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JAMA Oncol. 2018 Jun 1;4(6):783-790. doi: 10.1001/jamaoncol.2018.0126.

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.

Author information

Department of Epidemiology and Biostatistics, University of California, San Francisco.
Department of Urology, University of California, San Francisco.
Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut.
Alliance Statistics and Data Center, Duke University, Durham, North Carolina.
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Memorial Sloan Kettering Cancer Center, New York, New York.
Toledo Community Hospital Oncology Program, Toledo, Ohio.
Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.
Loyola University, Stritch School of Medicine, Naperville, Illinois.
Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois.
Virginia Oncology Associates, Norfolk, Virginia.
Southeast Clinical Oncology Research Consortium, Mission Hospitals Inc, Asheville, North Carolina.
University of Chicago Comprehensive Cancer Center, Chicago, Illinois.
Helen Diller Family Comprehensive Cancer Center, San Francisco, California.
Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco.
Program in Molecular Pathology Epidemiology (MPE), Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.



The American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors (ACS guidelines) include maintaining (1) a healthy body weight; (2) physical activity; and (3) a diet that includes vegetables, fruits, and whole grains. It is not known whether patients with colon cancer who follow these guidelines have improved survival.


To examine whether a lifestyle consistent with the ACS guidelines is associated with improved survival rates after colon cancer.

Design, Setting, and Participants:

This prospective cohort study included 992 patients with stage III colon cancer who were enrolled in the CALGB 89803 randomized adjuvant chemotherapy trial from 1999 through 2001. Data for the present study were analyzed between November 2016 and December 2017.


We assigned an ACS guidelines score for each included patient based on body mass index; physical activity; and intake of vegetables, fruits, whole grains, and red/processed meats (score range, 0-6, with higher score indicating healthier behaviors). Secondarily, we examined a score that also included alcohol intake in addition to the other factors (range, 0-8). Lifestyle was assessed during and 6 months after chemotherapy.

Main Outcomes and Measures:

Hazard ratios (HRs) and 95% confidence intervals (CIs) for disease-free, recurrence-free, and overall survival.


Of the 992 patients enrolled in the study, 430 (43%) were women, and the mean (SD) age was 59.6 (11.2) years (range, 21-85 years). Over a 7-year median follow-up, we observed 335 recurrences and 299 deaths (43 deaths without recurrence). Compared with patients with a 0 to 1 ACS guidelines score (n = 262; 26%), patients with a 5 to 6 score (n = 91; 9%) had a 42% lower risk of death during the study period (HR, 0.58; 95% CI, 0.34-0.99; P = .01 for trend) and improved disease-free survival (HR, 0.69; 95% CI, 0.45-1.06; P = .03 for trend). When alcohol consumption was included in the score, the adjusted HRs comparing patients with scores of 6 to 8 (n = 162; 16%) vs those with scores of 0 to 2 (187; 91%) were 0.49 for overall survival (95% CI, 0.32-0.76; P = .002 for trend), 0.58 for disease-free survival (95% CI, 0.40, 0.84; P = .01 for trend), and 0.64 for recurrence-free survival (95% CI, 0.44-0.94; P = .05 for trend).

Conclusions and Relevance:

Having a healthy body weight, being physically active, and eating a diet rich in vegetables, fruits, and whole grains after diagnosis of stage III colon cancer was associated with a longer survival.

Trial Registration: Identifier: NCT00003835.

[Indexed for MEDLINE]
Free PMC Article

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