Physical Activity Is Associated with Improved Overall Survival among Patients with Metastatic Colorectal Cancer.

Marjan A Davidis,Natascha A.j.b Peters ,Jeroen W.g Derksen ,Mathijs P Hendriks,A H W Schiphorst ,L Mekenkamp ,Wouter J Vles,A Haringhuizen ,Frederiek Terheggen,Jan N M Ijzermans,Maartje Los,Arjan Schouten Van Der Velden,J Konsten ,Ronald Hoekstra,Johannes De Wilt ,D J A Sonneveld ,Ron C Rietbroek,Patricia Quarles Van Ufford-Mannesse,Mark P.s Sie ,Eric Belt ,Joyce M Van Dodewaard-De Jong,Hans Pruijt ,Geerard L Beets ,Johan J B Janssen ,Null Author_Id ,Liselot Valkenburg-Van Iersel,K Smit ,Miriam Koopman,Dirkje W Sommeijer,P P L O Coene ,Maaike Berbée,Hester Van Cruijsen,Helgi H Helgason,Anne M May,Johannes A Wegdam,Peter Nieboer,Koen Peeters ,H B A C Stockmann ,M.l.r Tjin-A-Ton ,Marleen Tent,Ankie M.t Van Der Velden ,Theo Van Voorthuizen,Jan Willem T Dekker,Ignace H J T De Hingh,Ruud Schrauwen

doi:10.3390/cancers14041001

Abstract

Simple SummaryPhysical activity is linked to longer survival among non-metastasized colorectal cancer patients. It is unclear if physical activity is also beneficial for survival among patients with metastatic colorectal cancer. We researched this question in our study of 293 patients with metastatic colorectal cancer. We found that participants who reported higher levels of physical activity at diagnosis lived longer compared to patients who reported low activity levels. Furthermore, adherence to the physical activity guidelines for cancer survivors was related to prolonged survival. Our findings suggest that patients with metastatic colorectal cancer also benefit from being physically active. Future studies are needed to investigate whether improving exercise levels after diagnosis of metastasis is also beneficial and what kind of exercise interventions are most optimal for possibly improving survival time of patients with metastatic colorectal cancer.Regular physical activity (PA) is associated with improved overall survival (OS) in stage I–III colorectal cancer (CRC) patients. This association is less defined in patients with metastatic CRC (mCRC). We therefore conducted a study in mCRC patients participating in the Prospective Dutch Colorectal Cancer cohort. PA was assessed with the validated SQUASH questionnaire, filled-in within a maximum of 60 days after diagnosis of mCRC. PA was quantified by calculating Metabolic Equivalent Task (MET) hours per week. American College of Sports and Medicine (ACSM) PA guideline adherence, tertiles of moderate to vigorous PA (MVPA), and sport and leisure time MVPA (MVPA-SL) were assessed as well. Vital status was obtained from the municipal population registry. Cox proportional-hazards models were used to study the association between PA determinants and all-cause mortality adjusted for prognostic patient and treatment-related factors. In total, 293 mCRC patients (mean age 62.9 ± 10.6 years, 67% male) were included in the analysis. Compared to low levels, moderate and high levels of MET-hours were significantly associated with longer OS (fully adjusted hazard ratios: 0.491, (95% CI 0.299–0.807, p value = 0.005) and 0.485 (95% CI 0.303–0.778, p value = 0.003), respectively), as were high levels of MVPA (0.476 (95% CI 0.278–0.816, p value = 0.007)) and MVPA-SL (0.389 (95% CI 0.224–0.677, p value < 0.001)), and adherence to ACSM PA guidelines compared to non-adherence (0.629 (95% CI 0.412–0.961, p value = 0.032)). The present study provides evidence that higher PA levels at diagnosis of mCRC are associated with longer OS.

Highlights

A physically active lifestyle is broadly considered to be related to a decreased risk of developing colorectal cancer (CRC), with evidence being especially strong for colon cancer [1,2,3,4,5]
In this prospective observational cohort of metastatic colorectal cancer (mCRC) patients, we found that higher weekly total physical activity (PA) (MET-hours), moderate to vigorous PA (MVPA), and MVPA-SL at diagnosis of first metastasis was significantly associated with prolonged survival time compared to low levels
One study showed that walking was related to longer overall survival (OS) in mCRC patients [12], whereas two other studies found no associations with survival [13,14]

Summary

Introduction

A physically active lifestyle is broadly considered to be related to a decreased risk of developing colorectal cancer (CRC), with evidence being especially strong for colon cancer [1,2,3,4,5]. Several studies show beneficial associations between high levels of physical activity (PA) and reduced mortality in stage I–III CRC patients as well [6,7,8,9,10,11]. Evidence for an association between PA and survival among metastatic colorectal cancer (mCRC) patients, is sparse, and the described associations are less uniform. One large prospective study of patients with mCRC, embedded in a randomized phase III trial, reported a longer progression-free survival (PFS) and lower risk of treatmentrelated toxicities with higher total physical activity levels. As noted by the authors, selective enrollment in a trial context may affect the generalizability of these results, creating uncertainty as to what extent the results can be extrapolated to the general patient population

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