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Markozannes G, Becerra-Tomás N, Cariolou M, Balducci K, Vieira R, Kiss S, Aune D, Greenwood DC, Gunter MJ, Copson E, Renehan AG, Bours M, Demark-Wahnefried W, Hudson MM, May AM, Odedina FT, Skinner R, Steindorf K, Tjønneland A, Velikova G, Baskin ML, Chowdhury R, Hill L, Lewis SJ, Seidell J, Weijenberg MP, Krebs J, Cross AJ, Tsilidis KK, Chan DSM. Post-diagnosis physical activity and sedentary behaviour and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis. Int J Cancer 2024; 155:426-444. [PMID: 38692650 DOI: 10.1002/ijc.34903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/15/2023] [Accepted: 01/17/2024] [Indexed: 05/03/2024]
Abstract
Low physical activity and high sedentary behaviour have been clearly linked with colorectal cancer development, yet data on their potential role in colorectal cancer survival is limited. Better characterisation of these relationships is needed for the development of post-diagnosis physical activity and sedentary behaviour guidance for colorectal cancer survivors. We searched PubMed and Embase through 28 February 2022 for studies assessing post-diagnosis physical activity, and/or sedentary behaviour in relation to all-cause and cause-specific mortality and recurrence after colorectal cancer diagnosis. Total and recreational physical activity were assessed overall and by frequency, duration, intensity, and volume using categorical, linear, and non-linear dose-response random-effects meta-analyses. The Global Cancer Update Programme (CUP Global) independent Expert Committee on Cancer Survivorship and Expert Panel interpreted and graded the likelihood of causality. We identified 16 observational studies on 82,220 non-overlapping patients from six countries. Physical activity was consistently inversely associated with colorectal cancer morbidity and mortality outcomes, with 13%-60% estimated reductions in risk. Sedentary behaviour was positively associated with all-cause mortality. The evidence had methodological limitations including potential confounding, selection bias and reverse causation, coupled with a limited number of studies for most associations. The CUP Global Expert panel concluded limited-suggestive evidence for recreational physical activity with all-cause mortality and cancer recurrence. Total physical activity and its specific domains and dimensions, and sedentary behaviour were all graded as limited-no conclusion for all outcomes. Future research should focus on randomised trials, while observational studies should obtain objective and repeated physical activity measures and better adjustment for confounders.
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Affiliation(s)
- Georgios Markozannes
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Nerea Becerra-Tomás
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Margarita Cariolou
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Katia Balducci
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Rita Vieira
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Sonia Kiss
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Oslo New University College, Oslo, Norway
- Department of Research, The Cancer Registry of Norway, Oslo, Norway
| | - Darren C Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Marc J Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Ellen Copson
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andrew G Renehan
- The Christie NHS Foundation Trust, Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Martijn Bours
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Wendy Demark-Wahnefried
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital and Translational and Clinical Research Institute, and Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Diet, Cancer and Health, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Galina Velikova
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | | | - Rajiv Chowdhury
- Department of Global Health, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Lynette Hill
- World Cancer Research Fund International, London, UK
| | - Sarah J Lewis
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jaap Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Matty P Weijenberg
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - John Krebs
- Department of Biology, University of Oxford, Oxford, UK
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Doris S M Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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Galliardt M, Betz U, Birklein F, Drees P, Geber C. Falls during oxaliplatin-based chemotherapy for gastrointestinal malignancies - (lessons learned from) a prospective study. Open Med (Wars) 2023; 18:20230696. [PMID: 37251538 PMCID: PMC10224621 DOI: 10.1515/med-2023-0696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/21/2023] [Accepted: 03/20/2023] [Indexed: 05/31/2023] Open
Abstract
This prospective cohort study aimed to characterise the impact of oxaliplatin-based chemotherapy and its neurotoxic side effects (i.e., chemotherapy-induced neuropathy) on functional fall-risk and falls. Twenty chemotherapy-naïve participants (mean age, 59 years; 16 males) were consecutively included. A multimodal fall risk assessment was performed at four time points within 6 months. Polyneuropathy was assessed using the Neurologic Disability Scale; the fall risk was assessed by functional tests (Tinetti Test, Chair-Rising Test, and Timed up and Go Test). Patient-reported outcomes comprised the Hospitality Anxiety and Depression Scale (HADS), the Falls Efficacy Scale - International (FES-I) to assess the fear of falling, and the Physical Activity for the Elderly (PASE) questionnaire. Three falls occurred during the study. All fallen participants had a high fall risk-index (≥4 more risk factors) compared to only 30% of the non-fallen participants (p = 0.03) and suffered more frequently from pre-existing mild polyneuropathy (p = 0.049). Study discontinuation (n = 12) was associated with a higher rate of polypharmacy (p = 0.045), anxiety (HADS-A, p = 0.03), and specific fear of falling (FES-I, p = 0.025). In contrast, study completers (n = 8) reported an improvement in physical activity (PASE) (p = 0.018). In summary, pre-existing fall-risk factors impacted more falls than chemotherapy. A fall risk index offers a time-efficient screening option in an outpatient oncological setting.
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Affiliation(s)
- Melanie Galliardt
- Department of Neurology, University Medical Center, Johannes-Gutenberg-University, Mainz, Germany
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes-Gutenberg-University, Mainz, Germany
| | - Ulrich Betz
- Institute of Physical Therapy, Prevention and Rehabilitation, University Medical Center, Johannes-Gutenberg-University, Mainz, Germany
| | - Frank Birklein
- Department of Neurology, University Medical Center, Johannes-Gutenberg-University, Mainz, Germany
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes-Gutenberg-University, Mainz, Germany
| | - Christian Geber
- Department of Neurology, University Medical Center, Johannes-Gutenberg-University, Mainz, Germany
- DRK Schmerz-Zentrum, Auf der Steig 14-16, Mainz, 55131, Germany
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Macías-Valle A, Rodríguez-López C, González-Senac NM, Mayordomo-Cava J, Vidán MT, Cruz-Arnés ML, Jiménez-Gómez LM, Dujovne-Lindenbaum P, Pérez-Menéndez ME, Ortiz-Alonso J, Valenzuela PL, Rodríguez-Romo G, Serra-Rexach JA. Exercise effects on functional capacity and quality of life in older patients with colorectal cancer: study protocol for the ECOOL randomized controlled trial. BMC Geriatr 2023; 23:314. [PMID: 37211611 DOI: 10.1186/s12877-023-04026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Surgery and treatment for colorectal cancer (CRC) in the elderly patient increase the risk of developing post-operative complications, losing functional independence, and worsening health-related quality of life (HRQoL). There is a lack of high-quality randomized controlled trials evaluating the potential benefit of exercise as a countermeasure. The primary aim of this study is to evaluate the effectiveness of a home-based multicomponent exercise program for improving HRQoL and functional capacity in older adults undergoing CRC surgery and treatment. METHODS This randomized, controlled, observer-blinded, single-center trial aims to randomize 250 patients (>74 years) to either an intervention or a control group (i.e., usual care). The intervention group will perform an individualized home-based multicomponent exercise program with weekly telephone supervision from diagnosis until three months post-surgery. The primary outcomes will be HRQoL (EORTC QLQ-C30; CR29; and ELD14) and functional capacity (Barthel Index and Short Physical Performance Battery), which will be assessed at diagnosis, at discharge, and one, three, and six months after surgery. Secondary outcomes will be frailty, physical fitness, physical activity, inspiratory muscle function, sarcopenia and cachexia, anxiety and depression, ambulation ability, surgical complications, and hospital length of stay, readmission and mortality. DISCUSSION This study will examine the effects of an exercise program in older patients with CRC across a range of health-related outcomes. Expected findings are improvement in HRQoL and physical functioning. If proven effective, this simple exercise program may be applied in clinical practice to improve CRC care in older patients. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05448846.
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Affiliation(s)
- Angela Macías-Valle
- Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid, Madrid, Spain
| | - Carlos Rodríguez-López
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain.
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón. Health Research Institute Gregorio Marañón (IiSGM), Dr.Esquerdo 46, 28007, Madrid, Spain.
| | - Nicolas María González-Senac
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón. Health Research Institute Gregorio Marañón (IiSGM), Dr.Esquerdo 46, 28007, Madrid, Spain
| | - Jennifer Mayordomo-Cava
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón. Health Research Institute Gregorio Marañón (IiSGM), Dr.Esquerdo 46, 28007, Madrid, Spain
| | - María Teresa Vidán
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón. Health Research Institute Gregorio Marañón (IiSGM), Dr.Esquerdo 46, 28007, Madrid, Spain
- School of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain
| | - María Luisa Cruz-Arnés
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón. Health Research Institute Gregorio Marañón (IiSGM), Dr.Esquerdo 46, 28007, Madrid, Spain
| | - Luis Miguel Jiménez-Gómez
- Colorectal Surgery Unit - General Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Paula Dujovne-Lindenbaum
- Colorectal Surgery Unit - General Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Maria Elena Pérez-Menéndez
- Colorectal Surgery Unit - General Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Ortiz-Alonso
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón. Health Research Institute Gregorio Marañón (IiSGM), Dr.Esquerdo 46, 28007, Madrid, Spain
- School of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Pedro L Valenzuela
- Physical Activity and Health Research Group (PaHerg), Research Institute of the Hospital Universitario 12 de Octubre ("Imas12"), Madrid, Spain
| | - Gabriel Rodríguez-Romo
- Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Jose Antonio Serra-Rexach
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón. Health Research Institute Gregorio Marañón (IiSGM), Dr.Esquerdo 46, 28007, Madrid, Spain
- School of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain
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Pelosi AC, Rostirola GC, Pereira JS, Silva KC, Fontanari MER, Oliveira MSP, dos Reis IGM, Messias LHD. Remote and Unsupervised Exercise Strategies for Improving the Physical Activity of Colorectal Cancer Patients: A Meta-Analysis. Healthcare (Basel) 2023; 11:723. [PMID: 36900728 PMCID: PMC10000866 DOI: 10.3390/healthcare11050723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023] Open
Abstract
Colorectal cancer (CRC) burden across the world is expected to increase by ~2.2 million new cases and ~1.1 million deaths by 2030. Regular physical exercise is recommended to prevent CRC, but the myriad of protocols preclude further discussion on how to manage its variables for this population. Home-based exercise guided by remote monitoring provides an alternative to surpass the barriers of supervised exercise. However, no meta-analysis was conducted to verify the effectiveness of this intervention for improving physical activity (PA). We performed a systematic review of remote and unsupervised strategies imposed on CRC patients for improving PA and compared, via a meta-analysis, their effectiveness against CRC patients submitted to usual care or no intervention. The databases PubMed, Scopus, and Web of Science were searched on 20 September 2022. Eleven studies attained the criteria for eligibility in the qualitative approach, and seven were included in the meta-analysis. No significant effect (p = 0.06) of remote and unsupervised exercise intervention was observed. However, a sensitivity analysis including three studies that only considered CRC patients was performed, demonstrating a significant effect in favor of exercise (p = 0.008). Based on our sensitivity analysis, remote and unsupervised exercise strategies were effective to improve the PA of CRC patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Leonardo Henrique Dalcheco Messias
- Research Group on Technology Applied to Exercise Physiology (GTAFE), Laboratory of Multidisciplinary Research, São Francisco University, Bragança Paulista 12916-900, Brazil
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Chen X, Guo F, Chang-Claude J, Hoffmeister M, Brenner H. Physical activity, polygenic risk score, and colorectal cancer risk. Cancer Med 2023; 12:4655-4666. [PMID: 35891576 PMCID: PMC9972112 DOI: 10.1002/cam4.5072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Whether and to what extent the relationship between physical activity (PA) and colorectal cancer (CRC) differs according to CRC-related genetic risk remains to be determined, and no studies to date have quantified how much genetically determined risk could be compensated for with active exercise. METHODS Genetic risk was quantified by a polygenic risk score (PRS) summarizing the estimated effect of 140 CRC-associated genetic variants. Associations of PA with CRC risk were estimated by multivariable logistic regression across PRS levels. We also compared the impact of PA and specific PA types to the PRS using "genetic risk equivalent (GRE)", a novel approach to enhance effective risk communication. RESULTS Among 5058 CRC patients and 4134 controls, we observed no significant association between overall PA level in quartiles and CRC risk. However, the highest versus lowest lifetime leisure time physical activity (LTPA) was associated with a 13% lower CRC risk [odds ratio 0.87, 95% confidence interval (CI) 0.77-1.00] independent of PRS levels (adjusted p value for interaction = 0.18). This effect was equivalent to the effect of having 11 percentiles lower PRS (GRE -10.6, 95% CI -20.7 to -0.6). The GRE (95% CI) for the highest lifetime sports tertile was -23.0 (-33.9 to -12.0). CONCLUSIONS LTPA was inversely associated with CRC risk irrespective of polygenic risk for CRC, which reinforces the importance of LTPA in CRC prevention among the general population. Adequate sports activity can compensate for a large share of polygenic risk for CRC.
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Affiliation(s)
- Xuechen Chen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Feng Guo
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jenny Chang-Claude
- Unit of Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Genetic Tumor Epidemiology Group, University Medical Center Hamburg-Eppendorf, University Cancer Center Hamburg, Hamburg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
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6
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Chang WY, Chiu HM. Beyond colonoscopy: Physical activity as a viable adjunct to prevent colorectal cancer. Dig Endosc 2023; 35:33-46. [PMID: 35694899 DOI: 10.1111/den.14377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/09/2022] [Indexed: 01/17/2023]
Abstract
Colorectal cancer (CRC) is a common cancer with an increasing incidence worldwide. The implementation of a mass screening program has been proven effective in reducing the global burden of CRC, but its effectiveness is not ideal and some metabolic derangements and lifestyle factors were reported to be attributable for such a deficit. Implementing positive lifestyle intervention as primary prevention therefore becomes critical because colorectal carcinogenesis can be promoted by several lifestyle factors, such as a lack of physical activity. Herein, we review the current evidence on the association and possible mechanisms between physical activity and CRC carcinogenesis. In addition, since CRC prevention heavily relies on resection of precancerous polyps and subsequent surveillance by colonoscopy, this review will also explore the impact of physical activity on populations with different colorectal polyp risks and its potential adjunct role in altering surveillance outcomes.
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Affiliation(s)
- Wei-Yuan Chang
- Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Eyl-Armbruster RE, Thong MSY, Carr PR, Jansen L, Chang-Claude J, Hoffmeister M, Brenner H, Arndt V. Change Toward Healthier Lifestyles Is Associated With Better Health-Related Quality of Life in Long-Term Colorectal Cancer Survivors. J Natl Compr Canc Netw 2022; 20:1233-1243.e10. [PMID: 36351340 DOI: 10.6004/jnccn.2022.7049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/28/2022] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- Ruth Elisa Eyl-Armbruster
- 1Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
- 2Stuttgart Cancer Center-Tumorzentrum Eva Mayr-Stihl, Klinikum Stuttgart, Stuttgart, Germany
| | - Melissa S Y Thong
- 3Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Prudence R Carr
- 1Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
- 4Division of Chronic Disease and Aging, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lina Jansen
- 1Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Jenny Chang-Claude
- 5Unit of Genetic Epidemiology, Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
- 6Cancer Epidemiology Group, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Hoffmeister
- 1Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hermann Brenner
- 1Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
- 7Division of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany; and
- 8German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Volker Arndt
- 3Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
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Bouillet T, Joly F, Saghatchian M, Guéroult-Accolas L, Tahar JM, Descotes JM, Krakowski I. Activité Physique Adaptée et cancer métastatique : quels besoins et quelles attentes ? Bull Cancer 2022; 109:1287-1297. [DOI: 10.1016/j.bulcan.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/04/2022] [Accepted: 07/25/2022] [Indexed: 11/06/2022]
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9
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Hossain MS, Karuniawati H, Jairoun AA, Urbi Z, Ooi DJ, John A, Lim YC, Kibria KMK, Mohiuddin AM, Ming LC, Goh KW, Hadi MA. Colorectal Cancer: A Review of Carcinogenesis, Global Epidemiology, Current Challenges, Risk Factors, Preventive and Treatment Strategies. Cancers (Basel) 2022; 14:cancers14071732. [PMID: 35406504 PMCID: PMC8996939 DOI: 10.3390/cancers14071732] [Citation(s) in RCA: 219] [Impact Index Per Article: 109.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/22/2022] [Accepted: 03/27/2022] [Indexed: 02/07/2023] Open
Abstract
Colorectal cancer (CRC) is the second most deadly cancer. Global incidence and mortality are likely to be increased in the coming decades. Although the deaths associated with CRC are very high in high-income countries, the incidence and fatalities related to CRC are growing in developing countries too. CRC detected early is entirely curable by surgery and subsequent medications. However, the recurrence rate is high, and cancer drug resistance increases the treatment failure rate. Access to early diagnosis and treatment of CRC for survival is somewhat possible in developed countries. However, these facilities are rarely available in developing countries. Highlighting the current status of CRC, its development, risk factors, and management is crucial in creating public awareness. Therefore, in this review, we have comprehensively discussed the current global epidemiology, drug resistance, challenges, risk factors, and preventive and treatment strategies of CRC. Additionally, there is a brief discussion on the CRC development pathways and recommendations for preventing and treating CRC.
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Affiliation(s)
- Md. Sanower Hossain
- Department of Biomedical Science, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan 25200, Pahang, Malaysia
- Faculty of Science, Sristy College of Tangail, Tangail 1900, Bangladesh
- Correspondence: (M.S.H.); (L.C.M.); Tel.: +60-1169609649 (M.S.H.); +673-246-0922 (ext. 2202) (L.C.M.)
| | - Hidayah Karuniawati
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor 11800, Pulau Pinang, Malaysia; (H.K.); (A.A.J.)
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Muhammadiyah Surakarta, Surakarta 57102, Indonesia
| | - Ammar Abdulrahman Jairoun
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor 11800, Pulau Pinang, Malaysia; (H.K.); (A.A.J.)
- Health and Safety Department, Dubai Municipality, Dubai 67, United Arab Emirates
| | - Zannat Urbi
- Department of Industrial Biotechnology, Faculty of Industrial Sciences & Technology, Universiti Malaysia Pahang, Kuantan 26300, Pahang, Malaysia;
| | - Der Jiun Ooi
- Department of Oral Biology & Biomedical Sciences, Faculty of Dentistry, MAHSA University, Jenjarom 42610, Selangor, Malaysia;
| | - Akbar John
- Institute of Oceanography and Maritime Studies (INOCEM), Kulliyyah of Science, International Islamic University Malaysia, Kuantan 25200, Pahang, Malaysia;
| | - Ya Chee Lim
- PAP Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong BE1410, Brunei;
| | - K. M. Kaderi Kibria
- Department of Biotechnology & Genetic Engineering, Mawlana Bhashani Science and Technology University, Tangail 1902, Bangladesh; (K.M.K.K.); (A.K.M.M.)
| | - A.K. M. Mohiuddin
- Department of Biotechnology & Genetic Engineering, Mawlana Bhashani Science and Technology University, Tangail 1902, Bangladesh; (K.M.K.K.); (A.K.M.M.)
| | - Long Chiau Ming
- PAP Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong BE1410, Brunei;
- Correspondence: (M.S.H.); (L.C.M.); Tel.: +60-1169609649 (M.S.H.); +673-246-0922 (ext. 2202) (L.C.M.)
| | - Khang Wen Goh
- Faculty of Data Science and Information Technology, INTI International University, Nilai 71800, Negeri Sembilan, Malaysia;
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10
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Smit KC, Derksen JWG, Beets GLO, Belt EJT, Berbée M, Coene PPLO, van Cruijsen H, Davidis MA, Dekker JWT, van Dodewaard-de Jong JM, Haringhuizen AW, Helgason HH, Hendriks MP, Hoekstra R, de Hingh IHJT, IJzermans JNM, Janssen JJB, Konsten JLM, Los M, Mekenkamp LJM, Nieboer P, Peeters KCMJ, Peters NAJB, Pruijt HJFM, Quarles van Ufford-Mannesse P, Rietbroek RC, Schiphorst AHW, Schouten van der Velden A, Schrauwen RWM, Sie MPS, Sommeijer DW, Sonneveld DJA, Stockmann HBAC, Tent M, Terheggen F, Tjin-A-Ton MLR, Valkenburg-van Iersel L, van der Velden AMT, Vles WJ, van Voorthuizen T, Wegdam JA, de Wilt JHW, Koopman M, May AM. Physical Activity Is Associated with Improved Overall Survival among Patients with Metastatic Colorectal Cancer. Cancers (Basel) 2022; 14:cancers14041001. [PMID: 35205748 PMCID: PMC8870120 DOI: 10.3390/cancers14041001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 02/05/2023] Open
Abstract
Simple Summary Physical activity is linked to longer survival among non-metastasized colorectal cancer patients. It is unclear if physical activity is also beneficial for survival among patients with metastatic colorectal cancer. We researched this question in our study of 293 patients with metastatic colorectal cancer. We found that participants who reported higher levels of physical activity at diagnosis lived longer compared to patients who reported low activity levels. Furthermore, adherence to the physical activity guidelines for cancer survivors was related to prolonged survival. Our findings suggest that patients with metastatic colorectal cancer also benefit from being physically active. Future studies are needed to investigate whether improving exercise levels after diagnosis of metastasis is also beneficial and what kind of exercise interventions are most optimal for possibly improving survival time of patients with metastatic colorectal cancer. Abstract Regular physical activity (PA) is associated with improved overall survival (OS) in stage I–III colorectal cancer (CRC) patients. This association is less defined in patients with metastatic CRC (mCRC). We therefore conducted a study in mCRC patients participating in the Prospective Dutch Colorectal Cancer cohort. PA was assessed with the validated SQUASH questionnaire, filled-in within a maximum of 60 days after diagnosis of mCRC. PA was quantified by calculating Metabolic Equivalent Task (MET) hours per week. American College of Sports and Medicine (ACSM) PA guideline adherence, tertiles of moderate to vigorous PA (MVPA), and sport and leisure time MVPA (MVPA-SL) were assessed as well. Vital status was obtained from the municipal population registry. Cox proportional-hazards models were used to study the association between PA determinants and all-cause mortality adjusted for prognostic patient and treatment-related factors. In total, 293 mCRC patients (mean age 62.9 ± 10.6 years, 67% male) were included in the analysis. Compared to low levels, moderate and high levels of MET-hours were significantly associated with longer OS (fully adjusted hazard ratios: 0.491, (95% CI 0.299–0.807, p value = 0.005) and 0.485 (95% CI 0.303–0.778, p value = 0.003), respectively), as were high levels of MVPA (0.476 (95% CI 0.278–0.816, p value = 0.007)) and MVPA-SL (0.389 (95% CI 0.224–0.677, p value < 0.001)), and adherence to ACSM PA guidelines compared to non-adherence (0.629 (95% CI 0.412–0.961, p value = 0.032)). The present study provides evidence that higher PA levels at diagnosis of mCRC are associated with longer OS.
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Affiliation(s)
- Karel C. Smit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands; (K.C.S.); (J.W.G.D.)
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands;
| | - Jeroen W. G. Derksen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands; (K.C.S.); (J.W.G.D.)
| | - Geerard L. O. Beets
- Department of Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands;
- GROW School for Oncology and Developmental Biology, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Eric J. Th. Belt
- Department of Surgery, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands;
| | - Maaike Berbée
- Department of Radiotherapy, Maastro Clinic, 6202 NA Maastricht, The Netherlands;
| | - Peter Paul L. O. Coene
- Department of Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands;
| | - Hester van Cruijsen
- Department of Medical Oncology, Antonius Hospital, 8600 BA Sneek, The Netherlands;
| | - Marjan A. Davidis
- Department of Medical Oncology, Rivas, Banneweg 57, 4204 AA Gorinchem, The Netherlands;
| | - Jan Willem T. Dekker
- Department of Surgery, Reinier de Graaf Hospital, Reinier de Graafweg 5, 2600 GA Delft, The Netherlands;
| | | | | | - Helgi H. Helgason
- Department of Medical Oncology, Haaglanden Medical Center, 2501 CK Den Haag, The Netherlands;
| | - Mathijs P. Hendriks
- Department of Medical Oncology, Northwest Clinics, 1800 AM Alkmaar, The Netherlands;
| | - Ronald Hoekstra
- Department of Medical Oncology, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609 PP Hengelo, The Netherlands;
| | - Ignace H. J. T. de Hingh
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands;
| | - Jan N. M. IJzermans
- Department of Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3000 AD Rotterdam, The Netherlands;
| | - Johan J. B. Janssen
- Department of Medical Oncology, Canisius Wilhelmina Hospital, 6500 GS Nijmegen, The Netherlands;
| | - Joop L. M. Konsten
- Department of Surgery, Viecuri Hospital, Tegelseweg 210, 5912 BL Venlo, The Netherlands;
| | - Maartje Los
- Department of Medical Oncology, St. Antonius Hospital, 3430 EM Nieuwegein, The Netherlands;
| | - Leonie J. M. Mekenkamp
- Department of Medical Oncology, Medisch Spectrum Twente, 7500 KA Enschede, The Netherlands;
| | - Peter Nieboer
- Department of Medical Oncology, Wilhelmina Hospital, 9400 RA Assen, The Netherlands;
| | - Koen C. M. J. Peeters
- Department of Surgery, Leiden University Medical Center, University of Leiden, Postzone K6-39 Albinusdreef 2, 2300 RC Leiden, The Netherlands;
| | - Natascha A. J. B. Peters
- Department of Medical Oncology, Sint Jans Hospital, Vogelsbleek 5, 6001 BE Weert, The Netherlands;
| | - Hans J. F. M. Pruijt
- Department of Medical Oncology, Jeroen Bosch Hospital, 5200 ME Den Bosch, The Netherlands;
| | | | - Ron C. Rietbroek
- Department of Medical Oncology, Rode Kruis Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands;
| | - Anandi H. W. Schiphorst
- Department of Surgery, Diakonessenhuis Hospital, Bosboomstraat 1, 3582 KE Utrecht, The Netherlands;
| | | | - Ruud W. M. Schrauwen
- Department of Gastroenterology and Hepatology, Bernhoven Hospital, Nistelrodeseweg 10, 5406 PT Uden, The Netherlands;
| | - Mark P. S. Sie
- Department of Medical Oncology, ZorgSaam Hospital, Wielingenlaan 2, 4535 PA Terneuzen, The Netherlands;
| | - Dirkje W. Sommeijer
- Department of Medical Oncology, Academisch Medisch Centrum, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
- Department of Medical Oncology, Flevo Hospital, Hospitaalweg 1, 1315 RA Almere, The Netherlands
| | - Dirk J. A. Sonneveld
- Department of Surgery, Dijklander Hospital, Waterlandlaan 250, 1441 RN Purmerend, The Netherlands;
| | | | - Marleen Tent
- Department of Medical Oncology, Treant Hospital, 7800 RA Emmen, The Netherlands;
| | - Frederiek Terheggen
- Department of Medical Oncology, Bravis Hospital, Boerhaavelaan 25, 4708 AE Roosendaal, The Netherlands;
| | | | | | - Ankie M. T. van der Velden
- Department of Medical Oncology, Tergooi Hospital, Van Riebeeckweg 212, 1213 XZ Hilversum, The Netherlands;
| | - Wouter J. Vles
- Department of Surgery, Ikazia Hospital, Montessoriweg 1, 3083 AN Rotterdam, The Netherlands;
| | - Theo van Voorthuizen
- Department of Medical Oncology, Rijnstate Hospital, Postus 9555, 6800 TA Arnhem, The Netherlands;
| | - Johannes A. Wegdam
- Department of Surgery, Elkerliek Hospital, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands;
| | - Johannes H. W. de Wilt
- Department of Surgery, Radboud University Medical Center, University of Nijmegen, 6500 HB Nijmegen, The Netherlands;
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands;
| | - Anne M. May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands; (K.C.S.); (J.W.G.D.)
- Correspondence:
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11
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Fitz T, Sörgel C, Rutzner S, Hecht M, Fietkau R, Distel LV. Baseline Quality of Life of Physical Function Is Highly Relevant for Overall Survival in Advanced Rectal Cancer. Healthcare (Basel) 2022; 10:healthcare10010141. [PMID: 35052304 PMCID: PMC8775862 DOI: 10.3390/healthcare10010141] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/02/2022] [Accepted: 01/06/2022] [Indexed: 11/16/2022] Open
Abstract
In advanced rectal cancer, neoadjuvant radiochemotherapy and total mesorectal excision lead to long overall survival. The quality of life (QOL) of the patients is clearly related to the prognosis. Our question was whether the prognosis can be represented with only one question or one score from the QOL questionnaires. 360 consecutively recruited patients diagnosed with advanced rectal cancer were questioned during radiochemotherapy and a follow-up of 8 years. The questionnaires QLQ-C30 and QLQ-CR38 were used; 10 functional and 17 symptom scores were calculated. The functional score “physical function” and the symptom scores “fatigue”, “nausea and vomiting”, “pain” and “appetite loss” were highly prognostic (p < 0.001) for overall survival. “Physical function” was highly prognostic at all time points up to 1 year after starting therapy (p ≤ 0.001). The baseline “physical function” score divided the cohort into a favorable group with an 8-year overall survival rate of 70.4% versus an unfavorable group with 47.5%. In the multivariable analysis, baseline “physical function”, age and distant metastases were independent predictors of overall survival. The score “physical function” is a powerful unrelated risk factor for overall survival in patients with rectal cancer. Future analyses should study whether increased “physical function” after diagnosis could improve survival.
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Affiliation(s)
- Tim Fitz
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (C.S.); (S.R.); (M.H.); (R.F.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
- Correspondence: (T.F.); (L.V.D.)
| | - Christopher Sörgel
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (C.S.); (S.R.); (M.H.); (R.F.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
| | - Sandra Rutzner
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (C.S.); (S.R.); (M.H.); (R.F.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
| | - Markus Hecht
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (C.S.); (S.R.); (M.H.); (R.F.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (C.S.); (S.R.); (M.H.); (R.F.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
| | - Luitpold V. Distel
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (C.S.); (S.R.); (M.H.); (R.F.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
- Correspondence: (T.F.); (L.V.D.)
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12
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Wang T, Zhang Y, Taaffe DR, Kim JS, Luo H, Yang L, Fairman CM, Qiao Y, Newton RU, Galvão DA. Protective effects of physical activity in colon cancer and underlying mechanisms: A review of epidemiological and biological evidence. Crit Rev Oncol Hematol 2022; 170:103578. [PMID: 35007701 DOI: 10.1016/j.critrevonc.2022.103578] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/07/2021] [Accepted: 01/05/2022] [Indexed: 12/24/2022] Open
Abstract
Numerous epidemiological studies indicate that physical activity has a protective effect against colon cancer development and progression. Further, the relevant biological mechanisms where physical activity or exercise may improve survival have also been initially examined. In this review, we provide an overview of the epidemiological evidence to date which comprises 16 cohort studies of the effects of physical activity on colon cancer outcomes including cancer recurrence, cancer-specific and overall survival. Moreover, we present four potential mechanisms involving shear pressure, systemic milieu alteration, extracellular vesicles, and immune function by which physical activity and exercise may favorably impact colon cancer. Research currently in progress will provide definitive evidence of survival benefits resulting from exercise and future work will help clarify the role of targeted exercise and the relevant mechanisms involved.
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Affiliation(s)
- Tianzhen Wang
- Department of Pathology, Harbin Medical University, Harbin, 150081, China; Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Ying Zhang
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia; Department of Physiology, Harbin Medical University, Harbin, 150081, China
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Jin-Soo Kim
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Hao Luo
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Lirui Yang
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Ciaran M Fairman
- Exercise Science Department, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Yuandong Qiao
- Laboratory of Medical Genetics, Harbin Medical University, Harbin, 150081, China
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
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13
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Choy KT, Lam K, Kong JC. Exercise and colorectal cancer survival: an updated systematic review and meta-analysis. Int J Colorectal Dis 2022; 37:1751-1758. [PMID: 35882678 PMCID: PMC9388423 DOI: 10.1007/s00384-022-04224-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The benefit of exercise to colorectal cancer patients has been advocated. However, comparative data to quantify the survival benefit is lacking. The aim of this review was to assess the effect of exercise on colorectal cancer survival. METHODS An up-to-date systematic review was performed on the available literature between 2000 and 2021 on PubMed, EMBASE, Medline, and Cochrane Library databases. All studies reporting on the impact of exercise and colorectal cancer outcomes in patients treated for non-metastatic colorectal cancer were analysed. The main outcome measures were the overall survival (OS), cancer specific survival (CSS) and disease free survival (DFS). RESULTS A total of 13 prospective observational studies were included, accounting for 19,135 patients. Compared to negligible physical activity, overall survival (OS) was significantly increased for both moderate and highest activity group (HR 0.82, 95% CI: 0.74-0.90, p < 0.001 and HR 0.64, 0.56-0.72, p < 0.001 respectively). This was also reflected in cancer specific survival (CSS) analysis, but not disease-free survival (DFS) analysis. CONCLUSION Exercise was associated with an increased in overall survival after a colorectal cancer resection. This would support the promotion of exercise interventions amongst colorectal cancer patients.
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Affiliation(s)
- Kay T. Choy
- Department of Surgery, Austin Hospital, Melbourne, VIC Australia
| | - Kenneth Lam
- Department of Surgery, St. Vincent’s Hospital, Melbourne, VIC Australia
| | - Joseph C. Kong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC Australia ,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC Australia ,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC Australia
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14
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Lee M, Lee Y, Jang D, Shin A. Physical Activity after Colorectal Cancer Diagnosis and Mortality in a Nationwide Retrospective Cohort Study. Cancers (Basel) 2021; 13:cancers13194804. [PMID: 34638290 PMCID: PMC8508146 DOI: 10.3390/cancers13194804] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Physical activity can help to prevent colorectal cancer, but its importance after cancer diagnosis has not been validated. In this nationwide insurance data-based study of 43,596 colorectal cancer patients, a high level of physical activity after colorectal cancer diagnosis was negatively associated with a risk of death in both colon and rectal cancer patients, particularly in the surgically treated group. Our findings support the importance of the physical activity among colorectal cancer patients. Abstract Physical activity reduces the risk of colon cancer, but its prognostic impact after cancer diagnosis remains unclear. To evaluate the association between post-diagnosis activity and cause-specific mortality, we reconstructed a colorectal cancer patient cohort from the 2009–16 Korean National Health Insurance Service (NHIS) database. Subgroup analyses were performed by treatment group. In total, 27,143 colon cancer patients and 16,453 rectal cancer patients were included in the analysis (mean follow-up, 4.3 years; median 4.0 years). In the surgically treated group, a high level of activity (the weighted sum of the frequencies for walking, moderate, and vigorous activity greater than or equal to 3 times/week) was inversely associated with all-cause mortality (colon cancer: HR, 0.79; 95% CI, 0.72 to 0.88; rectal cancer: HR, 0.75; 95% CI, 0.66 to 0.86) and colorectal cancer-specific mortality (colon cancer: HR, 0.85; 95% CI, 0.76 to 0.97; rectal cancer: HR, 0.77; 95% CI, 0.66 to 0.90). No significant results were shown for cardiovascular disease-specific mortality. No association was shown in patients who received chemoradiotherapy without surgery. The present study may provide evidence for post-diagnosis physical activity as a prognostic factor in colorectal cancer, particularly in surgically treated early-stage patients.
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Affiliation(s)
- Meesun Lee
- Department of Medicine, Seoul National University College of Medicine, Seoul 03080, Korea; (M.L.); (Y.L.)
| | - Yunseo Lee
- Department of Medicine, Seoul National University College of Medicine, Seoul 03080, Korea; (M.L.); (Y.L.)
| | - Doeun Jang
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul 03080, Korea;
- Cancer Research Institute, Seoul National University, Seoul 03080, Korea
| | - Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul 03080, Korea;
- Cancer Research Institute, Seoul National University, Seoul 03080, Korea
- Integrated Major in Innovative Medical Science, Graduate School of Seoul National University, Seoul 03080, Korea
- Correspondence:
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15
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van Roekel EH, Bours MJL, van Delden L, Breukink SO, Aquarius M, Keulen ETP, Gicquiau A, Viallon V, Rinaldi S, Vineis P, Arts ICW, Gunter MJ, Leitzmann MF, Scalbert A, Weijenberg MP. Longitudinal associations of physical activity with plasma metabolites among colorectal cancer survivors up to 2 years after treatment. Sci Rep 2021; 11:13738. [PMID: 34215757 PMCID: PMC8253824 DOI: 10.1038/s41598-021-92279-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 05/20/2021] [Indexed: 11/09/2022] Open
Abstract
We investigated longitudinal associations of moderate-to-vigorous physical activity (MVPA) and light-intensity physical activity (LPA) with plasma concentrations of 138 metabolites after colorectal cancer (CRC) treatment. Self-reported physical activity data and blood samples were obtained at 6 weeks, and 6, 12 and 24 months post-treatment in stage I-III CRC survivors (n = 252). Metabolite concentrations were measured by tandem mass spectrometry (BIOCRATES AbsoluteIDQp180 kit). Linear mixed models were used to evaluate confounder-adjusted longitudinal associations. Inter-individual (between-participant differences) and intra-individual associations (within-participant changes over time) were assessed as percentage difference in metabolite concentration per 5 h/week of MVPA or LPA. At 6 weeks post-treatment, participants reported a median of 6.5 h/week of MVPA (interquartile range:2.3,13.5) and 7.5 h/week of LPA (2.0,15.8). Inter-individual associations were observed with more MVPA being related (FDR-adjusted q-value < 0.05) to higher concentrations of arginine, citrulline and histidine, eight lysophosphatidylcholines, nine diacylphosphatidylcholines, 13 acyl-alkylphosphatidylcholines, two sphingomyelins, and acylcarnitine C10:1. No intra-individual associations were found. LPA was not associated with any metabolite. More MVPA was associated with higher concentrations of several lipids and three amino acids, which have been linked to anti-inflammatory processes and improved metabolic health. Mechanistic studies are needed to investigate whether these metabolites may affect prognosis.
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Affiliation(s)
- Eline H van Roekel
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Martijn J L Bours
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Linda van Delden
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Stéphanie O Breukink
- Department of Surgery, GROW School for Oncology and Developmental Biology & NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Michèl Aquarius
- Department of Gastroenterology, VieCuri Medical Center, Venlo, the Netherlands
| | - Eric T P Keulen
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
| | - Audrey Gicquiau
- Biomarkers Group, Nutrition and Metabolism Section, International Agency for Research On Cancer (IARC-WHO), Lyon, France
| | - Vivian Viallon
- Nutritional Methodology and Biostatistics Group, Nutrition and Metabolism Section, International Agency for Research On Cancer (IARC-WHO), Lyon, France
| | - Sabina Rinaldi
- Biomarkers Group, Nutrition and Metabolism Section, International Agency for Research On Cancer (IARC-WHO), Lyon, France
| | - Paolo Vineis
- MRC Centre for Environment and Health, School of Public Health, Imperial College, London, UK
- Italian Institute of Technology, Genoa, Italy
| | - Ilja C W Arts
- Maastricht Centre for Systems Biology (MaCSBio), Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Marc J Gunter
- Nutritional Epidemiology Group, Nutrition and Metabolism Section, International Agency for Research On Cancer (IARC-WHO), Lyon, France
| | - Michael F Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Augustin Scalbert
- Biomarkers Group, Nutrition and Metabolism Section, International Agency for Research On Cancer (IARC-WHO), Lyon, France
| | - Matty P Weijenberg
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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16
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Physical activity and mortality in patients with colorectal cancer: a meta-analysis of prospective cohort studies. Eur J Cancer Prev 2021; 29:15-26. [PMID: 30964753 DOI: 10.1097/cej.0000000000000511] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The association between physical activity (PA) and colorectal cancer (CRC) patients' survival is inconsistent. We conducted a systematic review and meta-analysis to summarize published articles on this issue. We performed a comprehensive search of the PubMed, Embase, and Web of Science databases for relevant articles through 28 February 2018. The summary hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using a random-effects model. Eighteen prospective cohort studies were included in the meta-analysis, with a total of 9257 cases of total mortality (TM) and 4015 cases of colorectal cancer-specific mortality (CRCSM) among 31 873 CRC survivors and 557 150 general populations. Among CRC survivors, the highest versus the lowest levels of prediagnosis PA showed decreased risks of TM (summary HR = 0.81, 95% CI: 0.76-0.87, I = 1.8%) and CRCSM (summary HR = 0.85, 95% CI: 0.77-0.98, I = 0), respectively. Significant risk reductions for TM and CRCSM were also demonstrated for postdiagnosis PA (HR = 0.63, 95% CI: 0.54-0.74; and HR = 0.64, 95% CI: 0.47-0.88, respectively). The inverse association between prediagnosis PA and cancer mortality was more pronounced for colon cancer than that for rectal cancer (P = 0.08). The summary HRs (95% CIs) of TM were 0.89 (0.83-0.97) and 0.79 (0.69-0.90) per 10 metabolic equivalent task-h/week increase in prediagnosis and postdiagnosis PA, respectively. Our meta-analysis provides comprehensive evidence that PA performed before or after cancer diagnosis is related to reduced mortality risk among CRC survivors.
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17
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Liu X, Yang W, Wu K, Ogino S, Wang W, He N, Chan AT, Zhang ZF, Meyerhardt JA, Giovannucci E, Zhang X. Postdiagnostic dairy products intake and colorectal cancer survival in US males and females. Am J Clin Nutr 2021; 113:1636-1646. [PMID: 33871578 PMCID: PMC8244033 DOI: 10.1093/ajcn/nqab059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/16/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To evaluate the association between postdiagnostic dairy intake and survival among patients with colorectal cancer (CRC). METHODS This study analyzed data from the Nurses' Health Study (NHS) and the Health Professionals Follow-up Study (HPFS). Postdiagnostic dairy intake and other dietary and lifestyle factors were obtained from validated questionnaires. Individual dairy items including milk, cheese, yogurt, and so on were reported, and total, high-fat, and low-fat dairy intakes were derived. RESULTS A total of 1753 eligible CRC cases were identified until 2012, from which 703 deaths were documented after a median follow-up time of 8.2 y, and 242 were due to CRC. Overall, when comparing those who consumed 21+ servings/wk with <7 servings/wk, postdiagnostic total dairy intake did not show significant associations with CRC-specific mortality (HR: 1.35; 95% CI: 0.85, 2.13) or overall mortality (HR: 1.28; 95% CI: 0.98, 1.67). However, high-fat dairy, including whole milk and cream cheese, was positively associated with overall mortality (HR: 1.33; 95% CI: 1.08, 1.65) but not significantly with CRC-specific mortality (HR: 1.31; 95% CI: 0.91, 1.90) when comparing those who consumed 10.5+ servings/wk with <3.5 servings/wk. For the same comparison, low-fat dairy, including skim or nonfat milk and cottage cheese, was inversely associated with overall mortality (HR: 0.74; 95% CI: 0.59, 0.92) but not CRC-specific mortality (HR: 0.91; 95% CI: 0.63, 1.29). CONCLUSIONS Total dairy products intake did not show significant association with CRC-specific or overall mortality. However, high intake of high-fat dairy products was associated with increased mortality, whereas low-fat dairy was associated with lower risk of overall mortality.
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Affiliation(s)
- Xing Liu
- Department of Nutrition, T. H. Chan School of Public Health,
Harvard University, Boston, MA, USA
- Department of Epidemiology, School of Public Health, Fudan
University, Shanghai, P.R. China
| | - Wanshui Yang
- Channing Division of Network Medicine, Department of Medicine,
Brigham and Women's Hospital and Harvard Medical
School, Boston, MA, USA
- Department of Nutrition, School of Public Health, Anhui
Medical University, Hefei, Anhui, P.R. China
| | - Kana Wu
- Department of Nutrition, T. H. Chan School of Public Health,
Harvard University, Boston, MA, USA
| | - Shuji Ogino
- Department of Nutrition, T. H. Chan School of Public Health,
Harvard University, Boston, MA, USA
- Department of Oncologic Pathology, Dana-Farber Cancer
Institute and Harvard Medical School, Boston, MA, USA
- Program in MPE Molecular Pathological Epidemiology, Department
of Pathology, Brigham and Women's Hospital and Harvard Medical
School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge,
MA, USA
| | - Weibing Wang
- Department of Epidemiology, School of Public Health, Fudan
University, Shanghai, P.R. China
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan
University, Shanghai, P.R. China
| | - Andrew T Chan
- Channing Division of Network Medicine, Department of Medicine,
Brigham and Women's Hospital and Harvard Medical
School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge,
MA, USA
- Division of Gastroenterology, Massachusetts General Hospital
and Harvard Medical School, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts
General Hospital and Harvard Medical School, Boston, MA,
USA
| | - Zuo-Feng Zhang
- Department of Epidemiology, Fielding School of Public Health,
University of California, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, UCLA, Los
Angeles, CA, USA
| | | | - Edward Giovannucci
- Department of Nutrition, T. H. Chan School of Public Health,
Harvard University, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine,
Brigham and Women's Hospital and Harvard Medical
School, Boston, MA, USA
- Department of Epidemiology, Fielding School of Public Health,
University of California, Los Angeles, CA, USA
| | - Xuehong Zhang
- Department of Nutrition, T. H. Chan School of Public Health,
Harvard University, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine,
Brigham and Women's Hospital and Harvard Medical
School, Boston, MA, USA
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18
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Hong J, Park J. Systematic Review: Recommendations of Levels of Physical Activity among Colorectal Cancer Patients (2010-2019). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062896. [PMID: 33809006 PMCID: PMC7999512 DOI: 10.3390/ijerph18062896] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND It is necessary to engage in an appropriate level of physical activity to improve the prognoses of colorectal cancer patients, yet no guidelines currently exist. The goals of this systematic review are to determine the impact of levels of physical activity on the prognoses of colorectal cancer patients and to suggest recommended guidelines for levels of physical activity. METHODS This systematic review was conducted along PRISMA guidelines. Per the inclusion criteria, papers published in academic journals in English from 2010 to 2019 were selected. A literature search was performed on PubMed (Medline), and the results of the selected studies were qualitatively synthesized. RESULTS Of the 13 cohort studies included in this systematic review, most studies were conducted in the United States (N = 7). Immobility or low levels of physical activity adversely affected the prognoses of colorectal cancer patients. Contrarily, high levels of physical activity increased the survival rate in people with colorectal cancer. CONCLUSION For colorectal cancer patients, a level of physical activity of 17.5 to 35 MET hours per week is strongly recommended, which has been shown to reduce mortality by approximately 30 to 40%. Patients with limited physical capacity should maintain a minimum level of physical activity (≥3.5 MET hours/week).
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19
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Falz R, Thieme R, Tegtbur U, Bischoff C, Leps C, Hillemanns P, Kohlhaw K, Klempnauer J, Lordick F, Stolzenburg JU, Aktas B, Weitz J, Bork U, Wimberger P, Thomas C, Biemann R, Jansen-Winkeln B, Schulze A, Gockel I, Busse M. CRBP-TS - evaluation of a home-based training and health care program for colorectal, breast, and prostate cancer using telemonitoring and self-management: study protocol for a randomized controlled trial. BMC Sports Sci Med Rehabil 2021; 13:15. [PMID: 33622370 PMCID: PMC7901214 DOI: 10.1186/s13102-021-00244-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/07/2021] [Indexed: 01/19/2023]
Abstract
Background Physical training is recommended in various national and international guidelines for patients with cancer. Observational studies have shown that physical activity leads to reduced recurrence and mortality rates by 20–40% in colorectal, breast, and prostate cancer. Despite existing evidence, a systematic care structure is still lacking. The primary aim of this study is to implement and evaluate an online training platform to strengthen physical performance and patient empowerment after cancer surgery. Methods The evaluation will be conducted as a prospective multicenter randomized controlled trial with three subgroups (colorectal-, breast-, and prostate cancer). Each group will include 100 patients (total 300 patients including dropouts; clinical stages T1–3 and/or N+; M0 after surgery intervention) and the primary endpoint (13% increase in the maximal oxygen consumption during exercise) will be examined. The intervention group will receive a 6-month home-based online training (2–3 times per week strength-endurance training using video presentations), bidirectional activity feedback information, online communication, and online counseling. The control group (usual care) will be advised lifestyle improvement. In-hospital testing will be performed before, during, and after the intervention. In addition to cardiopulmonary capacity, tumor specific diagnostics (liquid biopsy, depression and fatigue assessment, metabolic and endothelial screening) will be applied. Discussion Due to the increasing incidence of cancer, associated with considerable mortality, morbidity and impaired quality of life, there is an imperative requirement for improved cancer care, of which structured physical training may become an integral component. Trial registration DRKS-ID: DRKS00020499; Registered 17 March 2020.
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Affiliation(s)
- Roberto Falz
- Institute of Sport Medicine and Prevention, University Leipzig, Marschnerstraße 29a, 04109, Leipzig, Germany.
| | - René Thieme
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Uwe Tegtbur
- Institute of Sport Medicine, Hannover Medical School, Hannover, Germany
| | - Christian Bischoff
- Institute of Sport Medicine and Prevention, University Leipzig, Marschnerstraße 29a, 04109, Leipzig, Germany
| | - Christian Leps
- Institute of Sport Medicine and Prevention, University Leipzig, Marschnerstraße 29a, 04109, Leipzig, Germany
| | - Peter Hillemanns
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Kay Kohlhaw
- Department of Surgery, Sana Hospitals "Leipziger Land", Borna, Germany
| | - Jürgen Klempnauer
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Florian Lordick
- Department of Oncology, Gastroenterology, Hepatology, Pulmonology and Infectious Diseases, University Hospital Leipzig, Leipzig, Germany.,University Cancer Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | | | - Bahriye Aktas
- Department of Gynaecology, University Hospital Leipzig, Leipzig, Germany
| | - Jürgen Weitz
- Department of Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner site Dresden, Dresden, Germany
| | - Ulrich Bork
- Department of Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner site Dresden, Dresden, Germany
| | - Pauline Wimberger
- National Center for Tumor Diseases (NCT), Partner site Dresden, Dresden, Germany.,Department of Gynecology and Obstetrics, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christian Thomas
- National Center for Tumor Diseases (NCT), Partner site Dresden, Dresden, Germany.,Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ronald Biemann
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany
| | - Boris Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Antina Schulze
- Institute of Sport Medicine and Prevention, University Leipzig, Marschnerstraße 29a, 04109, Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Martin Busse
- Institute of Sport Medicine and Prevention, University Leipzig, Marschnerstraße 29a, 04109, Leipzig, Germany
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20
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Asnong A, D'Hoore A, Van Kampen M, Devoogdt N, De Groef A, Sterckx K, Lemkens H, Wolthuis A, Van Molhem Y, Van Geluwe B, Debrun L, Geraerts I. Randomised controlled trial to assess efficacy of pelvic floor muscle training on bowel symptoms after low anterior resection for rectal cancer: study protocol. BMJ Open 2021; 11:e041797. [PMID: 33483444 PMCID: PMC7831707 DOI: 10.1136/bmjopen-2020-041797] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Radical surgery after a total mesorectal excision (TME) for rectal cancer often results in a significant decrease in the patient's quality of life, due to functional problems such as bowel, urinary and sexual dysfunction. The effect of pelvic floor muscle training (PFMT) on these symptoms has been scarcely investigated. We hypothesise that the proportion of successful patients will be significantly higher in the intervention group, receiving 12 weeks of PFMT, compared with the control group without treatment. The primary outcome of this trial is the severity of bowel symptoms, measured through the Low Anterior Resection Syndrome questionnaire, 4 months after TME or stoma closure. Secondary outcomes are related to other bowel and urinary symptoms, sexual function, physical activity and quality of life. METHODS AND ANALYSIS This research protocol describes a multicentre single blind prospective, randomised controlled trial. Since January 2017, patients treated for rectal cancer (n=120) are recruited after TME in three Belgian centres. One month following surgery or, in case of a temporary ileostomy, 1 month after stoma closure, patients are randomly assigned to the intervention group (n=60) or to the control group (n=60). The assessments concern the preoperative period and 1, 4, 6, 12 and 24 months postoperatively. ETHICS AND DISSEMINATION The study will be conducted in accordance with the Declaration of Helsinki. Ethics approval was granted by the local Ethical Committee of the University Hospitals Leuven (s59761) and positive advice from the others centres has been obtained. Dissemination of the results will be accomplished via guidelines and (non-)scientific literature for professionals as well as organisation of patient symposia. TRIAL REGISTRATION NUMBER NTR6383.
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Affiliation(s)
- Anne Asnong
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Vlaams-Brabant, Belgium
| | - André D'Hoore
- Department of Abdominal Surgery, KU Leuven University Hospitals Leuven Gasthuisberg Campus, Leuven, Vlaams-Brabant, Belgium
- Department of Oncology, KU Leuven, Leuven, Vlaams-Brabant, Belgium
| | - Marijke Van Kampen
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Vlaams-Brabant, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Vlaams-Brabant, Belgium
| | - An De Groef
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Vlaams-Brabant, Belgium
| | - Kim Sterckx
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Vlaams-Brabant, Belgium
| | - Hilde Lemkens
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Vlaams-Brabant, Belgium
| | - Albert Wolthuis
- Department of Abdominal Surgery, KU Leuven University Hospitals Leuven Gasthuisberg Campus, Leuven, Vlaams-Brabant, Belgium
- Department of Oncology, KU Leuven, Leuven, Vlaams-Brabant, Belgium
| | - Yves Van Molhem
- Department of Abdominal Surgery, OLVZ, Aalst, Oost-Vlaanderen, Belgium
| | - Bart Van Geluwe
- Department of Abdominal Surgery, KU Leuven University Hospitals Leuven Gasthuisberg Campus, Leuven, Vlaams-Brabant, Belgium
- Department of Abdominal Surgery, AZ Groeninge - Campus Kennedylaan, Kortrijk, West-Vlaanderen, Belgium
| | - Lynn Debrun
- Department of Abdominal Surgery, KU Leuven University Hospitals Leuven Gasthuisberg Campus, Leuven, Vlaams-Brabant, Belgium
| | - Inge Geraerts
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Vlaams-Brabant, Belgium
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21
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Carr PR, Weigl K, Edelmann D, Jansen L, Chang-Claude J, Brenner H, Hoffmeister M. Estimation of Absolute Risk of Colorectal Cancer Based on Healthy Lifestyle, Genetic Risk, and Colonoscopy Status in a Population-Based Study. Gastroenterology 2020; 159:129-138.e9. [PMID: 32179093 PMCID: PMC7387145 DOI: 10.1053/j.gastro.2020.03.016] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 03/04/2020] [Accepted: 03/07/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS Estimates of absolute risk of colorectal cancer (CRC) are needed to facilitate communication and better inform the public about the potentials and limits of cancer prevention. METHODS Using data from a large population-based case-control study in Germany (Darmkrebs: Chancen der Verhütung durch Screening [DACHS] study, which began in 2003) and population registry data, we calculated 30-year absolute risk estimates for development of CRC based on a healthy lifestyle score (derived from 5 modifiable lifestyle factors: smoking, alcohol consumption, diet, physical activity, and body fatness), a polygenic risk score (based on 90 single-nucleotide polymorphisms), and colonoscopy history. RESULTS We analyzed data from 4220 patients with CRC and 3338 individuals without CRC. Adherence to a healthy lifestyle and colonoscopy in the preceding 10 years were associated with a reduced relative risk of CRC in men and women. We observed a higher CRC risk in participants with high or intermediate genetic risk scores. For 50-year-old men and women without a colonoscopy, the absolute risk of CRC varied according to the polygenic risk score and the healthy lifestyle score (men, 3.5%-13.4%; women, 2.5%-10.6%). For 50-year-old men and women with a colonoscopy, the absolute risk of developing CRC was much lower but still varied according to the polygenic risk score and the healthy lifestyle score (men, 1.2%-4.8%; women, 0.9%-4.2%). Among all risk factor profiles, the 30-year absolute risk estimates consistently decreased with adherence to a healthy lifestyle. CONCLUSIONS In a population-based study, we found that a colonoscopy can drastically reduce the absolute risk of CRC and that the genetically predetermined risk of CRC can be further reduced by adherence to a healthy lifestyle. Our results show the magnitude of CRC prevention possible through colonoscopy and lifestyle at a predefined genetic risk. This observational study has been registered in the German Clinical Trials Register (DRKS00011793), which is a primary registry in the World Health Organization Registry Network.
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Affiliation(s)
- Prudence R Carr
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
| | - Korbinian Weigl
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany, 69120,German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany, 69120
| | - Dominic Edelmann
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany, 69120
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany, 69120
| | - Jenny Chang-Claude
- Genetic Tumour Epidemiology Group, University Medical Center Hamburg-Eppendorf, University Cancer Center Hamburg, Hamburg, Germany, 20246,Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany, 69120
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany, 69120,German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany, 69120,Division of Preventive Oncology, German Cancer Research Center, Heidelberg, Germany, 69120
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany, 69120
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22
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Eyl RE, Thong MSY, Carr PR, Jansen L, Koch-Gallenkamp L, Hoffmeister M, Chang-Claude J, Brenner H, Arndt V. Physical activity and long-term fatigue among colorectal cancer survivors - a population-based prospective study. BMC Cancer 2020; 20:438. [PMID: 32423448 PMCID: PMC7236466 DOI: 10.1186/s12885-020-06918-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 04/30/2020] [Indexed: 12/31/2022] Open
Abstract
Background Evidence suggests that physical activity (PA) is beneficial for reducing fatigue in colorectal cancer (CRC) survivors. However, little is known regarding long-term effects of PA on fatigue and whether pre-diagnosis PA is associated with less fatigue in the years after diagnosis. Our study aimed to investigate the association of pre- and post-diagnosis PA with long-term fatigue in CRC survivors. Methods This study used a German population-based cohort of 1781 individuals, diagnosed with CRC in 2003–2014, and alive at five-year follow-up (5YFU). Physical activity was assessed at diagnosis and at 5YFU. Fatigue was assessed by the Fatigue Assessment Questionnaire and the EORTC Quality of Life Questionnaire-Core 30 fatigue subscale at 5YFU. Multivariable linear regression was used to explore associations between pre- and post-diagnosis PA and fatigue at 5YFU. Results No evidence was found that pre-diagnosis PA was associated with less fatigue in long-term CRC survivors. Pre-diagnosis work-related PA and vigorous PA were even associated with higher levels of physical (Beta (ß) = 2.52, 95% confidence interval (CI) = 1.14–3.90; ß = 2.03, CI = 0.65–3.41), cognitive (ß = 0.17, CI = 0.05–0.28; ß = 0.13, CI = 0.01–0.25), and affective fatigue (ß = 0.26, CI = 0.07–0.46; ß = 0.21, CI = 0.02–0.40). In cross-sectional analyses, post-diagnosis PA was strongly associated with lower fatigue on all scales. Conclusions In this study, pre-diagnosis PA does not appear to be associated with less fatigue among long-term CRC survivors. Our results support the importance of ongoing PA in long-term CRC survivors. Our findings might be used as a basis for further research on specific PA interventions to improve the long-term outcome of CRC survivors.
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Affiliation(s)
- Ruth Elisa Eyl
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Melissa S Y Thong
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Prudence R Carr
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Lena Koch-Gallenkamp
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Jenny Chang-Claude
- Unit of Genetic Epidemiology, Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.,Cancer Epidemiology Group, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Martinistraße 54, 20251, Hamburg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.
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23
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Eyl RE, Koch-Gallenkamp L, Jansen L, Walter V, Carr PR, Hoffmeister M, Chang-Claude J, Brenner H, Arndt V. Physical Activity and Long-term Quality of Life among Colorectal Cancer Survivors-A Population-based Prospective Study. Cancer Prev Res (Phila) 2020; 13:611-622. [PMID: 32253267 DOI: 10.1158/1940-6207.capr-19-0377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 12/23/2019] [Accepted: 03/30/2020] [Indexed: 12/24/2022]
Abstract
Evidence suggests that physical activity (PA) is positively associated with (health-related) quality of life (QOL) in colorectal cancer survivors. However, little is known regarding long-term effects of PA on QOL and if prediagnosis PA is associated with QOL in the years after diagnosis. Our study aimed to investigate the association of prediagnosis and postdiagnosis PA with long-term QOL in colorectal cancer survivors.This study is based on a population-based cohort from Germany of 1,781 newly diagnosed colorectal cancer survivors over a 5-year period. PA was assessed at diagnosis and at 5-year follow-up (5YFU). Quality of life was assessed by the European Organisation for Research and Treatment of Cancer C Quality of Life Questionnaire QLQ-C30 at 5YFU. Multivariable linear regression was used to explore associations between prediagnosis and postdiagnosis PA and QOL at 5YFU.No evidence of a positive association between higher levels of prediagnosis PA and better long-term QOL was found. Higher levels of prediagnosis work-related PA and vigorous PA were even associated with decreased QOL in domains such as cognitive [Beta(β) = -2.52, 95% confidence interval (CI) = -3.77, -1.27; β = -1.92, CI = -3.17, -0.67) and emotional functioning (β = -2.52, CI = -3.84, -1.19; β = -2.12, CI = -3.44, -0.80). In cross-sectional analyses, higher postdiagnosis PA was strongly associated with higher QOL. Survivors physically active at both prediagnosis and postdiagnosis as well as survivors who increased their PA between prediagnosis and postdiagnosis reported significantly higher long-term QOL compared with survivors who remained inactive at prediagnosis and postdiagnosis. In this study, higher prediagnosis PA does not appear to be associated with higher QOL among long-term colorectal cancer survivors but our results support the importance of ongoing PA throughout survivorship.
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Affiliation(s)
- Ruth Elisa Eyl
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Lena Koch-Gallenkamp
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Viola Walter
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Prudence R Carr
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jenny Chang-Claude
- Unit of Genetic Epidemiology, Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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24
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Atinafu BT, Bulti FA, Demelew TM. Survival Status and Predictors of Mortality Among Colorectal Cancer Patients in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A Retrospective Followup Study. J Cancer Prev 2020; 25:38-47. [PMID: 32266178 PMCID: PMC7113412 DOI: 10.15430/jcp.2020.25.1.38] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 01/05/2023] Open
Abstract
Colorectal cancer is one of the commonest cancer types that has a great public health impact both in developed and developing countries. However, in Ethiopia, the survival status of colorectal cancer patients was not well understood. Therefore, the aim of this study was to determine the survival status and predictors of mortality among colorectal cancer patients in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia in 2019. The institution-based retrospective follow-up study was conducted with 621 subjects who were selected from patients registered between January 1, 2013 and December 30, 2017 with follow-up until December 30th, 2018. Data were collected from patient record review charts. A Kaplan-Meier analysis with a log-rank test, and bivariate and multivariable analysis using the Cox proportional hazard model were used. Of the 621 colorectal cancer patients who were included in the analysis, 202 (32.5%) died. The overall mortality rate was 20.3% per year (95% CI: 17.7-23.3). The overall survival was 18.1% with median survival time of 34.8 months (95% CI: 30.4-36.8). Comorbidity (adjusted hazard ratio [AHR] = 1.8, 95% CI: 1.3-2.5); stage (II [AHR = 3.8, 95% CI: 1.3-11.1], III [AHR = 8.0, 95% CI: 2.8-23.3], IV [AHR = 17.6, 95% CI: 6.1-50.7]); smoking (AHR = 1.6, 95% CI: 1.1-2.3); alcohol consumption (AHR = 1.5, 95% CI: 1.07-2.2); age ≥ 70 (AHR = 1.7, 95% CI: 1.02-2.9); and marital status (married [AHR = 2.4, 95% CI: 1.5-3.8], widowed [AHR = 2.4, 95% CI: 1.2-4.6], divorced [AHR = 2.0, 95% CI: 1.1-3.7]) were significant predictors of colorectal cancer mortality. It is crucial to implement early detection and screening, giving priority to rural dweller, comorbid patients and advanced stage diagnosed patients.
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Affiliation(s)
- Bantalem Tilaye Atinafu
- Department of Nursing, Health Science College, Debre Berhan University, Debre Birhan, Ethiopia
| | - Fekadu Aga Bulti
- Department of Nursing, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tefera Mulugeta Demelew
- Department of Nursing, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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25
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Pollán M, Casla-Barrio S, Alfaro J, Esteban C, Segui-Palmer MA, Lucia A, Martín M. Exercise and cancer: a position statement from the Spanish Society of Medical Oncology. Clin Transl Oncol 2020; 22:1710-1729. [PMID: 32052383 PMCID: PMC7423809 DOI: 10.1007/s12094-020-02312-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 01/27/2020] [Indexed: 12/16/2022]
Abstract
Due to improvements in the number of cancer survivors and survival time, there is a growing interest in healthy behaviors, such as physical activity (PA), and their potential impact on cancer- and non-cancer-related morbidity in individuals with cancer. Commissioned by the Spanish Society of Medical Oncology (SEOM), in this review, we sought to distill the most recent evidence on this topic, focusing on the mechanisms that underpin the effects of PA on cancer, the role of PA in cancer prevention and in the prognosis of cancer and practical recommendations for clinicians regarding PA counseling. Despite the available information, the introduction of exercise programs into the global management of cancer patients remains a challenge with several areas of uncertainty. Among others, the most effective behavioral interventions to achieve long-term changes in a patient’s lifestyle and the optimal intensity and duration of PA should be defined with more precision in future studies.
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Affiliation(s)
- M Pollán
- Cancer and Environmental Epidemiology, Carlos III Institute of Health, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - S Casla-Barrio
- Exercise-Oncology Unit, Spanish Cancer Association, Madrid, Spain.,GEICAM (Spanish Breast Cancer Group), Madrid, Spain
| | - J Alfaro
- Medical Oncology, Hospital de Terrassa, Barcelona, Spain
| | - C Esteban
- Medical Oncology, Hospital Virgen de la Salud, Toledo, Spain
| | - M A Segui-Palmer
- Medical Oncology, Parc Taulí Hospital Universitari, Sabadell, Spain
| | - A Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo, s/n, 28670, Villaviciosa de Odón, Madrid, Spain. .,Instituto de Investigación Hospital 12 de Octubre and CIBER de Envejecimiento Saludable y Fragilidad (CIBERFES), Madrid, Spain.
| | - M Martín
- GEICAM (Spanish Breast Cancer Group), Madrid, Spain. .,Instituto de Investigacion Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain. .,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain. .,Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Calle Dr. Esquerdo 46, 28007, Madrid, Spain.
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26
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Friedenreich CM, Stone CR, Cheung WY, Hayes SC. Physical Activity and Mortality in Cancer Survivors: A Systematic Review and Meta-Analysis. JNCI Cancer Spectr 2019; 4:pkz080. [PMID: 32337494 PMCID: PMC7050161 DOI: 10.1093/jncics/pkz080] [Citation(s) in RCA: 191] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 09/17/2019] [Accepted: 10/01/2019] [Indexed: 02/07/2023] Open
Abstract
Background Recommendations for improved survival after cancer through physical activity (PA) exist, although the evidence is still emerging. Our primary objective was to conduct a systematic review and meta-analysis of the association between prediagnosis and postdiagnosis PA and survival (cancer-specific, all-cause, and cardiovascular disease mortality) for all cancers and by tumor site. Secondary objectives were to examine the associations within population subgroups, by PA domain, and to determine the optimal dose of PA related to survival. Methods PubMed, EMBASE, and SportsDiscus databases were searched from inception to November 1, 2018. DerSimonian-Laird random-effects models were used to estimate the summary hazard ratios (HRs) and 95% confidence intervals (CI) for primary and secondary analyses and to conduct dose-response analyses. Results Evidence from 136 studies showed improved survival outcomes with highest vs lowest levels of prediagnosis or postdiagnosis total or recreational PA for all-cancers combined (cancer specific mortality: HR = 0.82, 95% CI = 0.79 to 0.86, and HR = 0.63, 95% CI = 0.53 to 0.75, respectively) as well as for 11 specific cancer sites. For breast and colorectal cancers, greater reductions were observed for postdiagnosis PA (HR = 0.58–0.63) compared with prediagnosis PA (HR = 0.80–0.86) for cancer-specific and all-cause mortality. Survival benefits through PA were observed in most subgroups (within sex, body mass index, menopausal status, colorectal subtypes, and PA domain) examined. Inverse dose-response relationships between PA and breast cancer-specific and all-cause mortality were observed, with steep reductions in hazards to 10–15 metabolic equivalent hours per week. Conclusion Higher prediagnosis and postdiagnosis levels of PA were associated with improved survival outcomes for at least 11 cancer types, providing support for global promotion of PA guidelines following cancer.
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Affiliation(s)
- Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada.,Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Chelsea R Stone
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Winson Y Cheung
- Division of Medical Oncology, Tom Baker Cancer Centre, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada.,Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sandra C Hayes
- Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
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27
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Guercio BJ, Zhang S, Ou FS, Venook AP, Niedzwiecki D, Lenz HJ, Innocenti F, O'Neil BH, Shaw JE, Polite BN, Hochster HS, Atkins JN, Goldberg RM, Sato K, Ng K, Van Blarigan E, Mayer RJ, Blanke CD, O'Reilly EM, Fuchs CS, Meyerhardt JA. Associations of Physical Activity With Survival and Progression in Metastatic Colorectal Cancer: Results From Cancer and Leukemia Group B (Alliance)/SWOG 80405. J Clin Oncol 2019; 37:2620-2631. [PMID: 31408415 DOI: 10.1200/jco.19.01019] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Regular physical activity is associated with reduced risk of recurrence and mortality in patients with nonmetastatic colorectal cancer. Its influence on patients with advanced/metastatic colorectal cancer (mCRC) has been largely unexplored. PATIENTS AND METHODS We conducted a prospective cohort study nested in Cancer and Leukemia Group B (Alliance)/SWOG 80405 (ClinicalTrials.gov identifier: NCT00265850), a National Cancer Institute-sponsored phase III trial of systemic therapy for mCRC. Within 1 month after therapy initiation, patients were invited to complete a validated questionnaire that reported average physical activity over the previous 2 months. On the basis of responses, we calculated metabolic equivalent task (MET) hours per week to quantify physical activity. The primary end point of the clinical trial and this companion study was overall survival (OS). Secondary end points included progression-free survival (PFS) and first grade 3 or greater treatment-related adverse events. To minimize confounding by poor and declining health, we excluded patients who experienced progression or died within 60 days of activity assessment and used Cox proportional hazards regression analysis to adjust for known prognostic factors, comorbidities, and weight loss. RESULTS The final cohort included 1,218 patients. Compared with patients engaged in less than 3 MET hours per week of physical activity, patients engaged in 18 or more MET hours per week experienced an adjusted hazard ratio for OS of 0.85 (95% CI, 0.71 to 1.02; PTrend = .06) and for PFS of 0.83 (95% CI, 0.70 to 0.99; PTrend = .01). Compared with patients engaging in less than 9 MET hours per week, patients engaging in 9 or more MET hours per week experienced an adjusted hazard ratio for grade 3 or greater treatment-related adverse events of 0.73 (95% CI, 0.62 to 0.86; PTrend < .001). CONCLUSION Among patients with mCRC in Cancer and Leukemia Group B (Alliance)/SWOG 80405, association of physical activity with OS was not statistically significant. Greater physical activity was associated with longer PFS and lower adjusted risk for first grade 3 or greater treatment-related adverse events.
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Affiliation(s)
| | - Sui Zhang
- Dana-Farber/Partners CancerCare, Boston, MA
| | | | - Alan P Venook
- University of California, San Francisco, San Francisco, CA
| | | | - Heinz-Josef Lenz
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | - Bert H O'Neil
- Indiana University School of Medicine, Indianapolis, IN
| | - James E Shaw
- Medstar Washington Hospital Center, Washington, DC
| | | | | | - James N Atkins
- Southeast Clinical Oncology Research Consortium, National Cancer Institute Community Oncology Research Program, Winston-Salem, NC
| | | | - Kaori Sato
- Dana-Farber/Partners CancerCare, Boston, MA
| | - Kimmie Ng
- Dana-Farber/Partners CancerCare, Boston, MA
| | | | | | - Charles D Blanke
- SWOG, Portland, OR.,Oregon Health & Science University, Portland, OR
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McTiernan A, Friedenreich CM, Katzmarzyk PT, Powell KE, Macko R, Buchner D, Pescatello LS, Bloodgood B, Tennant B, Vaux-Bjerke A, George SM, Troiano RP, Piercy KL. Physical Activity in Cancer Prevention and Survival: A Systematic Review. Med Sci Sports Exerc 2019; 51:1252-1261. [PMID: 31095082 PMCID: PMC6527123 DOI: 10.1249/mss.0000000000001937] [Citation(s) in RCA: 440] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE This article reviews and updates the evidence on the associations between physical activity and risk for cancer, and for mortality in persons with cancer, as presented in the 2018 Physical Activity Guidelines Advisory Committee Scientific Report. METHODS Systematic reviews of meta-analyses, systematic reviews, and pooled analyses were conducted through December 2016. An updated systematic review of such reports plus original research through February 2018 was conducted. This article also identifies future research needs. RESULTS In reviewing 45 reports comprising hundreds of epidemiologic studies with several million study participants, the report found strong evidence for an association between highest versus lowest physical activity levels and reduced risks of bladder, breast, colon, endometrial, esophageal adenocarcinoma, renal, and gastric cancers. Relative risk reductions ranged from approximately 10% to 20%. Based on 18 systematic reviews and meta-analyses, the report also found moderate or limited associations between greater amounts of physical activity and decreased all-cause and cancer-specific mortality in individuals with a diagnosis of breast, colorectal, or prostate cancer, with relative risk reductions ranging almost up to 40% to 50%. The updated search, with five meta-analyses and 25 source articles reviewed, confirmed these findings. CONCLUSIONS Levels of physical activity recommended in the 2018 Guidelines are associated with reduced risk and improved survival for several cancers. More research is needed to determine the associations between physical activity and incidence for less common cancers and associations with survival for other cancers. Future studies of cancer incidence and mortality should consider these associations for population subgroups, to determine dose-response relationships between physical activity and cancer risk and prognosis, and to establish mechanisms to explain these associations.
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Affiliation(s)
- Anne McTiernan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- Schools of Public Health and Medicine, Departments of Epidemiology and Medicine (Geriatrics), University of Washington, Seattle, WA
| | - Christine M. Friedenreich
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, CANADA
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, CANADA
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, CANADA
| | | | - Kenneth E. Powell
- Centers for Disease Control, Georgia Department of Public Health, Atlanta, GA
| | - Richard Macko
- Department of Neurology, University of Maryland School of Medicine; University Maryland Rehabilitation & Orthopedics Institute; Maryland Exercise & Robotics Center of Excellence, Veterans Affairs Maryland Health Care System; Geriatrics Research, Education, and Clinical Center, Veterans Affairs Medical Center, Baltimore, MD
| | - David Buchner
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Linda S. Pescatello
- Department of Kinesiology, College of Agriculture, Health and Natural Resources, University of Connecticut, Storrs, CT
| | | | | | - Alison Vaux-Bjerke
- Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services, Rockville, MD
| | - Stephanie M. George
- Office of Disease Prevention, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD
| | - Richard P. Troiano
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD
| | - Katrina L. Piercy
- Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services, Rockville, MD
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Oruç Z, Kaplan MA. Effect of exercise on colorectal cancer prevention and treatment. World J Gastrointest Oncol 2019; 11:348-366. [PMID: 31139306 PMCID: PMC6522766 DOI: 10.4251/wjgo.v11.i5.348] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/17/2019] [Accepted: 05/06/2019] [Indexed: 02/05/2023] Open
Abstract
In recent years, because of improved cancer screening, detection and treatment modalities, a rapid increase in the population of colorectal and other cancer survivors has been observed. The increasing population has justified the requirement of preventive strategies such as lifestyle modifications with regard to obesity, physical activity, diet and smoking. Physical activity may prevent approximately 15% of the colon cancers. Furthermore, several observational studies have demonstrated the efficacy and dose-dependent and anti-cancer effects of exercise on decreasing the mortality and risk of recurrence before and after the colorectal cancer (CRC) diagnosis. However, the required exercise dose, type and intensity are yet unclear. The results of randomised prospective studies are expected to determine the optimal amount, type and intensity of exercise and formulate the most appropriate exercise plan and guidelines, according to the requirements and comorbidities of the patients. In addition, recent studies have focused on the molecular and genetic mechanisms underlying the effect of physical activity on disease outcomes and recurrence rates. This review aimed to investigate the effects of physical activity and the biological basis of these effects in preventing the risk and recurrence of CRC and decreasing the hazards of cancer and cancer treatment.
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Affiliation(s)
- Zeynep Oruç
- Department of Medical Oncology, Mersin City Hospital, Mersin 33000, Turkey
| | - Muhammed Ali Kaplan
- Department of Medical Oncology, Faculty of Medicine, Dicle University, Diyarbakır 21280, Turkey
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30
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Koh H, Hamada T, Song M, Liu L, Cao Y, Nowak JA, da Silva A, Twombly T, Morikawa T, Kim SA, Masugi Y, Kosumi K, Shi Y, Gu M, Li W, Du C, Chen Y, Li W, Liu H, Li C, Wu K, Nosho K, Inamura K, Hanyuda A, Zhang X, Giannakis M, Chan AT, Fuchs CS, Nishihara R, Meyerhardt JA, Ogino S. Physical Activity and Colorectal Cancer Prognosis According to Tumor-Infiltrating T Cells. JNCI Cancer Spectr 2019; 2:pky058. [PMID: 31276098 PMCID: PMC6591576 DOI: 10.1093/jncics/pky058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/15/2018] [Accepted: 09/27/2018] [Indexed: 12/11/2022] Open
Abstract
Background Evidence suggests that high-level physical activity may potentially reduce cancer mortality through its immune enhancement effect. We therefore hypothesized that survival benefits associated with physical activity might be stronger in colorectal carcinomas with lower immune reaction at diagnosis. Methods Using molecular pathological epidemiology databases of 470 colon and rectal carcinoma cases in the Nurses’ Health Study and the Health Professionals Follow-up Study, we assessed the prognostic association of postdiagnosis physical activity in strata of densities of CD3+ cells, CD8+ cells, CD45RO (PTPRC)+ cells, or FOXP3+ cells in tumor tissue. Cox proportional hazards regression model was used to adjust for potential confounders, including microsatellite instability, CpG island methylator phenotype, long interspersed nucleotide element-1 methylation, KRAS, BRAF, and PIK3CA mutations, and expression of CTNNB1 (beta-catenin), PTGS2 (cyclooxygenase-2), and IRS1. Results The association of postdiagnosis physical activity with colorectal cancer-specific mortality differed by CD3+ cell density (Pinteraction < .001). Multivariable-adjusted colorectal cancer-specific mortality hazard ratios for a quartile-unit increase in physical activity were 0.56 (95% confidence interval = 0.38 to 0.83) among cases with the lowest quartile of CD3+ cell density compared with 1.14 (95% confidence interval = 0.79 to 1.65) in cases with the highest quartile. We observed no differential survival association of physical activity by densities of CD8+ cells, CD45RO+ cells, or FOXP3+ cells. Conclusions The association between postdiagnosis physical activity and colorectal cancer survival appeared stronger for carcinomas with lower T cell infiltrates, suggesting an interactive effect of exercise and immunity on colorectal cancer progression.
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Affiliation(s)
- Hideo Koh
- Department of Oncologic Pathology.,Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | | | - Mingyang Song
- Department of Nutrition.,Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA.,Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Li Liu
- Department of Oncologic Pathology.,Department of Nutrition.,Department of Epidemiology and Biostatistics, and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Yin Cao
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Jonathan A Nowak
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | | | | | - Teppei Morikawa
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sun A Kim
- Laboratory of Human Carcinogenesis, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | | | - Yan Shi
- Department of Oncologic Pathology.,Department of Medical Oncology, Chinese PLA General Hospital, Beijing, P.R. China
| | - Mancang Gu
- Department of Oncologic Pathology.,College of Pharmacy, Zhejiang Chinese Medical University, Zhejiang, P.R. China
| | | | | | | | | | | | | | - Kana Wu
- Department of Nutrition.,Department of Epidemiology.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Katsuhiko Nosho
- Department of Gastroenterology, Rheumatology, and Clinical Immunology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kentaro Inamura
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akiko Hanyuda
- Department of Nutrition.,Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Xuehong Zhang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Marios Giannakis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.,Broad Institute of MIT and Harvard, Cambridge, MA.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Andrew T Chan
- Department of Immunology and Infectious Diseases.,Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA.,Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Broad Institute of MIT and Harvard, Cambridge, MA
| | - Charles S Fuchs
- Yale Cancer Center, New Haven, CT.,Department of Medicine, Yale School of Medicine, New Haven, CT.,Smilow Cancer Hospital, New Haven, CT
| | - Reiko Nishihara
- Department of Oncologic Pathology.,Department of Nutrition.,Department of Epidemiology.,Department of Immunology and Infectious Diseases.,Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA.,Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Jeffrey A Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Shuji Ogino
- Department of Oncologic Pathology.,Department of Epidemiology.,Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Broad Institute of MIT and Harvard, Cambridge, MA
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Carr PR, Weigl K, Jansen L, Walter V, Erben V, Chang-Claude J, Brenner H, Hoffmeister M. Healthy Lifestyle Factors Associated With Lower Risk of Colorectal Cancer Irrespective of Genetic Risk. Gastroenterology 2018; 155:1805-1815.e5. [PMID: 30201362 PMCID: PMC6279591 DOI: 10.1053/j.gastro.2018.08.044] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 08/17/2018] [Accepted: 08/26/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS The combined effects of healthy lifestyle factors on colorectal cancer (CRC) risk are unclear. We aimed to develop a healthy lifestyle score, to investigate the joint effects of modifiable lifestyle factors on reduction of CRC risk and determine whether associations differ with genetic risk. METHODS We collected data from a large population-based case-control study in Germany and used multiple logistic regression analyses to examine associations between the healthy lifestyle score (derived from 5 modifiable lifestyle factors: smoking, alcohol consumption, diet, physical activity, and body fatness) and CRC risk. We created a genetic risk score, based on 53 risk variants, to investigate the association of the healthy lifestyle score and risk of CRC, stratified by genetic risk. RESULTS We included 4092 patients with CRC and 3032 individuals without CRC (controls) in our analysis. In adjusted models, compared with participants with 0 or 1 healthy lifestyle factor, participants with 2 (odds ratio [OR] 0.85; 95% confidence interval [CI] 0.67-1.06), 3 (OR 0.62; 95% CI 0.50-0.77), 4 (OR 0.53; 95% CI 0.42-0.66), or 5 (OR 0.33; 95% CI 0.26-0.43) healthy lifestyle factors had increasingly lower risks of CRC (P trend <.0001). We found no differences among subgroups stratified by genetic risk score, history of colonoscopy, or family history of CRC. Overall, 45% of CRC cases (95% CI 34%-53%) could be attributed to nonadherence to all 5 healthy lifestyle behaviors. CONCLUSIONS In a large population-based case-control study, we identified a combination of lifestyle factors that appears to reduce risk of CRC, regardless of the patient's genetic profile. These results reinforce the importance of primary prevention of CRC.
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Affiliation(s)
- Prudence R Carr
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
| | - Korbinian Weigl
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany; Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Viola Walter
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Vanessa Erben
- Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany; Genetic Tumour Epidemiology Group, University Medical Center Hamburg-Eppendorf, University Cancer Center Hamburg, Hamburg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
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32
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Brenner H, Chen C. The colorectal cancer epidemic: challenges and opportunities for primary, secondary and tertiary prevention. Br J Cancer 2018; 119:785-792. [PMID: 30287914 PMCID: PMC6189126 DOI: 10.1038/s41416-018-0264-x] [Citation(s) in RCA: 173] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 07/27/2018] [Accepted: 08/01/2018] [Indexed: 12/12/2022] Open
Abstract
Colorectal cancer (CRC) is both one of the most common and one of the most preventable cancers globally, with powerful but strongly missed potential for primary, secondary and tertiary prevention. CRC incidence has traditionally been the highest in affluent Western countries, but it is now increasing rapidly with economic development in many other parts of the world. CRC shares several main risk factors, such as smoking, excessive alcohol consumption, physical inactivity and being overweight, with other common diseases; therefore, primary prevention efforts to reduce these risk factors are expected to have multiple beneficial effects that extend beyond CRC prevention, and should have high public health impact. A sizeable reduction in the incidence and mortality of CRC can also be achieved by offering effective screening tests, such as faecal immunochemical tests, flexible sigmoidoscopy and colonoscopy, in organised screening programmes which have been implemented in an increasing number of countries. Countries with early and high uptake rates of effective screening have exhibited major declines in CRC incidence and mortality, in contrast to most other countries. Finally, increasing evidence shows that the prognosis and quality of life of CRC patients can be substantially improved by tertiary prevention measures, such as the administration of low-dose aspirin and the promotion of physical activity.
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Affiliation(s)
- Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Chen Chen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
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Eyl RE, Koch-Gallenkamp L, Jansen L, Walter V, Carr P, Hoffmeister M, Chang-Claude J, Brenner H, Arndt V. Potential determinants of physical inactivity among long-term colorectal cancer survivors. J Cancer Surviv 2018; 12:679-690. [PMID: 30097853 DOI: 10.1007/s11764-018-0705-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 07/18/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE Since physical activity (PA) has been shown to be associated with better prognosis and quality of life (QOL) in colorectal cancer (CRC) patients, this study focuses on the barriers of PA among CRC survivors. METHODS This study is based on a population-based study from Germany of 1343 women and men, diagnosed with CRC between 2003 and 2008 and being alive five years later. Multivariable logistic regression was used to explore associations between baseline as well as five-year follow-up (5YFU) characteristics and physical inactivity (PIA) at 5YFU. Quartiles were calculated based on metabolic equivalent hours per week of PA at baseline and at 5YFU. Participants in quartile 1 were defined as physically inactive, and patients in quartile 2 to quartile 4 were defined as physically active. RESULTS Cancer-specific factors such as having a stoma (odds ratio (OR) = 1.51, 95% confidence interval (CI) = 1.12-2.04), demographic factors such as living in a small town or city (OR = 1.46, 95% CI = 1.05-2.02; OR = 1.42, 95% CI = 1.01-2.02), older age (OR = 1.44, 95% CI = 0.80-2.58), or being divorced (OR = 1.72, 95% CI = 0.96-3.07), as well as lifestyle factors such as being a current smoker (OR = 1.54, 95% CI = 1.04-2.29) or being obese (OR = 1.43, 95% CI = 0.96-2.13) were associated with PIA at 5YFU. Subgroup analyses showed that the association between body mass index and PIA was stronger in women than in men. Baseline PA was identified as a strong predictor of PIA at 5YFU. CONCLUSIONS Findings suggest that predominately patients with a stoma, patients living in a more populated area, being older, divorced, a current smoker, or obese were more likely to be physically inactive and therefore could be targeted to be more physically active. IMPLICATIONS FOR CANCER SURVIVORS Addressing barriers for PA might help to develop specific, individually tailored PA interventions to overcome PIA and improve the long-term outcome of CRC survivors.
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Affiliation(s)
- Ruth Elisa Eyl
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
- Medical Faculty Heidelberg, University of Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Lena Koch-Gallenkamp
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Viola Walter
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Prudence Carr
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Jenny Chang-Claude
- Unit of Genetic Epidemiology, Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.
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Eyl RE, Xie K, Koch-Gallenkamp L, Brenner H, Arndt V. Quality of life and physical activity in long-term (≥5 years post-diagnosis) colorectal cancer survivors - systematic review. Health Qual Life Outcomes 2018; 16:112. [PMID: 29859108 PMCID: PMC5984808 DOI: 10.1186/s12955-018-0934-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 05/15/2018] [Indexed: 12/24/2022] Open
Abstract
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.
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Affiliation(s)
- Ruth Elisa Eyl
- German Cancer Research Center (DKFZ), Division of Clinical Epidemiology and Aging Research, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.,University of Heidelberg, Medical Faculty Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Kun Xie
- German Cancer Research Center (DKFZ), Division of Clinical Epidemiology and Aging Research, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.,University of Heidelberg, Medical Faculty Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Lena Koch-Gallenkamp
- German Cancer Research Center (DKFZ), Division of Clinical Epidemiology and Aging Research, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Hermann Brenner
- German Cancer Research Center (DKFZ), Division of Clinical Epidemiology and Aging Research, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.,German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Division of Preventive Oncology, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.,German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Volker Arndt
- German Cancer Research Center (DKFZ), Divison of Clinical Epidemiology and Aging Research, Unit of Cancer Survivorship, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.
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Phipps AI, Shi Q, Zemla TJ, Dotan E, Gill S, Goldberg RM, Hardikar S, Jahagirdar B, Limburg PJ, Newcomb PA, Shields A, Sinicrope FA, Sargent DJ, Alberts SR. Physical Activity and Outcomes in Patients with Stage III Colon Cancer: A Correlative Analysis of Phase III Trial NCCTG N0147 (Alliance). Cancer Epidemiol Biomarkers Prev 2018; 27:696-703. [PMID: 29563133 DOI: 10.1158/1055-9965.epi-17-0769] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/29/2017] [Accepted: 03/16/2018] [Indexed: 12/17/2022] Open
Abstract
Background: Prior studies have supported an inverse association between physical activity and colon cancer risk and suggest that higher physical activity may also improve cancer survival. Among participants in a phase III adjuvant trial for stage III colon cancer, we assessed the association of physical activity around the time of cancer diagnosis with subsequent outcomes.Methods: Before treatment arm randomization (FOLFOX or FOLFOX + cetuximab), study participants completed a questionnaire including items regarding usual daily activity level and frequency of participation in recreational physical activity (N = 1,992). Using multivariable Cox models, we calculated HRs for associations of aspects of physical activity with disease-free (DFS) and overall survival (OS).Results: Over follow-up, 505 participants died and 541 experienced a recurrence. Overall, 75% of participants reported recreational physical activity at least several times a month; for participants who reported physical activity at least that often (vs. once a month or less), the HRs for DFS and OS were 0.82 [95% confidence interval (CI), 0.69-0.99] and 0.76 (95% CI, 0.63-0.93), respectively. There was no evidence of material effect modification in these associations by patient or tumor attributes, except that physical activity was more strongly inversely associated with OS in patients with stage T3 versus T4 tumors (Pinteraction = 0.03).Conclusions: These findings suggest that higher physical activity around the time of colon cancer diagnosis may be associated with more favorable colon cancer outcomes.Impact: Our findings support further research on whether colon cancer survival may be enhanced by physical activity. Cancer Epidemiol Biomarkers Prev; 27(6); 696-703. ©2018 AACR.
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Affiliation(s)
- Amanda I Phipps
- Epidemiology Department, University of Washington, Seattle, Washington. .,Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Qian Shi
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Tyler J Zemla
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Efrat Dotan
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Sharlene Gill
- British Columbia Cancer Agency, Vancouver, British Canada, Canada
| | | | - Sheetal Hardikar
- Epidemiology Department, University of Washington, Seattle, Washington.,Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | - Polly A Newcomb
- Epidemiology Department, University of Washington, Seattle, Washington.,Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Anthony Shields
- Wayne State University/Karmanos Cancer Institute, Detroit, Michigan
| | | | - Daniel J Sargent
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
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Roy P, Chowdhury S, Roy HK. Exercise-induced myokines as emerging therapeutic agents in colorectal cancer prevention and treatment. Future Oncol 2018; 14:309-312. [PMID: 29318900 DOI: 10.2217/fon-2017-0555] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Priya Roy
- Section of Gastroenterology, Department of Internal Medicine, Boston University School of Medicine, MA 02118, USA
| | - Sanjib Chowdhury
- Section of Gastroenterology, Department of Internal Medicine, Boston University School of Medicine, MA 02118, USA
| | - Hemant K Roy
- Section of Gastroenterology, Department of Internal Medicine, Boston University School of Medicine, MA 02118, USA
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Ratjen I, Schafmayer C, di Giuseppe R, Waniek S, Plachta-Danielzik S, Koch M, Burmeister G, Nöthlings U, Hampe J, Schlesinger S, Lieb W. Postdiagnostic physical activity, sleep duration, and TV watching and all-cause mortality among long-term colorectal cancer survivors: a prospective cohort study. BMC Cancer 2017; 17:701. [PMID: 29070017 PMCID: PMC5657114 DOI: 10.1186/s12885-017-3697-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/19/2017] [Indexed: 01/17/2023] Open
Abstract
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.
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Affiliation(s)
- Ilka Ratjen
- Institute of Epidemiology, Christian-Albrechts-University of Kiel, University Hospital Schleswig-Holstein, Niemannsweg 11 (Haus 1), 24105, Kiel, Germany.
| | - Clemens Schafmayer
- Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Romina di Giuseppe
- Institute of Epidemiology, Christian-Albrechts-University of Kiel, University Hospital Schleswig-Holstein, Niemannsweg 11 (Haus 1), 24105, Kiel, Germany
| | - Sabina Waniek
- Institute of Epidemiology, Christian-Albrechts-University of Kiel, University Hospital Schleswig-Holstein, Niemannsweg 11 (Haus 1), 24105, Kiel, Germany
| | - Sandra Plachta-Danielzik
- Institute of Epidemiology, Christian-Albrechts-University of Kiel, University Hospital Schleswig-Holstein, Niemannsweg 11 (Haus 1), 24105, Kiel, Germany
| | - Manja Koch
- Institute of Epidemiology, Christian-Albrechts-University of Kiel, University Hospital Schleswig-Holstein, Niemannsweg 11 (Haus 1), 24105, Kiel, Germany.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Greta Burmeister
- Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Ute Nöthlings
- Nutritional Epidemiology, Department of Nutrition and Food Science, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
| | - Jochen Hampe
- Medical Department 1, University Hospital Dresden, Technical University Dresden, Dresden, Germany
| | - Sabrina Schlesinger
- Institute of Biometrics and Epidemiology, German Diabetes Center at Heinrich Heine University, Leibniz Institute for Diabetes Research, Düsseldorf, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Christian-Albrechts-University of Kiel, University Hospital Schleswig-Holstein, Niemannsweg 11 (Haus 1), 24105, Kiel, Germany
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Abstract
Colorectal cancer, the fourth leading cause of cancer-related death worldwide, is a multifactorial disease involving genetic, environmental and lifestyle risk factors. In addition, increased evidence has established a role for the intestinal microbiota in the development of colorectal cancer. Indeed, changes in the intestinal microbiota composition in colorectal cancer patients compared to control subjects have been reported. Several bacterial species have been shown to exhibit the pro-inflammatory and pro-carcinogenic properties, which could consequently have an impact on colorectal carcinogenesis. This review will summarize the current knowledge about the potential links between the intestinal microbiota and colorectal cancer, with a focus on the pro-carcinogenic properties of bacterial microbiota such as induction of inflammation, the biosynthesis of genotoxins that interfere with cell cycle regulation and the production of toxic metabolites. Finally, we will describe the potential therapeutic strategies based on intestinal microbiota manipulation for colorectal cancer treatment.
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Affiliation(s)
- Cécily Lucas
- M2iSH, UMR 1071 Inserm, University of Clermont Auvergne, INRA USC 2018, Clermont-Ferrand 63001, France.
| | - Nicolas Barnich
- M2iSH, UMR 1071 Inserm, University of Clermont Auvergne, INRA USC 2018, Clermont-Ferrand 63001, France.
| | - Hang Thi Thu Nguyen
- M2iSH, UMR 1071 Inserm, University of Clermont Auvergne, INRA USC 2018, Clermont-Ferrand 63001, France.
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Epidemiology and biology of physical activity and cancer recurrence. J Mol Med (Berl) 2017; 95:1029-1041. [PMID: 28620703 PMCID: PMC5613065 DOI: 10.1007/s00109-017-1558-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 05/24/2017] [Accepted: 06/02/2017] [Indexed: 12/12/2022]
Abstract
Physical activity is emerging from epidemiologic research as a lifestyle factor that may improve survival from colorectal, breast, and prostate cancers. However, there is considerably less evidence relating physical activity to cancer recurrence and the biologic mechanisms underlying this association remain unclear. Cancer patients are surviving longer than ever before, and fear of cancer recurrence is an important concern. Herein, we provide an overview of the current epidemiologic evidence relating physical activity to cancer recurrence. We review the biologic mechanisms most commonly researched in the context of physical activity and cancer outcomes, and, using the example of colorectal cancer, we explore hypothesized mechanisms through which physical activity might intervene in the colorectal recurrence pathway. Our review highlights the importance of considering pre-diagnosis and post-diagnosis activity, as well as cancer stage and timing of recurrence, in epidemiologic studies. In addition, more epidemiologic research is needed with cancer recurrence as a consistently defined outcome studied separately from survival. Future mechanistic research using randomized controlled trials, specifically those demonstrating the exercise responsiveness of hypothesized mechanisms in early stages of carcinogenesis, are needed to inform recommendations about when to exercise and to anticipate additive or synergistic effects with other preventive behaviors or treatments.
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