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Lifestyle and quality of life in colorectal cancer survivors

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Abstract

Purpose

As cancer survival rates improve, there is growing interest in the role of lifestyle in longer-term health and quality of life (QoL). This study examined the prevalence of health-related behaviours, and the associations between health behaviours and QoL, in colorectal cancer survivors.

Methods

Patients diagnosed with colorectal cancer within the last 5 years identified from five London (UK) hospitals (N = 495) completed a survey that included measures of fruit and vegetable (F&V) intake, physical activity, smoking status and alcohol consumption. The EORTC-QLQ-C30 questionnaire was used to index QoL.

Results

The majority of respondents were overweight/obese (58%), not physically active (<5 bouts of moderate activity per week; 82%) and ate fewer than five portions of F&V a day (57%). Few were smokers (6%) or heavy drinkers (weekly alcohol units >21 for men and >14 for women; 8%). Physical activity showed the strongest association with functional QoL and was also associated with lower fatigue, pain and insomnia (P < 0.05). F&V intake was associated with higher global QoL and physical, role and cognitive function (P < 0.05). Using a total health behaviour score (calculated by assigning one point for each of the following behaviours: not smoking, consuming ≥5 portions of F&V a day, being physically active and having moderate alcohol consumption), there was a linear relationship with global QoL, physical function and fatigue (P < 0.05).

Conclusion

A high proportion of colorectal cancer survivors in the UK have suboptimal health behaviours, and this is associated with poorer QoL.

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Abbreviations

CRC:

Colorectal cancer

QoL:

Quality of life

F&V:

Fruit and vegetables

EORTC-QLQ-C30:

Quality of life was assessed with the European Organization for Research and Treatment of Cancer Quality of life questionnaire, version C30

References

  1. Boyle, P., & Langman, J. S. (2000). ABC of colorectal cancer—epidemiology. British Medical Journal, 321(7264), 805–808.

    Article  PubMed  CAS  Google Scholar 

  2. Cancer Research UK. (2007). Cancer Research UK: Survival statistics. Cancer Research UK. Internet http://info.Cancerresearchuk.org/cancerstats/survival/.

  3. Parkin, D., Olsen, A., & Sasieni, P. (2009). The potential for prevention of colorectal cancer in the UK. European Journal of Cancer Prevention, 18(3), 179–190.

    Article  PubMed  Google Scholar 

  4. Giovannucci, E. (2001). An updated review of the epidemiological evidence that cigarette smoking increases risk of colorectal cancer. Cancer Epidemiology, Biomarkers and Prevention, 10(7), 725–731.

    PubMed  CAS  Google Scholar 

  5. Arden-Close, E., Pacey, A., & Eiser, C. (2010). Health-related quality of life in survivors of lymphoma: A systematic review and methodological critique. Leukemia & Lymphoma, 51(4), 628–640.

    Article  Google Scholar 

  6. Baker, F., Haffer, S. C., & Denniston, M. (2003). Health-related quality of life of cancer and noncancer patients in medicare managed care. Cancer, 97(3), 674–681.

    Article  PubMed  Google Scholar 

  7. Ernst, J., Peuker, M., Schwarz, R., Fischbeck, S., & Beutel, M. E. (2009). Long-term survival of adult cancer patients from a psychosomatic perspective—literature review and consequences for future research. Zeitschrift fur Psychosomatische Medizin und Psychotherapie, 55(4), 365–381.

    PubMed  Google Scholar 

  8. Carver, J. R., Shapiro, C. L., Ng, A., Jacobs, L., Schwartz, C., Virgo, K. S., et al. (2007). American Society of Clinical Oncology clinical evidence review on the ongoing care of adult cancer survivors: Cardiac and pulmonary late effects. Journal of Clinical Oncology, 25(25), 3991–4008.

    Article  PubMed  CAS  Google Scholar 

  9. Fossa, S. D., Dahl, A. A., & Loge, J. H. (2003). Fatigue, anxiety, and depression in long-term survivors of testicular cancer. Journal of Clinical Oncology, 21(7), 1249–1254.

    Article  PubMed  Google Scholar 

  10. Meyerhardt, J. A., Giovannucci, E. L., Holmes, M. D., Chan, A. T., Chan, J. A., Colditz, G. A., et al. (2006). Physical activity and survival after colorectal cancer diagnosis. Journal of Clinical Oncology, 24(22), 3527–3534.

    Article  PubMed  Google Scholar 

  11. Meyerhardt, J. A., Heseltine, D., Niedzwiecki, D., Hollis, D., Saltz, L. B., Mayer, R. J., et al. (2006). Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: Findings from CALGB 89803. Journal of Clinical Oncology, 24(22), 3535–3541.

    Article  PubMed  Google Scholar 

  12. Calle, E. E., Rodriguez, C., Walker-Thurmond, K., & Thun, M. J. (2003). Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. New England Journal of Medicine, 348(17), 1625–1638.

    Article  PubMed  Google Scholar 

  13. Meyerhardt, J. A., Niedzwiecki, D., Hollis, D., Saltz, L. B., Hu, F. B., Mayer, R. J., et al. (2007). Association of dietary patterns with cancer recurrence and survival in patients with stage III colon cancer. Journal of the American Medical Association, 298(7), 754–764.

    Article  PubMed  CAS  Google Scholar 

  14. Blanchard, C. M., Stein, K. D., Baker, F., Dent, M. F., Denniston, M. M., Courneya, K. S., et al. (2004). Association between current lifestyle behaviors and health-related quality of life in breast, colorectal, and prostate cancer survivors. Psychology & Health, 19(1), 1–13.

    Article  Google Scholar 

  15. Blanchard, C. M., Courneya, K. S., & Stein, K. (2008). Cancer survivors’ adherence to lifestyle behavior recommendations and associations with health-related quality of life: Results from the American Cancer Society’s SCS-II. Journal of Clinical Oncology, 26(13), 2198–2204.

    Article  PubMed  Google Scholar 

  16. Lynch, B. M., Cerin, E., Owen, N., & Aitken, J. F. (2007). Associations of leisure-time physical activity with quality of life in a large, population-based sample of colorectal cancer survivors. Cancer Causes and Control, 18(7), 735–742.

    Article  PubMed  Google Scholar 

  17. Lynch, B. M., Cerin, E., Owen, N., Hawkes, A. L., & Aitken, J. F. (2008). Prospective relationships of physical activity with quality of life among colorectal cancer survivors. Journal of Clinical Oncology, 26(27), 4480–4487.

    Article  PubMed  Google Scholar 

  18. World Cancer Research Fund/American Institute for Cancer Research. (2007). Food, nutrition, physical activity, and the prevention of cancer: A global perspective. Washington DC: AICR.

  19. Bellizzi, K. M., Rowland, J. H., Arora, N. K., Hamilton, A. S., Miller, M. F., & Aziz, N. M. (2009). Physical activity and quality of life in adult survivors of Non-Hodgkin’s lymphoma. Journal of Clinical Oncology, 27(6), 960–966.

    Article  PubMed  Google Scholar 

  20. Coups, E. J., & Ostroff, J. S. (2005). A population-based estimate of the prevalence of behavioral risk factors among adult cancer survivors and noncancer controls. Preventive Medicine, 40, 702–711.

    Article  PubMed  Google Scholar 

  21. Eakin, E. G., Youlden, D. R., Baade, P. D., Lawler, S. P., Reeves, M. M., Heyworth, J. S., et al. (2007). Health behaviors of cancer survivors: Data from an Australian population-based survey. Cancer Causes and Control, 18(8), 881–894.

    Article  PubMed  Google Scholar 

  22. Hawkes, A. L., Lynch, B. M., Youlden, D. R., Owen, N., & Aitken, J. F. (2008). Health behaviors of Australian colorectal cancer survivors, compared with noncancer population controls. Supportive Care in Cancer, 16(10), 1097–1104.

    Article  PubMed  Google Scholar 

  23. Bellizzi, K. M., Rowland, J. H., Jeffery, D. D., & McNeel, T. (2005). Health behaviors of cancer survivors: Examining opportunities for cancer control intervention. Journal of Clinical Oncology, 23(34), 8884–8893.

    Article  PubMed  Google Scholar 

  24. Grimmett, C., Wardle, J., & Steptoe, A. (2009). Health behaviours in older cancer survivors in the English Longitudinal Study of Ageing. European Journal of Cancer, 45(12), 2180–2186.

    Article  PubMed  Google Scholar 

  25. Courneya, K. S., Friedenreich, C. M., Quinney, H. A., Fields, A. L. A., Jones, L. W., & Fairey, A. S. (2003). A randomized trial of exercise and quality of life in colorectal cancer survivors. European Journal of Cancer Care, 12(4), 347–357.

    Article  PubMed  CAS  Google Scholar 

  26. Steginga, S. K., Lynch, B. M., Hawkes, A., Dunn, J., & Aitken, J. (2009). Antecedents of domain-specific quality of life after colorectal cancer. Psycho-Oncology, 18(2), 216–220.

    Article  PubMed  Google Scholar 

  27. Gil, K. M., Von Gruenigen, V. E., Frasure, H. E., Grandon, M., Hopkins, M. P., & Jenison, E. L. (2004). Simultaneous measurement of cancer specific quality of life and general health status in gynaecologic malignancies. Journal of Clinical Oncology, 22(14S), 8253.

    Google Scholar 

  28. Patwardhan, M. B., Samsa, G. P., McCrory, D. C., Fisher, D. A., Mantyh, C. R., Morse, M. A., Prosnitz, R. G., Cline, K. E., Gray, R. N. (2006) Cancer care quality measures: Diagnosis and treatment of colorectal cancer. Evidence report/technology assessment No. 138. (Prepared by the Duke Evidence-based Practice Center under Contract No. 290-02-0025) AHRQ Publication No. 06-E002. Rockville, MD: Agency for Healthcare Research and Quality.

  29. Wardle, J., Farrell, M., Hillesden, M., Jarvis, M., Sutton, S., & Thorogood, M. (1999). Smoking, drinking, physical activity and screening uptake and health inequalities. In D. Gorden, M. Shaw, & D. D. S. Dorling (Eds.), Inequalities in health (pp. 213–239). Bristol: Policy Press.

    Google Scholar 

  30. Craig, R., & Mindell, J. (2007). Health survey for England 2005, Volume 5, Methodology and documentation. London. United Kingdom: National Centre for Social Research.

  31. Godin, G., Jobin, J., & Bouillon, J. (1986). Assessment of leisure-time exercise behavior by self-report—a concurrent validity study. Canadian Journal of Public Health-Revue Canadienne de Sante Publique, 77(5), 359–362.

    PubMed  CAS  Google Scholar 

  32. Steptoe, A., Perkins-Porras, L., Rink, E., Hilton, S., & Cappuccio, F. P. (2004). Psychological and social predictors of changes in fruit and vegetable consumption over 12 months following behavioral and nutrition education counseling. Health Psychology, 23(6), 574–581.

    Article  PubMed  Google Scholar 

  33. Aaronson, N. K., Ahmedzai, S., Bergman, B., Bullinger, M., Cull, A., Duez, N. J., et al. (1993). The European-Organization-For-Research-And-Treatment-Of-Cancer Qlq-C30—a quality-of-life instrument for use in international clinical-trials in oncology. Journal of the National Cancer Institute, 85(5), 365–376.

    Article  PubMed  CAS  Google Scholar 

  34. Ulander, K., Jeppsson, B., & Grahn, G. (1997). Quality of life and independence in activities of daily living preoperatively and at follow-up in patients with colorectal cancer. Supportive Care in Cancer, 5(5), 402–409.

    Article  PubMed  CAS  Google Scholar 

  35. Khaw, K. T., Wareham, N. J., Bingham, S., Welch, A., Luben, R. N., & Day, N. E. (2008). Combined impact of health behaviours and mortality in men and women: The EPIC-Norfolk prospective population study. PLoS Medicine, 5(11), e12.

    Article  PubMed  Google Scholar 

  36. NHS information centre for health and social care. (2009). Health Survey for England: 2008 trend tables.

  37. Armstrong, T., Bauman, A., & Davies, J. (2000). Physical activity patterns of Australian adults: Results of the 1999 National Physical Activity Survey. Canberra: National Institute of Health and Welfare.

  38. Demark-Wahnefried, W., Peterson, B. L., McBride, C. M., Lipkus, I. M., & Clipp, E. (2000). Current health behaviors and readiness to pursue life-style changes among men and women diagnosed with early stage prostate and breast carcinomas. Cancer, 88, 674–684.

    Article  PubMed  CAS  Google Scholar 

  39. Skeie, G., Hjartaker, A., Braaten, T., & Lund, E. (2009). Dietary change among breast and colorectal cancer survivors and cancer-free women in the Norwegian Women and Cancer cohort study. Cancer Causes and Control, 20(10), 1955–1966.

    Article  PubMed  Google Scholar 

  40. Satia, J. A., Campbell, M. K., Galanko, J. A., James, A., Carr, C., & Sandler, R. S. (2004). Longitudinal changes in lifestyle behaviors and health status in colon cancer survivors. Cancer Epidemiology, Biomarkers and Prevention, 13(6), 1022–1031.

    PubMed  Google Scholar 

  41. Fayers, P., Weeden, S., Curran, D., & On behalf of the EORTC Quality of Life Study Group. (1998). EORTC QLQ-C30 reference values. In EORTC (Ed.) Brussels.

  42. Mosher, C. E., Sloane, R., Morey, M. C., Snyder, D. C., Cohen, H. J., Miller, P. E., et al. (2009). Associations between lifestyle factors and quality of life among older long-term breast, prostate, and colorectal cancer survivors. Cancer, 115(17), 4001–4009.

    Article  PubMed  Google Scholar 

  43. Duffy, S. A., Terrell, J. E., Valenstein, M., Ronis, D. L., Copeland, L. A., & Connors, M. (2002). Effect of smoking, alcohol, and depression on the quality of life of head and neck cancer patients. General Hospital Psychiatry, 24(3), 140–147.

    Article  PubMed  Google Scholar 

  44. Chan, A. M., von Muhlen, D., Kritz-Silverstein, D., & Barrett-Connor, E. (2009). Regular alcohol consumption is associated with increasing quality of life and mood in older men and women: The Rancho Bernardo Study. Maturitas, 62(3), 294–300.

    Article  PubMed  CAS  Google Scholar 

  45. Lang, I. L., Wallace, R., Huppert, F., & Melzer, D. (2007). Moderate alcohol consumption in older adults is associated with better cognition and well-being than abstinence. Age and Ageing, 36, 256–261.

    Article  PubMed  Google Scholar 

  46. King, M. T. (1996). The interpretation of scores from the EORTC quality of life questionnaire QLQ-C30. Quality of Life Research, 5(6), 555–567.

    Article  PubMed  CAS  Google Scholar 

  47. Bize, R., Johnson, J. A., & Plotnikoff, R. C. (2007). Physical activity level and health-related quality of life in the general adult population: A systematic review. Preventive Medicine, 45(6), 401–415.

    Article  PubMed  Google Scholar 

  48. Demark-Wahnefried, W., Morey, M. C., Clipp, E. C., Snyder, D. C., Sloane, R., Pieper, C. F., et al. (2005). Results of project LEAD (Leading the Way in Exercise and Diet)—a trial testing an intervention of telephone-counseling and mailed materials in improving physical functioning among older breast and prostate cancer survivors. Journal of Clinical Oncology, 23(16), 763S.

    Google Scholar 

  49. Morey, M. C., Snyder, D. C., Sloane, R., Cohen, H. J., Peterson, B., Hartman, T. J., et al. (2009). Effects of home-based diet and exercise on functional outcomes among older, overweight long-term cancer survivors RENEW: A randomized controlled trial. Journal of the American Medical Association, 301(18), 1883–1891.

    Article  PubMed  CAS  Google Scholar 

  50. Department of Health, Macmillan Cancer Support, NHS Improvement. (2010). National Cancer Survivorship Initiative (NCSI) vision.

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Acknowledgments

Dr Chloe Grimmett is supported by the Medical Research Council, Dr John Bridgewater by the University College London Hospitals and University College London Comprehensive Biomedical Research Centre, Professor Andrew Steptoe by the British Heart Foundation and Professor Jane Wardle by Cancer Research UK.

Conflict of interest

The authors indicate no potential conflicts of interest.

Author information

Authors and Affiliations

  1. Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK

    Chloe Grimmett & Jane Wardle

  2. Cancer Institute, University College London, Paul O’Gorman Building, Huntley Street, London, WC1E 6BT, UK

    John Bridgewater

  3. Psychobiology Group, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK

    Andrew Steptoe

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  1. Chloe Grimmett
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  2. John Bridgewater
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  4. Jane Wardle
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Correspondence to Chloe Grimmett.

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Grimmett, C., Bridgewater, J., Steptoe, A. et al. Lifestyle and quality of life in colorectal cancer survivors. Qual Life Res 20, 1237–1245 (2011). https://doi.org/10.1007/s11136-011-9855-1

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