Abstract
Simple SummaryPhysical activity can help to prevent colorectal cancer, but its importance after cancer diagnosis has not been validated. In this nationwide insurance data-based study of 43,596 colorectal cancer patients, a high level of physical activity after colorectal cancer diagnosis was negatively associated with a risk of death in both colon and rectal cancer patients, particularly in the surgically treated group. Our findings support the importance of the physical activity among colorectal cancer patients.Physical activity reduces the risk of colon cancer, but its prognostic impact after cancer diagnosis remains unclear. To evaluate the association between post-diagnosis activity and cause-specific mortality, we reconstructed a colorectal cancer patient cohort from the 2009–16 Korean National Health Insurance Service (NHIS) database. Subgroup analyses were performed by treatment group. In total, 27,143 colon cancer patients and 16,453 rectal cancer patients were included in the analysis (mean follow-up, 4.3 years; median 4.0 years). In the surgically treated group, a high level of activity (the weighted sum of the frequencies for walking, moderate, and vigorous activity greater than or equal to 3 times/week) was inversely associated with all-cause mortality (colon cancer: HR, 0.79; 95% CI, 0.72 to 0.88; rectal cancer: HR, 0.75; 95% CI, 0.66 to 0.86) and colorectal cancer-specific mortality (colon cancer: HR, 0.85; 95% CI, 0.76 to 0.97; rectal cancer: HR, 0.77; 95% CI, 0.66 to 0.90). No significant results were shown for cardiovascular disease-specific mortality. No association was shown in patients who received chemoradiotherapy without surgery. The present study may provide evidence for post-diagnosis physical activity as a prognostic factor in colorectal cancer, particularly in surgically treated early-stage patients.
Highlights
Colorectal cancer patients were defined as subjects with records for hospitalization with diagnostic codes corresponding to colorectal cancer (ICD-10 code C18–20) as well as treatment such as surgery, radiotherapy, or chemotherapy [21]
27,143 colon cancer patients and 16,453 rectal cancer patients were identified from the National Health Insurance Service (NHIS) database after applying the exclusion criteria (Figure 1)
The results indicate that satisfying the recommended level of activity is associated with a lowered risk of mortality in colorectal cancer patients, in patients who received surgery with or without other treatment options such as chemotherapy or radiotherapy
Summary
Colorectal cancer is the one of the most common cancer types, with an annual incidence of approximately 185 million cases worldwide [1]. In South Korea, it is the second-most common cancer in terms of incidence, with a relative 5 year survival rate of 75.9% [2]. Physical activity is a preventive factor for colon cancer [3,4,5,6]. Increasing evidence has shown the role of physical activity in colorectal cancer prognosis. Inverse associations between physical activity and mortality have been suggested across different types of activity, from exercise to leisure time or recreational physical activity, and tumor characteristics including site, stage, and molecular profiles [7,8,9,10,11,12,13,14,15,16,17,18]
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