Longitudinal associations of light-intensity physical activity with quality of life, functioning and fatigue after colorectal cancer

E H Van Roekel,I Kant,M L G Janssen-Heijnen,R L Jansen,V Lima Passos,M Kenkhuis,J L Koole,S O Breukink,M J L Bours,J Duchâteau,L Van Delden,K Meijer,E Keulen,P A Van Den Brandt,J J L Breedveld-Peters,M P Weijenberg

doi:10.1007/s11136-020-02566-7

E H Van Roekel, I Kant + Show 14 more

Open Access

https://doi.org/10.1007/s11136-020-02566-7

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Abstract

PurposeEvidence from cross-sectional studies suggests that higher levels of light-intensity physical activity (LPA) are associated with better health-related quality of life (HRQoL) in colorectal cancer (CRC) survivors. However, these associations have not been investigated in longitudinal studies that provide the opportunity to analyse how within-individual changes in LPA affect HRQoL. We investigated longitudinal associations of LPA with HRQoL outcomes in CRC survivors, from 6 weeks to 2 years post-treatment.MethodsData were used of a prospective cohort study among 325 stage I–III CRC survivors (67% men, mean age: 67 years), recruited between 2012 and 2016. Validated questionnaires were used to assess hours/week of LPA (SQUASH) and HRQoL outcomes (EORTC QLQ-C30, Checklist Individual Strength) at 6 weeks, and 6, 12 and 24 months post-treatment. We applied linear mixed regression to analyse longitudinal confounder-adjusted associations of LPA with HRQoL.ResultsWe observed statistically significant longitudinal associations between more LPA and better global quality of life and physical, role and social functioning, and less fatigue over time. Intra-individual analysis showed that within-person increases in LPA (per 8 h/week) were related to improved HRQoL, including better global quality of life (β = 1.67, 95% CI 0.71; 2.63; total range scale: 0–100) and less fatigue (β = − 1.22, 95% CI − 2.37; − 0.07; scale: 20–140). Stratified analyses indicated stronger associations among participants below the median of moderate-to-vigorous physical activity (MVPA) at diagnosis.ConclusionHigher levels of LPA were longitudinally associated with better HRQoL and less fatigue in CRC survivors up to two years post-treatment. Further prospective studies using accelerometer data are necessary to inform development of interventions targeting LPA.

Highlights

Colorectal cancer (CRC) ranks as the third most prevalent cancer in men and second in women worldwide, with an estimated 4.8 million people diagnosed with CRC in the past 5 years [1]
CRC and/or its treatment often lead to long-term complaints such as fatigue and bowel problems [3], which have a negative impact on the healthrelated quality of life (HRQoL) of CRC survivors [4]
In timelag analyses investigating longitudinal associations between light-intensity physical activity (LPA) and HRQoL at subsequent time points, we observed non-significant and weaker associations compared to the main analysis (Supplemental Table 4). Within this prospective cohort study, we found that higher levels of LPA were longitudinally associated with better global quality of life and better physical, role and social functioning and less fatigue among CRC survivors

Summary

Introduction

Colorectal cancer (CRC) ranks as the third most prevalent cancer in men and second in women worldwide, with an estimated 4.8 million people diagnosed with CRC in the past 5 years [1]. CRC and/or its treatment often lead to long-term complaints such as fatigue and bowel problems [3], which have a negative impact on the healthrelated quality of life (HRQoL) of CRC survivors [4]. Quality of Life Research (2020) 29:2987–2998 identify factors related to long-term HRQoL outcomes, to provide leads for interventions to improve well-being after CRC. Physical activity is a modifiable lifestyle behaviour that has been shown in many observational studies to be associated with better HRQoL outcomes in CRC survivors up to 10 years post-treatment [5]. More MVPA has been shown to be beneficially associated with physical, role and social functioning and fatigue after CRC in observational studies [5]. Intervention studies in survivors of other cancer types (mostly breast cancer) have shown beneficial effects of exercise interventions (including MVPA) on HRQoL [10]. Previous studies found that CRC survivors are often physically inactive and spend around two-thirds of their waking time in sedentary behaviour (i.e. sitting/lying with a low energy expenditure) [11, 12]

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