By adhering to the American Cancer Society’s (ACS) Nutrition and Physical Activity Guidelines for Cancer Survivors, patients with stage III colon cancer may have a higher 5-year survival rate, according to a study published in JAMA Oncology.

Erin L. Van Blargian, ScD, of the Department of Epidemiology and Biostatistics at the University of California in San Francisco, and associates conducted a prospective group analysis to understand the correlation between ACS guideline adherence and survival rate in colon cancer survivors.

In this investigation, 992 patients with stage III colon cancer were given an ACS guidelines score determined by the individual’s body mass index (BMI), physical activity, and consumption of fruits, vegetables, whole grains, and red/processed meats. The scores ranged from 0 to 6, 6 being the healthiest. A second score included alcohol intake combined with the factors previously listed: this ranged from 0 to 8.

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All participants were previously enrolled in the CALGB 89803 randomized adjuvant chemotherapy study from 1999 to 2001. The investigators scored the lifestyles during and 6 months following chemotherapy between November 2016 and December 2017.

The average age of the participants was 59.6 years (57% were men). During the course of a median 7-year follow-up, the researchers reported 335 cancer recurrences and 299 deaths; 43 deaths were not recurrence related.

Patients with ACS guidelines scores of 5 or 6 (n= 91, 9% of participants) had a 42% reduced risk of death during the study compared with individuals who had scores of 0 or 1 (n=262, 26% of participants) (hazard ratio [HR], 0.58). Higher scoring patients also had an improved disease-free survival compared with low scoring patients (HR, 0.69).

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For ACS guidelines scores including alcohol consumption, patients with scores between 6 and 8 (n=162; 16%) vs patients with scores between 0 and 2 (n=187, 91%) had adjusted HRs of 0.49 for overall survival, 0.58 for survival without disease, and 0.64 for survival without recurrence.

“In conclusion, patients with colon cancer who had a healthy body weight, were physically active, and ate a diet rich in vegetables and fruits and chose whole over refined grains had a 42% lower risk of death during the study period than patients who did not engage in these behaviors,” reported the authors. “Clinical trials of lifestyle change in colon cancer are needed.”


Van Blarigan EL, Fuchs CS, Niedzwiecki D, et al. Association of survival with adherence to the American Cancer Society Nutrition and Physical Activity Guidelines for cancer survivors after colon cancer diagnosis: The CALGB 89803/Alliance Trial. [Published online April 12, 2018]. JAMA Oncol.  doi:10.1001/jamaoncol.2018.0126