Abstract
The World Cancer Research Fund and American Institute for Cancer Research (WCRF/AICR) advise cancer survivors to follow their lifestyle recommendations for cancer prevention. Adhering to these recommendations may have beneficial effects on patient-reported outcomes after a cancer diagnosis, but evidence is scarce. We aimed to assess associations of the individual dietary WCRF/AICR recommendations regarding fruit and vegetables, fibre, fast foods, red and processed meat, sugar-sweetened drinks and alcohol consumption with patient-reported outcomes in colorectal cancer (CRC) survivors. Cross-sectional data of 150 stage I-III CRC survivors, 2-10 years post-diagnosis, were used. Dietary intake was measured by 7-d dietary records. Validated questionnaires were used to measure health-related quality of life (HRQoL), fatigue and neuropathy. Confounder-adjusted linear regression models were used to analyse associations of each WCRF/AICR dietary recommendation with patient-reported outcomes. Higher vegetable intake (per 50 g) was associated with better global QoL (β 2·6; 95 % CI 0·6, 4·7), better physical functioning (3·3; 1·2, 5·5) and lower levels of fatigue (-4·5; -7·6, -1·4). Higher fruit and vegetables intake (per 100 g) was associated with better physical functioning (3·2; 0·8, 5·5) and higher intake of energy-dense food (per 100 kJ/100 g) with worse physical functioning (-4·2; -7·1, -1·2). No associations of dietary recommendations with neuropathy were found. These findings suggest that adhering to specific dietary WCRF/AICR recommendations is associated with better HRQoL and less fatigue in CRC survivors. Although the recommendations regarding healthy dietary habits may be beneficial for the well-being of CRC survivors, longitudinal research is warranted to gain insight into the direction of associations.
Highlights
The number of colorectal cancer (CRC) survivors continues to rise, mainly due to population ageing, screening and improved treatments[1,2,3]
Lifestyle behaviours such as higher levels of physical activity, a healthy body weight and consumption of diets low in red meat, high in vegetables and high in fibre are associated with less recurrence and increased survival in cancer survivors, including CRC survivors[13,14,15,16], but are likely to be relevant for increasing health-related quality of life (HRQoL)[17,18,19,20] and decreasing fatigue and neuropathy[21]
Studies have shown that lower levels of physical activity as well as not meeting physical activity guidelines were significantly associated with lower HRQoL in CRC survivors up to 10 years post-diagnosis[22,23,24], whereas higher levels of moderate-to-vigorous physical activity (MVPA) were found to be associated with lower levels of fatigue and neuropathy[9,25,26]
Summary
The number of colorectal cancer (CRC) survivors continues to rise, mainly due to population ageing, screening and improved treatments[1,2,3]. As the evidence to formulate-specific recommendations for cancer survivors is insufficient to date, WCRF/AICR advises cancer survivors to follow the lifestyle recommendations for cancer prevention Lifestyle behaviours such as higher levels of physical activity, a healthy body weight and consumption of diets low in red meat, high in vegetables and high in fibre are associated with less recurrence and increased survival in cancer survivors, including CRC survivors[13,14,15,16], but are likely to be relevant for increasing HRQoL[17,18,19,20] and decreasing fatigue and neuropathy[21]. Several small intervention studies in diabetic neuropathy showed that a low-fat, plant-based diet was associated with decreased pain of diabetic neuropathy in patients experiencing diabetic neuropathy complaints, increasing the plausibility that dietary factors may be associated with CIPN complaints after CRC[38,39]
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