Estimates of the current and future burden of cancer attributable to lack of physical activity in Canada

Estimating cancers attributable to physical inactivity in Australia

OBJECTIVES

It was previously estimated that 1814 (1.6 % of incident cancers) were attributable to physical inactivity in Australia in 2010, when only three sites were considered. We estimated the burden of cancer due to physical inactivity in Australia for 13 sites.

DESIGN

The population attributable fraction estimated site-specific cancer cases attributable to physical inactivity for 13 cancers. The potential impact fraction was used to estimate cancers that could have been prevented in 2015 if Australian adults had increased their physical activity by a modest amount in 2004-05.

METHODS

We used 2004-05 national physical activity prevalence data, 2015 national cancer incidence data, and contemporary relative-risk estimates for physical inactivity and cancer. We assumed a 10-year latency period.

RESULTS

An estimated 6361 of the cancers observed in 2015 were attributable to physical inactivity, representing 4.8 % of all cancers diagnosed. If Australian adults had increased their physical activity by one category in 2004-05, 2564 cases (1.9 % of all cancers) could have been prevented in 2015.

CONCLUSIONS

More than three times as many cancers are attributable to physical inactivity than previously reported. Physical activity promotion should be a central component of cancer prevention programmes in Australia.

Associations between healthy lifestyle score and health-related quality of life among Chinese rural adults: variations in age, sex, education level, and income

PURPOSE

This study aimed to investigate the associations between overall lifestyles and HRQoL, as well as the variations in age, sex, education level, and income.

METHODS

A total of 23,402 participants from the Henan rural cohort were included. The healthy lifestyle score (HLS) consists of five lifestyle factors: smoking, alcohol drinking, physical activity, diet, and body mass index. HRQoL was assessed by the EQ-5D-5L questionnaire. The general linear model and Tobit regression model were utilized to assess the associations of HLS with visual analogue score (VAS) and utility index.

RESULTS

Compared with participants with an HLS of 0-2, the corresponding regression coefficients (β) and 95% confidence intervals (CI) of participants with an HLS of 3, 4, and 5 for VAS score were 1.09 (0.59, 1.59), 1.92 (1.38, 2.46), and 2.60 (1.83, 3.37); the corresponding β and 95% CI for utility index were 0.02 (0.01, 0.03), 0.05 (0.03, 0.06), and 0.06 (0.04, 0.07). Notably, these positive associations were greater among the elderly, female, and those with lower education level and average monthly income (p for interaction < 0.05). For instance, the corresponding β and 95% CI of individuals with an HLS of 5 for utility index in average monthly income < 500 RMB, 500-999 RMB, and ≥ 1000 RMB groups were 0.08 (0.05, 0.11), 0.06 (0.03, 0.09), and 0.02 (- 0.00, 0.05).

CONCLUSION

Engaging in healthier lifestyle habits was associated with a higher level of HRQoL, especially in the elderly, females, and those with low education level and average monthly income.

Proportion of Cancer Cases Attributable to Physical Inactivity by US State, 2013-2016

INTRODUCTION/PURPOSE

Little is known concerning the cancer burden attributable to physical inactivity by state. Our objective was to calculate the proportion of incident cancer cases attributable to physical inactivity among adults aged ≥30 years in 2013-2016 in all 50 states and District of Columbia.

METHODS

State-level, self-reported physical activity data from the Behavioral Risk Factor Surveillance System were adjusted by sex, age, and race/ethnicity using national level, self-reported physical activity data from the National Health and Nutrition Examination Survey. Age-, sex-, and state-specific cancer incidence data were obtained from the US Cancer Statistics database. Sex-, age-, and state-specific adjusted prevalence estimates for 8 physical activity categories and cancer-specific relative risks for the same categories from a large-scale pooled analysis were used to calculate PAFs by state for stomach, kidney, esophageal (adenocarcinoma), colon, bladder, breast, and endometrial cancer.

RESULTS

When optimal physical activity was defined ≥5 hours/week of moderate-intensity activity, equivalent to ≥15 metabolic equivalent task (MET)-hours/week, 3.0% (95% CI 2.9%-3.0%) of all incident cancer cases (excluding non-melanoma skin cancers) were attributable to physical inactivity, accounting for an average of 46,356 attributable cases per year. The PAF ranged from 2.3% (95% CI 2.2%-2.5%) in Utah to 3.7% (95% CI 3.4%-3.9%) in Kentucky. By cancer site, the PAF ranged from 3.9% (95% CI 3.6%-4.2%) for urinary bladder to 16.9% (95% CI 16.1%-17.7%) for stomach.

CONCLUSION

Our results indicate that promoting physical activity through broad implementation of interventions could prevent many cancer cases. Over 46,000 cancer cases annually could be potentially avoided if the American population met the recommended 5 hours/week of moderate-intensity (or 15 (MET)-hours/week) physical activity.

Prediction of cancer survival for cohorts of patients most recently diagnosed using multi-model inference

Despite a large choice of models, functional forms and types of effects, the selection of excess hazard models for prediction of population cancer survival is not widespread in the literature. We propose multi-model inference based on excess hazard model(s) selected using Akaike information criteria or Bayesian information criteria for prediction and projection of cancer survival. We evaluate the properties of this approach using empirical data of patients diagnosed with breast, colon or lung cancer in 1990-2011. We artificially censor the data on 31 December 2010 and predict five-year survival for the 2010 and 2011 cohorts. We compare these predictions to the observed five-year cohort estimates of cancer survival and contrast them to predictions from an a priori selected simple model, and from the period approach. We illustrate the approach by replicating it for cohorts of patients for which stage at diagnosis and other important prognosis factors are available. We find that model-averaged predictions and projections of survival have close to minimal differences with the Pohar-Perme estimation of survival in many instances, particularly in subgroups of the population. Advantages of information-criterion based model selection include (i) transparent model-building strategy, (ii) accounting for model selection uncertainty, (iii) no a priori assumption for effects, and (iv) projections for patients outside of the sample.

Increasing Physical Activity in Empty Nest and Retired Populations Online: A Randomized Feasibility Trial Protocol

Despite the extensive evidence on the benefits of physical activity (PA) in older adults, including reduced risk of disease, mortality, falls, and cognitive and functional decline, most do not attain sufficient PA levels. Theoretical work suggests that behavioral change interventions are most effective during life transitions, and as such, a theory-based, online intervention tailored for recently retired and empty nest individuals could lend support for increasing levels of PA. The aim of this study is to examine the feasibility of the intervention and study procedures for a future controlled trial. This study has a randomized controlled trial design with an embedded qualitative and quantitative process evaluation. Participants are randomized at 1:1 between the intervention and waitlist controls. Potential participants are within six months of their final child leaving the familial home or within six months of retiring (self-defined), currently not meeting the Canadian PA guidelines, have no serious contraindications to exercise, and are residing in Victoria, British Columbia, Canada. Participants are recruited by online and print flyers as well as in-person at community events. The study aims to recruit 40 empty nest and 40 retired participants; half of each group received the intervention during the study period. The internet-delivered intervention is delivered over a 10-week period, comprising 10 modules addressing behavior change techniques associated with PA. Primary outcomes relate to recruitment, attrition, data collection, intervention delivery, and acceptability. Secondary behavioral outcomes are measured at baseline and post-treatment (10 weeks). Intervention-selected participants are invited to an optional qualitative exit interview. The results of this feasibility study will inform the planning of a randomized effectiveness trial, that will examine the behavior change, health-related fitness, and well-being outcomes by exploring how reflexive processes of habit and identity may bridge adoption and maintenance in behavioral adherence.

Estimates of the current and future burden of cancer attributable to low fruit and vegetable consumption in Canada

Low fruit and vegetable consumption is associated with colorectal cancer and may be associated with lung, breast, bladder, pancreatic, ovarian, liver, stomach, esophageal, head and neck cancers. We estimated the current attributable and future avoidable burden of cancer associated with low fruit and vegetable consumption in Canada. Using data on cancer incidence, exposure prevalence and risk effects, we estimated the population attributable risk (PAR) for cancers associated with low fruit and vegetable consumption as well as the future avoidable burden. The prevalence of fruit and vegetable consumption was projected to 2032 and cancer incidence was projected to 2042 to estimate the future potential impact fraction of cancer attributable to low fruit and vegetable consumption. Based on estimates from the Canadian Community Health Survey, the prevalence of low fruit (<4 servings/day) and vegetable (<4 servings/day) consumption in the Canadian population was 80.5% and 86.6%, respectively. The PARs for colorectal cancer associated with low fruit and vegetable consumption were 6.1% (1, 371 cases) and 2.2% (487 cases), respectively. For all incident cancers in 2015, 0.7% and 0.3% were attributable to low fruit and vegetable consumption, respectively. An increase of one serving/week of fruit could prevent 20,710 colorectal cancer cases cumulatively by 2042, and the same increase in vegetable consumption could prevent 10,185 cases. Although more research on the association between fruit and vegetable consumption and cancer risk is needed, our results demonstrate that with reasonable increases in current fruit and vegetable consumption by Canadians, over 30,000 colorectal cancer cases could be prevented by 2042.