Erin L. Van Blarigan, ScD
IN A STUDY reported in JAMA Oncology, Erin L. Van Blarigan, ScD, of the University of California, San Francisco, and colleagues found that adherence to American Cancer Society (ACS) nutrition and physical activity guidelines for cancer survivors was associated with improved survival among patients with colon cancer in the Cancer and Leukemia Group B (CALBG) 89803/Alliance trial.1
THE STUDY INCLUDED 992 (of 1,264) patients with stage III colon cancer enrolled in the randomized adjuvant therapy trial between 1999 and 2001. The ACS guidelines include recommendations for maintaining a healthy body weight; physical activity; and a diet that includes vegetables, fruits, and whole grains. An ACS guideline score for each patient was assigned based on body mass index; physical activity; and intake of vegetables, fruits, whole grains, and red/processed meats (score range = 0–6, with higher score indicating healthier behaviors). A second score (range = 0–8) was designed that also included alcohol intake (0 points for > 1 drink per day for women or > 2 drinks per day for men, 1 point for no drinks for both men and women, and 2 points for > 0 but ≤ 1 drinks per day for women or > 0 but ≤ 2 drinks per day for men). Patients were assessed during and 6 months after chemotherapy. The mean age of patients was 60 years (range = 21–85 years), and 43% were women.
ACS Score and Outcomes
“Having a healthy body weight, being physically active, and eating a diet rich in vegetables, fruits, and whole grains after diagnosis of stage III colon cancer was associated with a longer survival.”— Erin L. Van Blarigan, ScD, and colleagues
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DURING A MEDIAN follow-up of 7 years, there were 335 recurrences and 299 deaths. Compared with patients with ACS guideline scores of 0 to 1 (n = 262, 26%), those with a score of 5 to 6 (n = 91; 9%) had significantly improved overall survival (92 events per 1,485 person-years vs 18 events per 552 person-years; hazard ratio [HR] = 0.58, 95% confidence interval [CI]: 0.34–0.99; P = .01 for trend) and disease-free survival (110 events per 1,292 person-years vs 27 events per 496 person-years; HR = 0.69, 95% CI: 0.45–1.06; P = .03 for trend). When alcohol consumption was included in the score, adjusted hazard ratios for patients with scores of 6 to 8 (n = 162, 16%) vs those with scores of 0 to 2 (n = 187, 19%) were 0.49 for overall survival (95% CI: 0.32–0.76; P = .002 for trend), 0.58 for disease-free survival (95% CI: 0.40–0.84; P = .01 for trend), and 0.64 for recurrence-free survival (95% CI: 0.44–0.94; P = .05 for trend).
The investigators concluded: “Having a healthy body weight, being physically active, and eating a diet rich in vegetables, fruits, and whole grains after diagnosis of stage III colon cancer was associated with a longer survival.” ■
DISCLOSURE: The study was supported by grants from the National Cancer Institute. For full disclosures of the study authors, visit www.jama.jamanetwork.com.
1. Van Blarigan EL, et al: Association of survival with adherence to the American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors After Colon Cancer Diagnosis. JAMA Oncol 4:783-790, 2018.