Advertisement

Cancer Causes & Control

, Volume 23, Issue 12, pp 1939–1948 | Cite as

Recreational physical activity, body mass index, and survival in women with colorectal cancer

  • Josephina G. Kuiper
  • Amanda I. PhippsEmail author
  • Marian L. Neuhouser
  • Rowan T. Chlebowski
  • Cynthia A. Thomson
  • Melinda L. Irwin
  • Dorothy S. Lane
  • Jean Wactawski-Wende
  • Lifang Hou
  • Rebecca D. Jackson
  • Ellen Kampman
  • Polly A. Newcomb
Original paper

Abstract

Background and purpose

Previous studies have shown that physical inactivity and obesity are risk factors for the development of colorectal cancer. However, controversy exists regarding the influence of these factors on survival in colorectal cancer patients. We evaluated the impact of recreational physical activity and body mass index (BMI) before and after colorectal cancer diagnosis on disease-specific mortality and all-cause mortality.

Patients and methods

This prospective cohort study included 1,339 women enrolled in the Women’s Health Initiative study who were diagnosed with colorectal cancer subsequent to study enrollment. BMI and recreational physical activity were measured before cancer diagnosis at study entry (pre-diagnostic) and after diagnosis at study follow-up interviews (post-diagnostic). We used Cox regression to estimate the association between pre- and post-diagnostic exposures and survival after colorectal cancer diagnosis.

Results

Among women diagnosed with colorectal cancer, 265 (13 %) deaths occurred during a median study follow-up of 11.9 years, of which 171 (65 %) were attributed to colorectal cancer. Compared with women reporting no pre-diagnostic recreational physical activity, those reporting activity levels of ≥18 MET-h/week had significantly lower colorectal cancer-specific mortality (hazard ratio (HR) = 0.68; 95 % confidence interval (CI): 0.41–1.13) and all-cause mortality (HR = 0.63; 95 % CI: 0.42–0.96). Similar inverse associations were seen for post-diagnostic recreational physical activity. Neither pre- nor post-diagnostic BMI were associated with mortality after colorectal cancer diagnosis.

Conclusion

Recreational physical activity before and after colorectal cancer diagnosis, but not BMI, is associated with more favorable survival.

Keywords

Physical activity Body mass index Colorectal cancer Survival Post-menopausal 

Notes

Acknowledgments

This work was supported by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services (contracts N01WH22110, 24152, 32100-2, 32105-6, 32108-9, 32111-13, 32115, 32118-32119, 32122, 42107-26, 42129-32, and 44221). This publication was also supported by the National Cancer Institute (R25-CA94880 and K05152715).

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    American Cancer Society (2010) Cancer facts and figures 2010. American Cancer Society, AtlantaGoogle Scholar
  2. 2.
    Chao A, Connell CJ, Jacobs EJ et al (2004) Amount, type, and timing of recreational physical activity in relation to colon and rectal cancer in older adults: the cancer prevention study II nutrition cohort. Cancer Epidemiol Biomarkers Prev 13:2187–2195PubMedGoogle Scholar
  3. 3.
    Friedenreich C, Norat T, Steindorf K et al (2006) Physical activity and risk of colon and rectal cancers: the European prospective investigation into cancer and nutrition. Cancer Epidemiol Biomarkers Prev 15:2398–2407PubMedCrossRefGoogle Scholar
  4. 4.
    Larsson SC, Rutegard J, Bergkvist L, Wolk A (2006) Physical activity, obesity, and risk of colon and rectal cancer in a cohort of Swedish men. Eur J Cancer 42:2590–2597PubMedCrossRefGoogle Scholar
  5. 5.
    Mai PL, Sullivan-Halley J, Ursin G et al (2007) Physical activity and colon cancer risk among women in the California Teachers Study. Cancer Epidemiol Biomarkers Prev 16:517–525PubMedCrossRefGoogle Scholar
  6. 6.
    Campbell PT, Jacobs ET, Ulrich CM et al (2010) Case-control study of overweight, obesity, and colorectal cancer risk, overall and by tumor microsatellite instability status. J Natl Cancer Inst 102:391–400PubMedCrossRefGoogle Scholar
  7. 7.
    Lin J, Zhang SM, Cook NR, Rexrode KM, Lee IM, Buring JE (2004) Body mass index and risk of colorectal cancer in women (United States). Cancer causes control 15:581–589PubMedCrossRefGoogle Scholar
  8. 8.
    Slattery ML, Ballard-Barbash R, Edwards S, Caan BJ, Potter JD (2003) Body mass index and colon cancer: an evaluation of the modifying effects of estrogen (United States). Cancer causes control 14:75–84PubMedCrossRefGoogle Scholar
  9. 9.
    Moghaddam AA, Woodward M, Huxley R (2007) Obesity and risk of colorectal cancer: a meta-analysis of 31 studies with 70,000 events. Cancer Epidemiol Biomarkers Prev 16:2533–2547PubMedCrossRefGoogle Scholar
  10. 10.
    Haydon AM, Macinnis RJ, English DR, Giles GG (2006) Effect of physical activity and body size on survival after diagnosis with colorectal cancer. Gut 55:62–67PubMedCrossRefGoogle Scholar
  11. 11.
    Meyerhardt JA, Giovannucci EL, Holmes MD et al (2006) Physical activity and survival after colorectal cancer diagnosis. J Clin Oncol 24:3527–3534PubMedCrossRefGoogle Scholar
  12. 12.
    Meyerhardt JA, Heseltine D, Niedzwiecki D et al (2006) Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803. J Clin Oncol 24:3535–3541PubMedCrossRefGoogle Scholar
  13. 13.
    Meyerhardt JA, Ogino S, Kirkner GJ et al (2009) Interaction of molecular markers and physical activity on mortality in patients with colon cancer. Clin Cancer Res 15:5931–5936PubMedCrossRefGoogle Scholar
  14. 14.
    Batty GD, Shipley MJ, Jarrett RJ, Breeze E, Marmot MG, Smith GD (2005) Obesity and overweight in relation to organ-specific cancer mortality in London (UK): findings from the original Whitehall study. International Journal of Obesity 29:1267–1274PubMedCrossRefGoogle Scholar
  15. 15.
    Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. The New England journal of medicine 348:1625–1638PubMedCrossRefGoogle Scholar
  16. 16.
    Doria-Rose VP, Newcomb PA, Morimoto LM, Hampton JM, Trentham-Dietz A (2006) Body mass index and the risk of death following the diagnosis of colorectal cancer in postmenopausal women (United States). Cancer causes control 17:63–70PubMedCrossRefGoogle Scholar
  17. 17.
    Meyerhardt JA, Catalano PJ, Haller DG et al (2003) Influence of body mass index on outcomes and treatment-related toxicity in patients with colon carcinoma. Cancer 98:484–495PubMedCrossRefGoogle Scholar
  18. 18.
    Moghimi-Dehkordi B, Safaee A, Zali MR (2008) Prognostic factors in 1,138 Iranian colorectal cancer patients. Int J Colorectal Dis 23:683–688PubMedCrossRefGoogle Scholar
  19. 19.
    Murphy TK, Calle EE, Rodriguez C, Kahn HS, Thun MJ (2000) Body mass index and colon cancer mortality in a large prospective study. Am J Epidemiol 152:847–854PubMedCrossRefGoogle Scholar
  20. 20.
    Prizment AE, Flood A, Anderson KE, Folsom AR (2010) Survival of women with colon cancer in relation to precancer anthropometric characteristics: the Iowa women’s health study. Cancer epidemiology biomarkers prev 19:2229–2237CrossRefGoogle Scholar
  21. 21.
    Sinicrope FA, Foster NR, Sargent DJ, O’Connell MJ, Rankin C (2010) Obesity Is an Independent Prognostic Variable in Colon Cancer Survivors. Clin Cancer Res 16:1884–1893PubMedCrossRefGoogle Scholar
  22. 22.
    van Wayenburg CA, van der Schouw YT, van Noord PA, Peeters PH (2000) Age at menopause, body mass index, and the risk of colorectal cancer mortality in the dutch diagnostisch onderzoek mammacarcinoom (DOM) cohort. Epidemiology 11:304–308PubMedCrossRefGoogle Scholar
  23. 23.
    Ballian N, Yamane B, Leverson G et al (2010) Body mass index does not affect postoperative morbidity and oncologic outcomes of total mesorectal excision for rectal adenocarcinoma. Ann Surg Oncol 17:1606–1613PubMedCrossRefGoogle Scholar
  24. 24.
    Dignam JJ, Polite BN, Yothers G et al (2006) Body mass index and outcomes in patients who receive adjuvant chemotherapy for colon cancer. J Natl Cancer Inst 98:1647–1654PubMedCrossRefGoogle Scholar
  25. 25.
    Dray X, Boutron-Ruault MC, Bertrais S, Sapinho D, Benhamiche-Bouvier AM, Faivre J (2003) Influence of dietary factors on colorectal cancer survival. Gut 52:868–873PubMedCrossRefGoogle Scholar
  26. 26.
    Garcia-Oria Serrano MJ, Armengol Carrasco M, Caballero Millan A, Ching CD, Codina Cazador A (2011) Is body mass index a prognostic factor of survival in colonic cancer? A multivariate analysis. Cirugia espanola 89:152–158PubMedCrossRefGoogle Scholar
  27. 27.
    Meyerhardt JA, Tepper JE, Niedzwiecki D et al (2004) Impact of body mass index on outcomes and treatment-related toxicity in patients with stage II and III rectal cancer: findings from Intergroup Trial 0114. J Clin Oncol 22:648–657PubMedCrossRefGoogle Scholar
  28. 28.
    Park SM, Lim MK, Shin SA, Yun YH (2006) Impact of prediagnosis smoking, alcohol, obesity, and insulin resistance on survival in male cancer patients: National health insurance corporation study. J clin oncol 24:5017–5024PubMedCrossRefGoogle Scholar
  29. 29.
    Asghari-Jafarabadi M, Hajizadeh E, Kazemnejad A, Fatemi SR (2009) Site-specific evaluation of prognostic factors on survival in Iranian colorectal cancer patients: a competing risks survival analysis. Asian Pac j cancer prev 10:815–821PubMedGoogle Scholar
  30. 30.
    Hines RB, Shanmugam C, Waterbor JW et al (2009) Effect of comorbidity and body mass index on the survival of African-American and Caucasian patients with colon cancer. Cancer 115:5798–5806PubMedCrossRefGoogle Scholar
  31. 31.
    Meyerhardt JA, Niedzwiecki D, Hollis D et al (2008) Impact of body mass index and weight change after treatment on cancer recurrence and survival in patients with stage III colon cancer: findings from cancer and leukemia group B 89803. J Clin Oncol 26:4109–4115PubMedCrossRefGoogle Scholar
  32. 32.
    The Women’s Health Initiative Study Group (1998) Design of the women’s health initiative clinical trial and observational study. Control Clin Trials 19: 61–109Google Scholar
  33. 33.
    Johnson-Kozlow M, Rock CL, Gilpin EA, Hollenbach KA, Pierce JP (2007) Validation of the WHI brief physical activity questionnaire among women diagnosed with breast cancer. Am J Health Behav 31:193–202PubMedCrossRefGoogle Scholar
  34. 34.
    Ainsworth BE, Haskell WL, Leon AS et al (1993) Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 25:71–80PubMedCrossRefGoogle Scholar
  35. 35.
    Meyer AM, Evenson KR, Morimoto L, Siscovick D, White E (2009) Test-retest reliability of the Women’s Health Initiative physical activity questionnaire. Med Sci Sports Exerc 41:530–538PubMedGoogle Scholar
  36. 36.
    Curb JD, McTiernan A, Heckbert SR et al (2003) Outcomes ascertainment and adjudication methods in the Women’s Health Initiative. Ann Epidemiol 13:S122–S128PubMedCrossRefGoogle Scholar
  37. 37.
    Irwin ML, McTiernan A, Manson JE et al (2011) Physical Activity and Survival in Postmenopausal Women with Breast Cancer: results from the Women’s Health Initiative. Cancer Prev Res (Phila) 4:522–529CrossRefGoogle Scholar
  38. 38.
    Courneya KS, Booth CM, Gill S et al (2008) The Colon Health and Life-Long Exercise Change trial: a randomized trial of the National Cancer Institute of Canada Clinical Trials Group. Curr oncol 15:279–285PubMedCrossRefGoogle Scholar
  39. 39.
    Morikawa T, Kuchiba A, Yamauchi M et al (2011) Association of CTNNB1 (beta-catenin) alterations, body mass index, and physical activity with survival in patients with colorectal cancer. JAMA 305:1685–1694PubMedCrossRefGoogle Scholar
  40. 40.
    Ogino S, Nosho K, Baba Y et al (2009) A cohort study of STMN1 expression in colorectal cancer: body mass index and prognosis. Am J Gastroenterol 104:2047–2056PubMedCrossRefGoogle Scholar
  41. 41.
    Ogino S, Nosho K, Meyerhardt JA et al (2008) Cohort study of fatty acid synthase expression and patient survival in colon cancer. J Clin Oncol 26:5713–5720PubMedCrossRefGoogle Scholar
  42. 42.
    Ogino S, Nosho K, Shima K et al (2009) p21 expression in colon cancer and modifying effects of patient age and body mass index on prognosis. Cancer Epidemiol Biomarkers Prev 18:2513–2521PubMedCrossRefGoogle Scholar
  43. 43.
    Ogino S, Shima K, Nosho K et al (2009) A cohort study of p27 localization in colon cancer, body mass index, and patient survival. Cancer Epidemiol Biomarkers Prev 18:1849–1858PubMedCrossRefGoogle Scholar
  44. 44.
    Fuchs CS, Goldberg RM, Sargent DJ et al (2008) Plasma insulin-like growth factors, insulin-like binding protein-3, and outcome in metastatic colorectal cancer: results from intergroup trial N9741. Clinical Cancer Res 14:8263–8269CrossRefGoogle Scholar
  45. 45.
    Haydon AM, Macinnis RJ, English DR, Morris H, Giles GG (2006) Physical activity, insulin-like growth factor 1, insulin-like growth factor binding protein 3, and survival from colorectal cancer. Gut 55:689–694PubMedCrossRefGoogle Scholar
  46. 46.
    Volkova E, Willis JA, Wells JE, Robinson BA, Dachs GU, Currie MJ (2011) Association of angiopoietin-2, C-reactive protein and markers of obesity and insulin resistance with survival outcome in colorectal cancer. Br J Cancer 104:51–59PubMedCrossRefGoogle Scholar
  47. 47.
    Courneya KS, Segal RJ, Mackey JR et al (2007) Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. J Clin Oncol 25:4396–4404PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2012

Authors and Affiliations

  • Josephina G. Kuiper
    • 1
  • Amanda I. Phipps
    • 2
    Email author
  • Marian L. Neuhouser
    • 2
  • Rowan T. Chlebowski
    • 3
  • Cynthia A. Thomson
    • 4
  • Melinda L. Irwin
    • 5
  • Dorothy S. Lane
    • 6
  • Jean Wactawski-Wende
    • 7
  • Lifang Hou
    • 8
  • Rebecca D. Jackson
    • 9
  • Ellen Kampman
    • 1
    • 10
  • Polly A. Newcomb
    • 2
  1. 1.Division of Human NutritionWageningen UniversityWageningenThe Netherlands
  2. 2.Cancer Prevention Program, Public Health Sciences DivisionFred Hutchinson Cancer Research CenterSeattleUSA
  3. 3.Los Angeles Biomedical Research Institute Harbor-UCLA Medical CenterTorranceUSA
  4. 4.Department of Nutritional SciencesUniversity of ArizonaTucsonUSA
  5. 5.Yale School of Public HealthYale UniversityNew HavenUSA
  6. 6.Community and Behavioral Health FacultyStony Brook University Medical CenterStony BrookUSA
  7. 7.Department of Social and Preventive MedicineUniversity at BuffaloBuffaloUSA
  8. 8.Department of Preventive Medicine, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  9. 9.Division of Endocrinology, Diabetes and MetabolismOhio State UniversityColumbusUSA
  10. 10.Department of Health SciencesVU AmsterdamAmsterdamThe Netherlands

Personalised recommendations