From the Journals

Healthy lifestyle linked to better colon cancer survival

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Findings help pinpoint recommendations

“If you previously gave [colorectal cancer survivors] vague recommendations about diet and exercise, now you can be more precise and recommend five to six servings per day of fruits and vegetables and 150 minutes per week of exercise,” Michael J. Fisch, MD, MPH; Lorna H. McNeill, PhD, MPH; and Karen M. Basen-Engquist, PhD, MPH, wrote in an accompanying editorial in JAMA Oncology.

Although this was an observational study, the size of the association between survival and high adherence to American Cancer Society Nutrition and Physical Activity Guidelines was “certainly striking,” they wrote.

However, few study patients were younger than 50 years, were nonwhite, or had poor performance status, they noted. Additionally, contemporary adjuvant regimens (FOLFOX and CAPEOX) include oxaliplatin, which can cause chronic neurotoxicities that undermine physical activity.

Nonetheless, the data “strengthen the call to focus on lifestyle changes to extend and improve the lives of cancer survivors,” the editorialists concluded. Although making such changes is “notoriously difficult,” clues may come from six ongoing trials of weight control and physical activity in cancer survivors.

Dr. Fisch, Dr. McNeill, and Dr. Basen-Engquist all are at the University of Texas MD Anderson Cancer Center, Houston. Dr. Fisch also is with AIM Specialty Health, Chicago, Ill.; AIM is a subsidiary of Anthem. No other disclosures were reported. This editorial accompanied the article by Van Blanigan et al. (JAMA Oncology. 2018 Apr 12. doi: 10.1001/jamaoncol.2018.0124 ).


 

FROM JAMA ONCOLOGY

A closer look at individual factors linked survival with BMI between 23 kg/m2 and 29.9 kg/m2, with engaging in at least 150 minutes of moderate exercise per week, with consuming at least five daily servings of fruits and vegetables, and with choosing whole grains over refined grains. Although the ACS recommends limiting red or processed meat, this behavior did not show a protective effect, which mirrors findings from a prior study (J Clin Oncol. 2013 Aug 1;31[22]:2773-82). “Higher protein intake may be beneficial for cancer survivors,” the investigators noted.

They also examined alcohol consumption, which the ACS guidelines did not address. Women who consumed more than one alcoholic drink per day and men who consumed more than two drinks per day had a nonsignificantly higher risk of death than abstainers (HR, 1.28; 95% CI, 0.81-2.01). Compared with abstention, low to moderate alcohol consumption was tied to a lower risk of death, but this link also did not reach significance (HR, 0.87; 95% CI, 0.66-1.14).

The National Cancer Institute funded the study. Pharmacia and Upjohn Company (now Pfizer Oncology) provided partial funding for the CALGB 89803/Alliance trial. Dr. Van Blarigan and several of the other investigators were supported by National Cancer Institute awards. No other disclosures were reported.

SOURCE: Van Blarigan EL et al. JAMA Oncol. 2018 Apr 12. doi: 10.1001/jamaoncol.2018.0126.

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