause mortality. Individualized healthcare programs for CRC survivors (including psychosocial screening and interventions) are needed to detect decreased HRQOL and to further improve long-term HRQOL and survival.

Electronic supplementary material

The online version of this article (10.1186/s12885-018-5075-1) contains supplementary material, which is available to authorized users.

Dietary Patterns and Quality of Life in Older Adults: A Systematic Review

Dietary patterns may be related to quality of life (QoL) of older adults, although evidence from literature is conflicting. The demographic shifts toward ageing populations in many countries increases the importance of understanding the relationship between diet and QoL in older adults. This review was designed to investigate associations between dietary patterns and QoL in older adults. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eight electronic databases were searched to identify articles published in English from January 1975 to March 2018 that investigated associations between dietary patterns and QoL in older adults. Relevant studies were identified based on set inclusion and exclusion criteria, data were extracted and analysed to examine the relationships and possible implications for public health recommendations. The systematic review included 15 articles (One randomized control trial, six prospective cohorts and eight cross sectional). The studies looked at correlations between different dietary patterns and/or adherence to particular dietary patterns and self-reported QoL or self-rated health status. Excluding two studies which showed no significant association, healthy dietary patterns were associated with better self-rated health and QoL in one or more domains, and adherence to healthy dietary patterns like the Mediterranean diet were significantly associated with improvement in at least one of the QoL domains.

Validation of two short questionnaires assessing physical activity in colorectal cancer patients

Background

In order to investigate the impact of adherence to recommendations of physical activity and sedentary time on health outcomes in clinical trials, there is a need for feasible tools such as questionnaires that can give representative estimates of these measures. The primary aim of the present study was to validate two such questionnaires and their ability to estimate adherence to the recommendations of physical activity defined as moderate-to- vigorous physical activity or moderate physical activity of at least 150 min/week in colorectal cancer patients. Secondarily, self-reported sedentary time from the HUNT-PAQ was also evaluated.

Methods

Participants from 'The Norwegian dietary guidelines and colorectal cancer survival-study’ (CRC-NORDIET study) completed two short questionnaires; the NORDIET-FFQ (n = 78) and the HUNT-PAQ (n = 77). The physical activity monitor SenseWear Armband Mini was used as the reference method during seven consecutive days.

Results

The NORDIET-FFQ provided better estimates of time in moderate-to- vigorous physical activity and moderate physical activity than the HUNT-PAQ. The NORDIET-FFQ was unable to rank individual time in moderate-to- vigorous physical activity and moderate physical activity (Spearman’s rho = 0.08, p = 0.509 and Spearman’s rho rho = 0.01, p = 0.402, respectively). All intensities were under-reported by the HUNT-PAQ, but ranking of individual time in moderate physical activity and sedentary time were acceptable among women only (Spearman’s rho = 0.37, p = 0.027 and Spearman’s rho = 0.36, p = 0.035, respectively). The HUNT-PAQ correctly classified 71% of those not meeting the recommendations (sensitivity), and the NORDIET-FFQ correctly classified 63% of those who met the recommendations (specificity). About 67% and 33% reported to meet the recommendation of moderate-to- vigorous physical activity with the NORDIET-FFQ and HUNT-PAQ, respectively, whereas 55% actually met the moderate-to- vigorous physical activity according to the SenseWear Armband Mini.

Conclusions

The NORDIET-FFQ provided better specificity and better estimates of PA than the HUNT-PAQ. The HUNT-PAQ provided better sensitivity, and provided better ranking of PA and sedentary time among women than NORDIET-FFQ. It is important to be aware of the limitations documented in the present study.

Trial registration

The study is registered on the National Institutes of Health Clinical Trials (Identifier: NCT01570010). Registered 4 April 2012.

Electronic supplementary material

The online version of this article (10.1186/s13102-018-0096-2) contains supplementary material, which is available to authorized users.

Quality of life and physical activity in long-term (≥5 years post-diagnosis) colorectal cancer survivors - systematic review

BACKGROUND

Due to the increasing number of long-term (≥5 years post diagnosis) colorectal cancer survivors, long-term quality of life of these patients is highly relevant. Several studies have reported a positive association between physical activity and quality of life in colorectal cancer survivors, however, so far no systematic review has been published which focuses on long-term colorectal cancer survivors.

MATERIAL AND METHODS

A systematic review was conducted using the databases PubMed, Web of Science, PsychINFO, and CINAHL. Studies which investigated associations between physical activity and quality of life in long-term colorectal cancer survivors were included.

RESULTS AND CONCLUSION

Ten articles based on seven studies were identified. Long-term colorectal cancer survivors who were physically active reported better quality of life than long-term survivors who were not physically active. Both, moderate to vigorous physical activity and lower levels like light physical activity were associated with higher quality of life. Most studies assessed the association between physical activity and quality of life cross-sectionally but one prospective study which measured physical activity and quality of life at three different points in time also found associations between physical activity and quality of life. The association between physical activity and quality of life seemed to be stronger among women than among men. The findings of this systematic review support an association between physical activity and quality of life in long-term colorectal cancer survivors. However, the evidence is limited as most studies were based on cross-sectional and observational design.

Colorectal cancers survivors' adherence to lifestyle recommendations and cross-sectional associations with health-related quality of life

The lifestyle recommendations of the World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) are primarily intended for cancer prevention. In the absence of specific recommendations for cancer survivors, we investigated adherence of colorectal cancer (CRC) survivors to the WCRF/AICR lifestyle recommendations and associations with health-related quality of life (HRQoL). The cross-sectional part of the Energy for life after ColoRectal cancer (EnCoRe) study was conducted in 155 CRC survivors (stage I-III), 2-10 years post diagnosis. Dietary intake, physical activity and general body fatness were measured by 7-d food diaries, by questionnaires and accelerometers and BMI, respectively. Adherence to each of the ten WCRF/AICR recommendations was scored as 0 (no/low adherence), 0·5 (moderate adherence) or 1 point (complete adherence), and summed into an overall adherence score (range: 0-10). HRQoL, disability and distress were assessed by validated questionnaires. Associations of the overall WCRF/AICR adherence score with HRQoL outcomes were analysed by confounder-adjusted linear regression. The mean adherence score was 5·1 (sd 1·4, range: 1·5-8·5). In confounder-adjusted models, a higher adherence score was significantly associated with the HRQoL dimension better physical functioning (β per 1 point difference in score: 2·6; 95 % CI 0·2, 5·1) and with less fatigue (β: -3·3; 95 % CI -6·4, -0·1). In conclusion, higher adherence of CRC survivors to WCRF/AICR lifestyle recommendations for cancer prevention was associated with better physical functioning and with less fatigue. This study adds to the limited knowledge on adherence to lifestyle behaviours in CRC survivors and relationships with quality of life. Prospective studies are needed to investigate longitudinal associations.

A randomized dose-response trial of aerobic exercise and health-related quality of life in colon cancer survivors

OBJECTIVE

To examine the dose-response effects of aerobic exercise on health-related quality of life (HRQoL) among colon cancer survivors.

METHODS

Thirty-nine stage I to III colon cancer survivors were randomized to 1 of 3 groups: usual-care control, 150 min·wk^-1 of aerobic exercise (low-dose) and 300 min·wk^-1 of aerobic exercise (high-dose) for 6 months. HRQoL outcomes included the Short Form (SF)-36 physical and mental component summary, Functional Assessment of Cancer Therapy-Colorectal, Pittsburgh Sleep Quality Index, Fear of Cancer Recurrence Inventory, Fatigue Symptom Inventory, and North Central Cancer Treatment Group bowel function questionnaire, assessed at baseline and post intervention. The primary hypothesis was that exercise would improve HRQoL outcomes in a dose-response fashion, such that high-dose aerobic exercise would yield the largest improvements in HRQoL outcomes.

RESULTS

Over 6 months, the low-dose group completed 141 ± 10 min·wk^-1 of aerobic exercise, and the high-dose group completed 247 ± 11 min·wk^-1 of aerobic exercise. Over 6 months, exercise improved the physical component summary score of the SF-36 (P_trend  = 0.002), the Functional Assessment of Cancer Therapy-Colorectal (P_trend  = 0.025), the Pittsburgh Sleep Quality Index (P_trend  = 0.049), and the Fatigue Symptom Inventory (P_trend  = 0.045) in a dose-response fashion. Between-group standardized mean difference effects sizes for the above-described findings were small to moderate in magnitude (0.35-0.75). No dose-response effects were observed for the mental component summary score of the SF-36, the Fear of Cancer Recurrence Inventory, or bowel function.

CONCLUSION

Higher doses of aerobic exercise, up to 300 min·wk^-1 , improve multiple HRQoL outcomes among stage I to III colon cancer survivors. These findings provide evidence that aerobic exercise may provide multiple health benefits for colon cancer survivors.

Associations Between Dietary Patterns and Longitudinal Quality of Life Changes in Colorectal Cancer Patients: The ColoCare Study

Quality of life (QoL) is an important clinical outcome in cancer patients. We investigated associations between dietary patterns and QoL changes in colorectal cancer (CRC) patients. The study included 192 CRC patients with available EORTC QLQ-C30 data before and 12 months post-surgery and food frequency questionnaire data at 12 months post-surgery. Principal component analysis was used to identify dietary patterns. Multivariate regression models assessed associations between dietary patterns and QoL changes over time. We identified four major dietary patterns: "Western" dietary pattern characterized by high consumption of potatoes, red and processed meat, poultry, and cakes, "fruit&vegetable" pattern: high intake of vegetables, fruits, vegetable oils, and soy products, "bread&butter" pattern: high intake of bread, butter and margarine, and "high-carb" pattern: high consumption of pasta, grains, nonalcoholic beverages, sauces and condiments. Patients following a "Western" diet had lower chances to improve in physical functioning (OR = 0.45 [0.21-0.99]), constipation (OR = 0.30 [0.13-0.72]) and diarrhea (OR: 0.44 [0.20-0.98]) over time. Patients following a "fruit&vegetable" diet showed improving diarrhea scores (OR: 2.52 [1.21-5.34]. A "Western" dietary pattern after surgery is inversely associated with QoL in CRC patients, whereas a diet rich in fruits and vegetables may be beneficial for patients' QoL over time.

Psychological symptoms and subsequent healthy lifestyle after a colorectal cancer diagnosis

OBJECTIVE

Although medical professionals recommend lifestyle changes following a colorectal cancer (CRC) diagnosis to improve outcomes, such changes are not consistently implemented. This study examines whether higher distress is associated with lower likelihood of engaging in favorable behaviors after CRC diagnosis.

METHOD

Women from the Nurses' Health Study prospective cohort who completed anxiety (n = 145) and depression (n = 227) symptom scales within 4 years after receiving a CRC diagnosis were included. Measures of lifestyle (diet, physical activity, alcohol, smoking, body mass index [BMI]) were queried prediagnosis, when psychological symptoms were assessed (1988 and 1992, respectively), and then every 4 years thereafter until 2010. Women were categorized according to initial psychological symptoms levels and followed through 2010 or until last follow-up completed.

RESULTS

Higher versus lower anxiety symptoms were significantly related to unhealthier lifestyle scores throughout follow-up (β = -0.25, CI [-0.44, -0.05]); however, the rate of change over time was similar across groups (pinteraction effect = 0.41). Stratified analyses hinted that higher anxiety and depression symptoms were related to increased odds of reporting a future unhealthy lifestyle within 10-years postdiagnosis. Beyond 10 years, anxiety became statistically unrelated with future lifestyle, and higher depressive symptoms were associated with lower odds of subsequently having an unhealthy lifestyle, albeit nonstatistically significant (OR = 0.35, 95% CI [0.10, 1.24], p = 0.10).

CONCLUSIONS

Among women with CRC, higher anxiety and depression symptoms were associated with subsequent unhealthier lifestyle in the 10 years following diagnosis. With replication, such findings may suggest that treating psychological symptoms early in the cancer trajectory may not solely reduce psychological distress but also promote healthier lifestyle. (PsycINFO Database Record

Postdiagnostic physical activity, sleep duration, and TV watching and all-cause mortality among long-term colorectal cancer survivors: a prospective cohort study

BACKGROUND

Lifestyle recommendations for cancer survivors are warranted to improve survival. In this study, we aimed to examine the association of total physical activity, different types of physical activity, hours of sleeping at day and night, and hours spent watching television (TV) with all-cause mortality in long-term colorectal cancer (CRC) survivors.

METHODS

We assessed physical activity in 1376 CRC survivors (44% women; median age, 69 years) at median 6 years after CRC diagnosis using a validated questionnaire. Multivariable-adjusted Cox regression models were used to estimate hazard ratios (HRs) for all-cause mortality according to categories of physical activities, sleep duration, and TV watching.

RESULTS

During a median follow-up time of 7 years, 200 participants had died. Higher total physical activity was significantly associated with lower all-cause mortality (HR: 0.53; 95% CI: 0.36-0.80, 4th vs. 1st quartile). Specifically, sports, walking, and gardening showed a significant inverse association with all-cause mortality (HR: 0.34; 95% CI: 0.20-0.59, HR: 0.65; 95% CI: 0.43-1.00, and HR: 0.62; 95% CI: 0.42-0.91, respectively for highest versus lowest category). Individuals with ≥2 h of sleep during the day had a significantly increased risk of all-cause mortality compared to individuals with no sleep at day (HR: 2.22; 95% CI: 1.43-3.44). TV viewing of ≥4 h per day displayed a significant 45% (95% CI: 1.02-2.06) higher risk of dying compared to ≤2 h per day of watching TV.

CONCLUSIONS

Physical activity was inversely related to all-cause mortality; specific activity types might be primarily responsible for this association. More hours of sleep during the day and a higher amount of TV viewing were each associated with higher all-cause mortality. Based on available evidence, it is reasonable to recommend CRC survivors to engage in regular physical activity.

The Impact of Body Mass Index and Waist Circumference on Health-related Quality of Life Among Colorectal Cancer Survivors: Results from the PROFILES Registry

BACKGROUND

We aimed to assess the association of waist circumference (WC) and body mass index (BMI) with health-related quality of life (HRQL) among colorectal cancer (CRC) survivors.

METHODS

CRC survivors diagnosed between 2000 and 2009 completed questionnaires in August 2013 (with self-reported weight, height, and self-assessed WC) and January 2014 (with HRQL using the EORTC-QLQ-C30). Clinical characteristics were retrieved from the Netherlands Cancer Registry. In multivariable linear regression analyses associations of BMI only, WC only and both BMI and WC with HRQL outcomes were assessed.

RESULTS

1,111 CRC survivors were included of whom 34% had a normal weight (18.5 ≤ BMI < 25 kg/m²), 49% had overweight (25 ≤ BMI < 30 kg/m²), 17% had obesity (BMI ≥ 30 kg/m²), and 44% had an increased WC (i.e., >102 and >88 cm for men and women, respectively). Both BMI and WC were separately associated with worse global health status, functioning, and more symptoms of fatigue. Increased WC was associated with lower physical, role and emotional functioning, regardless of BMI, with average differences ranging between 3 and 5 points.

CONCLUSION

Future research on HRQL among CRC survivors should consider both BMI and WC. Furthermore, weight reduction trials should not only focus on general weight loss but also on the loss of abdominal fat.

Associations of adipose and muscle tissue parameters at colorectal cancer diagnosis with long-term health-related quality of life

PURPOSE

Increased visceral adiposity (visceral obesity) and muscle wasting (sarcopenia) at colorectal cancer (CRC) diagnosis, quantified by computed tomography (CT) image analysis, have been unfavorably associated with short-term clinical outcomes and survival, but associations with long-term health-related quality of life (HRQoL) have not been investigated. We studied associations of visceral adiposity, muscle fat infiltration, muscle mass, and sarcopenia at CRC diagnosis with HRQoL 2-10 years post-diagnosis.

METHODS

A cross-sectional study was conducted in 104 stage I‒III CRC survivors, diagnosed at Maastricht University Medical Center+, the Netherlands (2002-2010). Diagnostic CT images at the level of the third lumbar vertebra were analyzed to retrospectively determine visceral adipose tissue area (cm2); intermuscular adipose tissue area (cm2) and mean muscle attenuation (Hounsfield units) as measures of muscle fat infiltration; and skeletal muscle index (SMI, cm2/m2) as measure of muscle mass and for determining sarcopenia.

RESULTS

Participants showed a large variation in body composition parameters at CRC diagnosis with a mean visceral adipose tissue area of 136.1 cm2 (standard deviation: 93.4) and SMI of 47.8 cm2/m2 (7.2); 47% was classified as being viscerally obese, and 32% as sarcopenic. In multivariable linear regression models, associations of the body composition parameters with long-term global quality of life, physical, role and social functioning, disability, fatigue, and distress were not significant, and observed mean differences were below predefined minimal important differences.

CONCLUSIONS

Although visceral obesity and sarcopenia are relatively common at CRC diagnosis, we found no significant associations of these parameters with long-term HRQoL in stage I-III CRC survivors.

Postdiagnostic Mediterranean and Healthy Nordic Dietary Patterns Are Inversely Associated with All-Cause Mortality in Long-Term Colorectal Cancer Survivors

Background: Dietary factors are known to affect the risk of new-onset colorectal cancer (CRC), but information on the extent to which postdiagnostic diet affects mortality in long-term CRC survivors is scarce.Objective: We investigated the association of 2 a priori-defined postdiagnostic dietary patterns [Modified Mediterranean Diet Score (MMDS) and healthy Nordic Food Index (HNFI)] with all-cause mortality in long-term CRC survivors.Methods: Diet was assessed at a median time of 6 y after cancer diagnosis in 1404 CRC survivors (median age: 69 y; 56% men) in a prospective cohort study in Northern Germany by using a semiquantitative food-frequency questionnaire. Cox proportional hazard models, adjusting for clinical and sociodemographic characteristics, were used to assess associations of the MMDS and the HNFI with all-cause mortality.Results: A total of 204 patients died during a median follow-up time of 7 y after diet assessment. In multivariable-adjusted models, higher adherence to the modified Mediterranean diet was significantly associated with lower all-cause mortality (HR: 0.48; 95% CI: 0.32, 0.74 for highest compared with lowest score quartile and HR: 0.88; 95% CI: 0.81, 0.96 per 1-point increment in pattern score). Similarly, the HNFI was inversely associated with all-cause mortality when the highest was compared with the lowest index quartile (HR: 0.63; 95% CI: 0.39, 1.04) and when modeled as a continuous trait (HR: 0.90; 95% CI: 0.82, 0.99 per 1-point increment in the score).Conclusions: Our results suggest that higher adherences to the Mediterranean diet and to the healthy Nordic diet after CRC diagnosis are associated with better overall survival in long-term CRC survivors.

The short-term impact of colorectal cancer treatment on physical activity, functional status and quality of life: a systematic review

BACKGROUND

Physical activity, functional status and quality of life (QoL) are important determinants of the quality of life (QoL) after colorectal cancer (CRC) treatment; however, little is known on how the treatment impacts these outcomes. Having this understanding could help clinicians develop and implement strategies that would enhance or maintain the QoL of CRC patients.

OBJECTIVES

To identify the impact of curative CRC treatment (surgery with or without radiotherapy and/or chemotherapy) on physical activity, functional status and QoL within one year of treatment or diagnosis.

INCLUSION CRITERIA TYPES OF PARTICIPANTS

Colorectal cancer survivors aged 18 years and over.

TYPES OF INTERVENTIONS

Curative CRC treatment, which was surgery with or without radiotherapy and/or chemotherapy.

TYPES OF STUDIES

Pre- and post-observational and experimental studies.

OUTCOMES

Physical activity, ability to perform activities of daily living (functional status) and QoL.

SEARCH STRATEGY

CINAHL, Embase, MEDLINE, OpenGrey and ProQuest Dissertations and Theses were used to obtain published and unpublished studies in English. The date range was the start of indexing to February 2015.

METHODOLOGICAL QUALITY

All studies were assessed independently by two reviewers for relevance, eligibility and methodological quality.

DATA EXTRACTION

Data from included papers were extracted using a modified data extraction tool. Data that were presented graphically were extracted using online software.

DATA SYNTHESIS

The differences between postoperative and baseline values were calculated using the Review Manager 5.3.5 (Copenhagen: The Nordic Cochrane Centre, Cochrane) calculator and expressed as mean difference and their corresponding 95% confidence interval. Where possible, study results were pooled in statistical meta-analysis. The physical activity, functional status and some QoL results are presented in a narrative and table form.

RESULTS

A total of 23 studies were included in this review: two studies (N = 2019 patients) evaluated physical activity, two studies (N = 6908 patients) assessed functional status and 22 studies (N = 2890 patients) measured QoL. Physical activity was observed to decrease at six months after treatment. The functional status of CRC patients decreased, particularly in the elderly (Summary of findings 1 and 2). As for QoL, only the physical and functional aspects were seen to decline up to six months, but scores almost returned to baseline levels at one year after treatment. The QoL studies that used the European Organization for Research and Treatment of Cancer QLQ-C30 tool were pooled in statistical meta-analysis and summarized in Summary of findings 2. The results must be interpreted carefully due to the heterogeneity of studies and scarcity of recent studies.

CONCLUSION

In spite of the limitations, it is likely that the physical and functional capacity of CRC survivors deteriorates after treatment.

IMPLICATIONS FOR PRACTICE

The period between diagnosis and treatment provides an opportunity for clinicians to implement interventions (e.g. exercise interventions) that could enhance or restore the physical and functional capacity of CRC survivors.

IMPLICATIONS FOR RESEARCH

The paucity of studies and heterogeneity need to be addressed. The outcomes for colon and rectal cancer survivors, ostomates and non-ostomates must be analyzed separately.

Lifestyle factors and health-related quality of life in bladder cancer survivors: a systematic review

PURPOSE

Diet, physical activity, and smoking cessation are modifiable lifestyle factors that have been shown to improve health-related quality of life (HRQOL) in many cancer survivors. Our objective was to systematically review the literature on the associations between lifestyle factors, namely diet, physical activity, smoking status, and HRQOL in bladder cancer survivors.

METHODS

We queried PubMed, EMBASE, and Cochrane libraries. Two reviewers reviewed abstracts independently, and a third reviewer arbitrated disagreements. A descriptive analysis was performed. Quality assessment was conducted using the Newcastle-Ottawa Quality Assessment Scale for observational studies and the Cochrane Risk of Bias Tool for clinical trials.

RESULTS

We identified 1167 publications in the initial search, of which 9 met inclusion criteria for full-text review. We were able to obtain data on the outcomes of interest for 5 publications. A total of 1288 patients who underwent treatment for bladder cancer were included. Three studies were observational by design and two were randomized controlled trials. Physical activity was addressed by 4 studies, smoking status by 2 studies, and diet by 1 study.

CONCLUSIONS

The review highlights the limited evidence around lifestyle factors and quality of life in bladder cancer survivors. There is some evidence for a positive association between HRQOL and physical activity, but insufficient evidence upon which to draw conclusions about the effects of consuming fruits and vegetables or non-smoking.

IMPLICATIONS FOR CANCER SURVIVORS

There is limited evidence to support a positive association between health-related quality of life and physical activity, but insufficient evidence upon which to base any conclusions about consumption of fruits and vegetables or smoking cessation in bladder cancer survivors.

Associations of sedentary time and patterns of sedentary time accumulation with health-related quality of life in colorectal cancer survivors

Sedentary behavior (sitting/lying at low energy expenditure while awake) is emerging as an important risk factor that may compromise the health-related quality of life (HRQoL) of colorectal cancer (CRC) survivors. We examined associations of sedentary time with HRQoL in CRC survivors, 2–10 years post-diagnosis. In a cross-sectional study, stage I–III CRC survivors (n = 145) diagnosed (2002−2010) at Maastricht University Medical Center+, the Netherlands, wore the thigh-mounted MOX activity monitor 24 h/day for seven consecutive days. HRQoL outcomes were assessed by validated questionnaires (EORTC QLQ-C30, WHODAS II, Checklist Individual Strength, and Hospital Anxiety and Depression Scale). Confounder-adjusted linear regression models were used to estimate associations with HRQoL outcomes of MOX-derived total and prolonged sedentary time (in prolonged sedentary bouts ≥ 30 min), and usual sedentary bout duration, corrected for waking wear time. On average, participants spent 10.2 h/day sedentary (SD, 1.6), and 4.5 h/day in prolonged sedentary time (2.3). Mean usual sedentary bout duration was 27.3 min (SD, 16.8). Greater total and prolonged sedentary time, and longer usual sedentary bout duration were associated with significantly (P < 0.05) lower physical functioning, and higher disability and fatigue scores. Greater prolonged sedentary time and longer usual sedentary bout duration also showed significant associations with lower global quality of life and role functioning. Associations with distress and social functioning were non-significant. Sedentary time was cross-sectionally associated with poorer HRQoL outcomes in CRC survivors. Prospective studies are needed to investigate whether sedentary time reduction is a potential target for lifestyle interventions aiming to improve the HRQoL of CRC survivors.

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Sedentary time may negatively affect health outcomes in colorectal cancer survivors.

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Thigh-worn accelerometers provided objective and accurate estimates of sedentary time.

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Colorectal cancer survivors spent on average 10.2 h/day in sedentary time.

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Sedentary time was associated with worse quality of life, fatigue, and disability.

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Decreasing sedentary time could be a relevant target for lifestyle intervention.

Candidate Predictors of Health-Related Quality of Life of Colorectal Cancer Survivors: A Systematic Review

The population of colorectal cancer (CRC) survivors is growing and many survivors experience deteriorated health-related quality of life (HRQoL) in both early and late post-treatment phases. Identification of CRC survivors at risk for HRQoL deterioration can be improved by using prediction models. However, such models are currently not available for oncology practice. As a starting point for developing prediction models of HRQoL for CRC survivors, a comprehensive overview of potential candidate HRQoL predictors is necessary. Therefore, a systematic literature review was conducted to identify candidate predictors of HRQoL of CRC survivors. Original research articles on associations of biopsychosocial factors with HRQoL of CRC survivors were searched in PubMed, Embase, and Google Scholar. Two independent reviewers assessed eligibility and selected articles for inclusion (N = 53). Strength of evidence for candidate HRQoL predictors was graded according to predefined methodological criteria. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) was used to develop a biopsychosocial framework in which identified candidate HRQoL predictors were mapped across the main domains of the ICF: health condition, body structures and functions, activities, participation, and personal and environmental factors. The developed biopsychosocial ICF framework serves as a basis for selecting candidate HRQoL predictors, thereby providing conceptual guidance for developing comprehensive, evidence-based prediction models of HRQoL for CRC survivors. Such models are useful in clinical oncology practice to aid in identifying individual CRC survivors at risk for HRQoL deterioration and could also provide potential targets for a biopsychosocial intervention aimed at safeguarding the HRQoL of at-risk individuals.

IMPLICATIONS FOR PRACTICE

More and more people now survive a diagnosis of colorectal cancer. The quality of life of these cancer survivors is threatened by health problems persisting for years after diagnosis and treatment. Early identification of survivors at risk of experiencing low quality of life in the future is thus important for taking preventive measures. Clinical prediction models are tools that can help oncologists identify at-risk individuals. However, such models are currently not available for clinical oncology practice. This systematic review outlines candidate predictors of low quality of life of colorectal cancer survivors, providing a firm conceptual basis for developing prediction models.

Modeling how substitution of sedentary behavior with standing or physical activity is associated with health-related quality of life in colorectal cancer survivors

PURPOSE

Previous research indicates that sedentary behavior is unfavorably associated with health-related quality of life (HRQoL) of colorectal cancer (CRC) survivors. Using isotemporal substitution modeling, we studied how substituting sedentary behavior with standing or physical activity was associated with HRQoL in CRC survivors, 2-10 years post-diagnosis.

METHODS

A cross-sectional study was conducted in stage I-III CRC survivors (n = 145) diagnosed at Maastricht University Medical Center+, the Netherlands (2002-2010). Sedentary, standing, and physical activity time were measured by the thigh-mounted MOX activity monitor. HRQoL outcomes comprised global quality of life, physical, role, and social functioning, and disability (scales: 0-100), fatigue (20-140), and depression and anxiety (0-21). Isotemporal substitution modeling was applied to analyze associations with HRQoL of substituting sedentary time with equal time in standing or physical activity.

RESULTS

On average, participants spent 10.2 h/day sedentary (SD, 1.7), 3.4 h/day standing (1.3), and 1.7 h/day in physical activity (0.8). In confounder-adjusted isotemporal models, substituting sedentary time with standing or with physical activity was associated with significantly better physical functioning (regression coefficient [β], i.e., difference in outcome score per 1 h/day of sedentary time substituted with standing or physical activity, 3.1; 95% confidence interval [CI] 0.5, 5.7; and 5.6; 0.7, 10.6, respectively). Substituting sedentary time with standing was also associated with significantly lower disability (β, -3.0; 95% CI -4.9, -1.1) and fatigue (-4.0; -7.6, -0.3).

CONCLUSIONS

Our results suggest that substituting sedentary behavior with standing or physical activity may be beneficially associated with certain HRQoL outcomes in CRC survivors. Prospective studies are warranted to confirm whether actual substitution of sedentary behavior with these activities may improve HRQoL in CRC survivors.

Health Behaviors in Cervical Cancer Survivors and Associations with Quality of Life

PURPOSE

Improvement in health behaviors following cancer diagnosis may contribute to better prognosis and well-being. This study examines the prevalence of health behaviors in cervical cancer survivors who have completed treatment, and associations between health behaviors and quality of life (QOL).

METHODS

We recruited 204 women who had completed treatment for cervical cancer to participate in a randomized counseling intervention. Participants provided information on health behaviors (smoking, physical activity, and alcohol consumption); QOL (Functional Assessment of Cancer Therapy-Cervical questionnaire); and depression (Patient-Reported Outcomes Measurement Information System), anxiety (Patient-Reported Outcomes Measurement Information System), and distress (Brief Symptom Inventory) at baseline (9-30 months after diagnosis) and subsequent to the intervention. Data were analyzed using multivariate general linear models.

FINDINGS

Participants ranged in age from 20 to 72 years at diagnosis (mean = 43 years), 41% were Hispanic, and 52% were non-Hispanic white. Three-fourths were stage 1 at diagnosis and 51% were treated with radiation with or without chemotherapy. At baseline, 15% of patients were current smokers, 4% reported alcohol consumption of >10 drinks per week, and 63% reported exercising <3 hours per week. Overall, 67.4% of cervical cancer survivors did not meet recommended national guidelines for at least 1 of these health behaviors. QOL scores were significantly higher for patients with greater physical activity (128 vs 118; P = 0.002) and increased with the number of recommended guidelines met (P for trend = 0.030). Associations between patient-reported outcomes and smoking and alcohol consumption did not reach statistical significance. Participants who met guidelines for all health behaviors also had less depression (P = 0.008), anxiety (P = 0.051), and distress (P = 0.142). Participants who improved their aggregate health behaviors during the 4-month follow-up experienced a greater improvement in QOL than those who did not improve their health behaviors (10.8 vs 4.5; P = 0.026).

IMPLICATIONS

Results indicate that two-thirds of cervical cancer survivors are not meeting national guidelines for smoking, physical activity, and alcohol consumption following completion of definitive treatment. These adverse health behaviors were associated with impaired QOL and higher levels of depression and distress. Positive changes in health behaviors are associated with significant improvement in QOL.

Prevalence and correlates of healthy lifestyle behaviors among early cancer survivors

Background

Healthy lifestyle behaviors have been demonstrated to be beneficial for positive health outcomes and the quality of life in cancer survivors. However, adherence to recommendations is low. More insight is needed in factors that may explain engagement in lifestyle behaviors to develop effective cancer aftercare interventions. This study assessed different factors, namely socio-demographic, cancer-related, psychological, social cognitive factors (attitude, social support, self-efficacy) and intention, in relationship to five lifestyle behaviors (smoking, physical activity, alcohol, and fruit and vegetable consumption).

Methods

Early survivors of various types of cancer were recruited from eighteen Dutch Hospitals (n = 255). Distal factors (socio-demographic, cancer related, psychological), proximal factors (social cognitive), intention and five lifestyle behaviors (smoking, physical activity, alcohol, fruit and vegetable consumption) were assessed through a self-reported questionnaire. Cross-sectional analyses (correlations and regression analyses) were conducted.

Results

The lifestyle of a small group (11 %) of the cancer survivors was coherent with all five health recommendations, the majority (>80 %) adhered to two, three of four recommendations, and only few (<7 %) adhered to one or none recommendation. The highest prevalence in followed recommendations have been detected in physical activity (87.4 %), refrain from smoking (82 %), and alcohol consumption (75.4 %). There was low adherence to the fruit recommendation (54.8 %) and to the vegetable recommendation (27.4 %). Only weak associations were found between the different behaviors. Each separate lifestyle behavior was influenced by different patterns of correlates. Self-efficacy, attitude, and intention were the strongest correlates in all examined behaviors, although with various contributions, while socio-demographic, cancer-related and psychological factors provided a much smaller contribution.

Conclusions

Outcomes of engagement in healthy lifestyle behaviors were more positive in this study compared to other research in cancer survivors; however, there is room for improvements in adherence to all five lifestyle behaviors. Especially fruit consumption was poor and vegetable consumption even worse. Our findings emphasized that all examined lifestyle behaviors need to be encouraged, with taken into account that each lifestyle behavior may be influenced by a specific set of mainly social cognitive factors or intention.

Prospectively measured lifestyle factors and BMI explain differences in health-related quality of life between colorectal cancer patients with and without comorbid diabetes

PURPOSE

This study aimed to assess the longitudinal association between lifestyle factors, body mass index (BMI), and health-related quality of life (HRQoL) among colorectal cancer patients with (CRCDM+) and without diabetes (CRCDM-).

METHODS

Data from a longitudinal study among CRC patients diagnosed between 2000 and 2009 were used. Clinical characteristics were retrieved from the Netherlands Cancer Registry and questionnaires were sent in 2010, 2011, and 2012 using the Patient Reported Outcomes Following Initial Treatment and Long term Evaluation of Survivorship (PROFILES) registry. Lifestyle (including moderate-to-vigorous physical activity (MVPA), smoking and alcohol use), BMI, diabetes status, and HRQoL were assessed in the questionnaire.

RESULTS

One thousand seven hundred thirty-nine (49 %) patients responded to ≥2 questionnaires, of whom 126 CRCDM+ and 789 CRCDM- patients were included. CRCDM+ patients had a higher BMI (29.1 ± 4.2 vs. 26.4 ± 3.7 kg/m(2)), whereas the number of alcohol users was lower (50 vs. 70 %, p value <0.0001) among CRCDM+ as compared to CRCDM- patients. Analyses adjusted for sociodemographic and cancer characteristics showed that CRCDM+ patients reported statistically significantly lower physical function (beta = -5.76; SE = 1.67), global QoL (beta = -4.31; SE = 1.48), and more symptoms of fatigue (beta = 5.38; SE = 1.95) than CRCDM- patients. However, these effects disappeared after adjustments for lifestyle factors and BMI which were all significant predictors of HRQoL. Additional adjustment for comorbidity further attenuated the main effect of DM on HRQoL.

CONCLUSIONS

Diabetes was not independently associated with HRQoL but deteriorated HRQoL among CRCDM+ patients seem to be explained by an unhealthier lifestyle and other comorbid conditions. Moreover, residual confounding cannot be ruled out.