Prediagnostic lifestyle factors and survival after colon and rectal cancer diagnosis in the National Institutes of Health (NIH)-AARP Diet and Health Study

Authors

  • Colleen Pelser PhD,

    Corresponding author
    1. Cancer Prevention Fellowship Program, Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
    2. Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
    • Corresponding author: Colleen Pelser, PhD, University of Maryland, Greenebaum Cancer Center, Room N9E02, Baltimore, MD 21201; Fax: (410) 328-9166; cpelser@umm.edu

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  • Hannah Arem PhD,

    1. Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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  • Ruth M. Pfeiffer PhD,

    1. Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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  • Joanne W. Elena PhD,

    1. Clinical and Translational Epidemiology Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
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  • Catherine M. Alfano PhD,

    1. Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
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  • Albert R. Hollenbeck PhD,

    1. AARP, Washington, DC
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  • Yikyung Park ScD

    1. Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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  • Cancer incidence data were collected from following state cancer registries: Georgia Center for Cancer Statistics, Department of Epidemiology, Rollins School of Public Health, Emory University; California Department of Health Services, Cancer Surveillance Section; Michigan Cancer Surveillance Program, Community Health Administration, State of Michigan; Florida Cancer Data System (FCDC) under contract with the Florida Department of Health (FDOH); Louisiana Tumor Registry, Louisiana State University Medical Center in New Orleans; New Jersey State Cancer Registry, Cancer Epidemiology Services, New Jersey State Department of Health and Senior Services; North Carolina Central Cancer Registry; Division of Health Statistics and Research, Pennsylvania Department of Health, Harrisburg, Pennsylvania; Arizona Cancer Registry, Division of Public Health Services, Arizona Department of Health Services; Texas Cancer Registry, Cancer Epidemiology and Surveillance Branch, Texas Department of State Health Services; and Nevada Central Cancer Registry, Center for Health Data and Research, Bureau of Health Planning and Statistics, State Health Division, State of Nevada Department of Health and Human Services. The views expressed herein are solely those of the authors and do not necessarily reflect those of the FCDC or FDOH. The Pennsylvania Department of Health specifically disclaims responsibility for any analyses, interpretations, or conclusions.

  • See editorial on pages 1450–2.

Abstract

BACKGROUND

Few studies have examined the relationship of lifestyle factors with mortality among patients with colorectal cancer.

METHODS

Among NIH-AARP Diet and Health study participants, 4213 colon and 1514 rectal cancer cases were identified through linkage to state cancer registries and determined date and cause of death using the National Death Index. Lifestyle factors were assessed at baseline and included: healthy diet (measured by Healthy Eating Index 2005 [HEI-2005]), body mass index (BMI), physical activity, alcohol consumption and smoking. The association of factors was examined individually and combined into a lifestyle score with 5-year mortality from all-causes, colorectal cancer, and cardiovascular disease (CVD). Relative risks (RRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models.

RESULTS

Among colon cancer survivors, smokers had increased risk of total mortality (RR = 1.74; 95% CI = 1.45-2.08) and colorectal cancer mortality (RR = 1.46; 95% CI = 1.17-1.82), compared to never smokers. Obese (BMI, ≥ 30) individuals had increased risk of all death (RR = 1.19; 95% CI = 1.02-1.39) and CVD death (RR = 1.84; 95% CI = 1.05-3.23), compared to normal weight (BMI, 18.5 to < 25) individuals. Compared to those with the lowest lifestyle score, those with the highest score had a 34% lower risk of all-cause mortality (RR = 0.66; 95% CI = 0.50-0.87). Among rectal cancer survivors, individuals in the highest quintile of HEI-2005 scores had reduced all-cause mortality (RR = 0.60; 95% CI = 0.42-0.86) compared to those in the lowest. Higher combined lifestyle scores were associated with a 46% lower risk of total mortality (0.54; 0.32-0.91).

CONCLUSIONS

Healthier lifestyle before cancer diagnosis was associated with improved overall survival after diagnosis with colorectal cancer. Cancer 2014;120:1540–1547 2014.

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