The Cognitive Appraisal Path of Physical Activity, Benefit Finding, and Cancer‐Related Fatigue Among Patients With Colorectal Cancer in China: Mediation Model Analysis

To understand the incidence and mortality of colorectal cancer in China. The data from GLOBOCAN 2012, Chinese Cancer Registry Annual Report 2012, Cancer Incidence in Five Continents (CI5), the Three National Death Cause Surveys in China and WHO Mortality Database were used to learn about the incidence and mortality of colorectal cancer and related trends in China. It was estimated by GLOBOCAN 2012 that in 2012 the age-standardized incidence of colorectal cancer in China was 16.9 per 100 000 in males and 11.6 per 100 000 in females, and the age-standardized mortality was 9.0 per 100 000 in males and 6.1 per 100 000 in females. GLOBOCAN 2012 estimated that colorectal cancer incidence and mortality would increase with the level of human development index. China's human development level was high, suggesting that the burden of colorectal cancer would be more serious in China with the development of social economy. The data from CI5 Volume IV and GLOBOCAN 2012 indicated that the incidence of colorectal cancer began to increase obviously at age of 50 years in China. Chinese Cancer Registry Annual Report 2012 showed that the incidence and mortality of colorectal cancer in urban population were two times higher than those in rural population in 2009, the proportions of colon cancer among colorectal and anus cancers, which was 49.0% in males and 54.2% in females, 53.4% in urban population and 41.7% in rural population. CI5 Volumes IV-X showed that colon cancer and rectum and anus cancer incidence in Shanghai for both males and females were increasing during the period 1973-2007. The percentage change in colon cancer and rectum and anus cancer incidence between 1973-1977 and 2003-2007 increased by 138.8% and 31.1% in males, 146.7% and 49.1% in females, respectively. The data from the Three National Death Cause Surveys showed that the crude mortality of colorectal cancer increased by 77.9% form mid 1970's (1973-1975) to mid 2000's (2004-2005). WHO Mortality Database showed that average annual percentage change (AAPC) of age-standardized colorectal cancer mortality increased by 0.7% (P < 0.05) from 1987 to 2000. More attention should be paid to the prevention and control of colorectal cancer in urban area and in male population in China. Similar to the western countries, the burden of colorectal cancer in China would continue to become serious if no population based prevention and control programs are conducted.

BackgroundUnderstanding the temporal trends in the epidemiology of colorectal cancer (CRC) and early-onset CRC (EOCRC) in China is essential for policymakers to develop appropriate strategies to reduce the CRC burden.MethodsThe prevalence, incidence, mortality, years of life lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs) of CRC were obtained from the Global Burden of Disease (GBD) Study 2019. The incidence and mortality of CRC over the next 25 years were predicted.ResultsFrom 1990 to 2019, the prevalence, incidence, and mortality of total CRC and EOCRC significantly increased in males, with milder trends in females. In 2019, the number of people living with CRC (or EOCRC) in China was approximately 3.4 (0.59) million, which was over seven (five) times higher than that in 1990. The DALYs, YLDs, and YLLs moderately increased from 1990 to 2019 in both sexes. The age-standardized mortality rate (ASMR) for females has shown a stable trend in total CRC, and a downward trend in EOCRC since 2000. While the ASMR for males showed increasing trends in total CRC and EOCRC. In 2019, the highest incidence, prevalence, YLDs, YLLs, and DALYs were all observed in the 65 to 69 age group, while the highest mortality was in the 70 to 74. By 2044, the incidence and deaths of CRC are expected to reach 1310 thousand and 484 thousand, respectively. For EOCRC, the incidence will peak at about 101 thousand around 2034, and the mortality will continuously decrease to a nadir at about 18 thousand around 2044.ConclusionAlthough the age-standardized incidence and mortality of total CRC and EOCRC in China will reach a plateau, the number of incident cases and deaths of CRC have been increasing in the last three decades and will continue to increase in the next 25 years.

e22610 Background: Emerging evidence suggests that physical activity may play a pivotal role in improving survival outcomes among cancer patients. However, the extent of its impact across different cancer types remains unclear. Here we aimed to quantify the association between physical activity and survival outcomes in patients with various solid tumors through a comprehensive meta-analysis. Methods: A literature search was performed in PubMed, Web of Science, Cochrane Library, Embase, and Google Scholar databases, covering studies up to December, 2024. Prospective studies examining physical activity and survival in solid tumors were included. Hazard ratios (HR) and 95% confidence intervals (CI) were extracted and pooled using a random-effects model to account for study heterogeneity. Meta-analyses were conducted using the MetaAnalysisOnline.com platform, with rigorous screening and inclusion criteria applied to ensure high-quality data. Results: Our meta-analysis included 85 studies investigating the relationship between physical activity and survival outcomes across various cancer types. For breast cancer (33 studies), physical activity was associated with a significant reduction in all-cause mortality (HR = 0.64, 95% CI: 0.59–0.70) and breast cancer-specific mortality (HR = 0.69, 95% CI: 0.63–0.75), with substantial heterogeneity observed for all-cause mortality (I² = 61%). In lung cancer (13 studies), physical activity reduced all-cause mortality (HR = 0.78, 95% CI: 0.72–0.84) and lung cancer-specific mortality (HR = 0.76, 95% CI: 0.69–0.84), although significant heterogeneity was detected (I² = 93% and 83%, respectively). Prostate cancer (13 studies) showed a reduced risk of all-cause and cancer-specific mortality (HR = 0.68, 95% CI: 0.60–0.77), with no significant heterogeneity. Similarly, in colorectal cancer (25 studies), physical activity was associated with reduced all-cause mortality (HR = 0.71, 95% CI: 0.66–0.75) and cancer-specific mortality (HR = 0.71, 95% CI: 0.63–0.80). For skin cancer, no significant association was observed between physical activity and survival outcomes (HR = 0.86, 95% CI: 0.71–1.05), with consistent effect sizes across studies. Conclusions: Our analysis demonstrates that physical activity significantly improves survival outcomes in cancer patients, particularly in breast, lung, prostate, and colorectal cancers, emphasizing its potential as an adjunctive strategy in cancer care.

Introduction Over the last 30 years the incidences of cancer and diabetes have been increasing progressively and there is both epidemiologic and experimental data linking diabetes and various cancer outcomes. Previous studies has shown that physical activity, height, and obesity; measured by weight, waist circumference, waist-to-hip ratio and body mass index were associated with the risk of diabetes and common cancer outcomes such as breast, colorectal and prostate cancer. However, there is little data on whether these modifiable risk factors are predictive of these malignancies among diabetics. The identification of factors that modify the risk of cancer among diabetics could lead to better surveillance or intervention to reduce cancer incidence among those at highest risk. Aim The aim of this study was to observe the relationship between anthropometric measures, including weight, height, and adiposity and physical activity with the risk of breast, colorectal and prostate cancer among diabetic individuals within the European Prospective Investigation into Cancer and Nutrition cohort. Methods Data from 27,365 diabetics from nine European countries between the ages of 20 to 85 years and a mean follow-up of 11.1 years from the European Prospective Investigation into Cancer and Nutrition (EPIC) was used. Of the 27,365 diabetics, 546 developed breast cancer, 363 developed prostate cancer and 308 developed colorectal cancer. Hazard ratios (HR) and 95% confidence interval (CI) were estimated using a Cox proportional hazard model, stratified by age in one year increments, gender and centre and adjusted for smoking status, alcohol consumption, education, BMI and physical activity. The HR was used to examine the association between anthropometric measures at recruitment and PA estimated from questionnaires with breast, prostate and colorectal cancer. Results There were no significant associations between height, weight, waist circumference waist-to-hip ratio, BMI and physical activity with breast, prostate and colorectal cancer when comparing the highest and lowest quartiles. However, there was a significant association between height and breast cancer when comparing the third quartile to the first (Q3 vs Q1, HR: 3.34, 95%CI: 1.09-10.22). Moreover, there was a suggestive inverse association between physical activity with breast and prostate cancer (P-trend 0.085 and P-trend 0.07, respectively). There was also a suggestive positive association between abdominal obesity and colorectal cancer (P-trend 0.04 for waist circumference and P-trend 0.08 for waist-to-hip ratio). Conclusion In this study of diabetic patients nested within the EPIC cohort, there was little evidence for an association between anthropometric measures and physical activity with breast, prostate and colorectal cancer. However, there was a suggestive association between physical activity with breast and prostate cancer and a suggestive association between abdominal obesity and colorectal cancer. Due to the limited number of cases in this study, further investigations between the associations of these modifiable factors with these cancers among diabetics are required.

Screening, Surveillance, and Primary Prevention for Colorectal Cancer: A Review of the Recent Literature

Decision letter: Polygenic risk scores for the prediction of common cancers in East Asians: A population-based prospective cohort study

Glycaemic index, breast and colorectal cancer

e22544 Background: Lynch syndrome is the most common hereditary cause of colorectal and endometrial cancer. Non-genetic risk factors, including obesity, physical activity, alcohol intake, and smoking are well-established in sporadic cancers but are less studied in Lynch syndrome. A better understanding of these risk factors could directly contribute to cancer prevention. Methods: Searches were conducted on MEDLINE, Embase and Web of Science for retrospective or prospective cohort studies that investigated the association between modifiable risk factors and the risk of colorectal or endometrial cancer in people with Lynch syndrome. Screening, data extraction and quality assessment were completed by 2 reviewers independently. Adjusted hazard ratios (HR) and 95% confidence intervals (CI) for colorectal and endometrial cancer were pooled using a random effects model. The protocol was prospectively registered on PROSPERO (CRD 42022378462) and the meta-analysis conducted in accordance with PRISMA and MOOSE reporting guidelines. Results: A total of 770 citations were reviewed. Twelve cohort studies involving 12685 patients with Lynch syndrome investigated risk of colorectal cancer, while 3 studies including 1865 patients assessed risk factors for endometrial cancer. Eight colorectal cancer studies were eligible for meta-analysis. Obesity (HR 2.38, 95% CI 1.52-3.73) and alcohol intake (HR 1.43, 95% CI 1.05-1.94) increased colorectal cancer risk, physical activity was protective (HR 0.66, 95% CI 0.52-0.83), and smoking had no effect (HR 1.02 95% CI 0.83-1.27). Type 2 diabetes mellitus and low dietary intake of calcium and multivitamins might increase risk of colorectal cancer, although more studies are needed. There is a paucity of data pertaining to endometrial cancer. In a qualitative synthesis of 3 endometrial cancer cohort studies, female hormonal risk factors and type 2 diabetes mellitus may affect the risk of endometrial cancer, but obesity was not associated with an increased risk. Conclusions: Lifestyle recommendations related to weight, physical activity, and alcohol may also be relevant to cancer prevention for individuals with Lynch syndrome and may provide a meaningful adjunct to standard interventions for risk modification. There are very poor data examining modifiable risk factors in endometrial cancer. Further high-quality prospective cohort studies, in particular including endometrial cancer as an endpoint, are needed to inform evidence-based cancer prevention strategies in this high-risk population.

Development of Colorectal Tumors in Colonoscopic Surveillance in Lynch Syndrome

Cancer remains a major global health challenge, and growing evidence suggests that physical activity is a key modifiable factor that may improve survival outcomes in cancer patients. However, a comprehensive, large-scale synthesis of the effects of post-diagnosis physical activity across multiple cancer types remains lacking. This meta-analysis aims to systematically evaluate the association between physical activity and survival in patients diagnosed with breast, lung, prostate, colorectal, and skin cancers. We conducted a comprehensive search in PubMed, Web of Science, Scopus, and Cochrane Library for studies on physical activity and cancer survival. Eligible studies (January 2000–November 2024) included adults (≥ 18 years) with breast, lung, prostate, colorectal, or skin cancer. Only prospective cohort and case–control studies reporting hazard ratios (HRs) with 95% confidence intervals (CIs) for overall or cancer-specific mortality were included, with a minimum sample size of 100 and at least six months of follow-up. Meta-analysis was performed using metaanalysisonline.com, applying random-effects models and assessing heterogeneity via the I2 statistic. Sensitivity analyses and publication bias (Egger’s test, funnel plots) were evaluated. The meta-analysis included 151 cohorts with almost 1.5 million cancer patients. Post-diagnosis physical activity was associated with significantly lower cancer-specific mortality across all five cancer types. The greatest benefit was observed in breast cancer, with a pooled hazard ratio (HR) of 0.69 (95% CI: 0.63–0.75), followed by prostate cancer (HR: 0.73, 95% CI: 0.62–0.87). Lung cancer patients who engaged in physical activity had a 24% lower risk of cancer-specific death (HR: 0.76, 95% CI: 0.69–0.84), while colorectal cancer patients experienced a similar benefit (HR: 0.71, 95% CI: 0.63–0.80). In skin cancer, physical activity was associated with a non-significant reduction in mortality (HR: 0.86, 95% CI: 0.71–1.05). These findings provide robust evidence supporting the survival benefits of post-diagnosis physical activity in cancer patients, particularly for breast, prostate, lung, and colorectal cancers. The results underscore the potential for incorporating structured physical activity interventions into oncological care to improve long-term patient outcomes.

The project intended to analyze the impact of burden and related risk factors of late-onset colorectal cancer (LOCRC) and early-onset colorectal cancer (EOCRC) in China, thus offering essential references for optimizing prevention and control strategies. Global Burden of Disease Study was employed to describe burden changes of EOCRC and LOCRC in China during 1990-2019, containing the numbers of incidence, deaths, prevalence, and disability-adjusted life years (DALYs), and to compare attributable deaths and DALYs risk factors in varying age and sex segments. The numbers and corresponding crude rates of incidence, deaths, prevalence, and DALYs of EOCRC and LOCRC in China during 1990-2019 demonstrated an upward trend across all age categories, with males being dramatically predominant. Overall, over time, the impact of a low-calcium diet and a low-fiber diet on mortality and DALY rates decreased, while the impact of other risk factors increased. In terms of gender, the risk factors affecting males changed greatly, with smoking, inadequate milk intake, and the low whole-grain diet being the main factors in 2019, while in 1990, the main factors were the low-calcium diet, smoking, and inadequate milk intake. The burden of colorectal cancer in China is concerning. Patients grouped by diagnostic age exhibit different characteristics, indicating the need for high-quality research in the future to achieve personalized medicine tailored to different population characteristics.

Background: Independent of physical activity, television (TV) watching, a major sedentary behavior in the United States, is associated with increased risk of obesity and diabetes, established risk factors for colorectal neoplasia. Although data suggest probable positive associations between sitting time, in particular time spent watching TV, and risk of colorectal adenoma and cancer, the impact of sedentary behaviors on mortality among colorectal cancer patients is unclear. Methods: We assessed the association between pre- and post-diagnostic time spent sitting while watching TV as well as other sedentary behaviors (other sitting at home and sitting at work/driving) and mortality from colorectal cancer and other causes, as well as overall mortality among nonmetastatic colorectal cancer cases identified between 1986 to 2010 from the Health Professionals Follow-up Study. Starting from 1988, participants reported average weekly time spent sitting watching TV/VCR biennially, and hours of other sitting at home and sitting at work/driving since 1990. For analyses of prediagnosis sedentary behavior, we calculated cumulative hours of sitting to the time of diagnosis to capture long-term sitting behavior. For postdiagnosis analyses, the first assessment collected at least 6 months but no more than 3 years after diagnosis was used to avoid assessment during the period of active treatment. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: A total of 858 and 662 eligible colorectal cancer patients were included in the analysis of prediagnostic and postdiagnostic TV watching, respectively. More time spent sitting watching TV before diagnosis was significantly associated with increased risk of colorectal cancer-specific mortality but not with mortality from other causes or overall mortality in multivariate analyses adjusted for age and years of diagnosis, stage, grade and location of the tumor, and smoking status. Further adjusting for leisure-time physical activity or potential mediators including body mass index and dietary score did not appreciably change the estimates. The HRs (95% CIs) of colorectal cancer-specific mortality across categories of prediagnostic TV watching (0-6, 7-13,14-20, ≥21 h h/wk) were 1.00 (referent), 0.82 (0.55-1.24), 1.13 (0.72-1.76), 2.10 (1.27-3.47) (P for trend=0.01). We combined the first three categories of TV watching based on the dose response relationship (HR for ≥21 vs &amp;lt; 21 h/wk=2.19; 95% CI 1.39-3.44) to assess potential effect modifications, and found that the association was slightly stronger among stage I and II than among stage III cancer patients, and among those with BMI ≥25 kg/m2 than among patients with BMI &amp;lt;25 kg/m2, although interactions were not significant. Similar associations were observed for colon vs rectal cancer, cancer diagnosed before vs after 2000, and those who engaged in &amp;lt;18 vs ≥ 18 MET (Metabolic Equivalent of Task)-hrs per week of physical activity. When restricted to mortality within 5-year after diagnosis, prolonged TV watching before diagnosis was also associated with higher overall mortality (HR for ≥21 vs &amp;lt; 21 h/wk=1.55; 95% CI 1.03-2.35). Other prediagnostic sedentary behaviors including sitting at home or at work/driving were not associated with mortality from colorectal cancer or other causes, as well as overall mortality. With limited power, we also observed that postdiagnostic time spent sitting watching TV was associated with higher but non-significant increased risk of colorectal cancer-specific mortality (HR for ≥21 vs &amp;lt; 21 h/wk=1.57; 95% CI 0.81-3.03). Conclusion: Prolonged TV watching is associated with higher colorectal cancer-specific mortality independent of leisure-time physical activity. Reducing sedentary behavior, in particular time spent sitting watching TV, may be important in the prognosis of colorectal cancer. Citation Format: Yin Cao, Jeffrey Meyerhardt, Andrew Chan, Charles Fuchs, Edward Giovannucci. Television watching, other sedentary behaviors and colorectal cancer survival in men. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr A25.

375 Background: Frailty reflects decreased physiologic reserve and subsequent increased vulnerability to stress. Frailty has been associated with poor health outcomes in patients with cancer, however traditional frailty indices are time consuming and not widely implemented in clinical oncology practice. An electronic frailty index (EFI) derived from electronic medical records (EMR) is an objective and standardized approach to frailty that can be automated. Little is known about the association between EFI and survival and healthcare utilization outcomes in patients with colorectal cancer (CRC). Methods: We used VA administrative files from 2016 – 2020 and the VA Central Cancer Registry to identify a cohort of patients diagnosed with CRC. EFI was calculated based on the Veterans Affairs-FI (VA-FI), a validated 31-item cumulative deficit FI, to define three groups: robust (≤0.1), prefrail (0.1-0.2), and frail (&gt; 0.2). We conducted Cox proportional hazard analyses to evaluate survival. We performed logistic regression to examine prolonged length of stay (LOS) ≥ median (11 days) during all-cause hospitalization and emergency department (ED) visits within one year after diagnosis. All models were adjusted for age, gender, race, Charlson comorbidity index, and stage. Confidence intervals (CI) were calculated as 95%. Results: Of 6,043 CRC patients (age: 69.7 ± 10.6 years), 45.6% were robust, 34.5% were prefrail, and 19.9% were frail. The cohort included 22.9% rectal cancer and 77.1% colon cancer cases, distributed across stages I (29.2%), II (25.0%), III (25.2%), and IV (20.6%). Increased risk of death was found in prefrail (adjusted hazard ratio [aHR] 1.21; CI 1.10-1.32) and frail (aHR 1.90; CI 1.71-2.11) patients when compared to robust patients. Increased odds of one-year ED visits were identified in prefrail (adjusted odds ratio [aOR] 1.18; CI 1.06 – 1.35) and frail (aOR, 1.66, CI 1.43-1.94) patients. Frailty status was associated with increased odds of one-year hospitalization of prolonged LOS among prefrail (aOR 1.38; CI 1.11-1.70) and frail patients (aOR 1.79; 95% CI 1.39-2.30). Conclusions: EFI was significantly associated with survival and healthcare utilization among patients with CRC, independent of stage. Frail patients had nearly 80% increased likelihood of prolonged hospitalization. EFI has the potential to be an automated and objective decision support tool at the point of care for risk assessment prior to CRC treatment-related stressors, such as surgery or chemotherapy. Future work is needed to develop a cancer specific EFI with dynamic variables that can be followed prospectively, as well as evaluating barriers to implementation within the EMR to guide treatment decisions and improve the quality of cancer care.

Due to their known variation by geography and economic development, we aimed to evaluate the incidence and mortality of colorectal cancer (CRC) in China over the past decades and identify factors associated with CRC among the Chinese population to provide targeted information on disease prevention. We conducted a systemic review and meta-analysis of epidemiolocal studies on the incidence, mortality, and associated factors of CRC among the Chinese population, extracting and synthesising data from eligible studies retrieved from seven global and Chinese databases. We pooled age-standardised incidence rates (ASIRs) and mortality rates (ASMRs) for each province, subregion, and the whole of China, and applied a joinpoint regression model and annual per cent changes (APCs) to estimate the trends of CRC incidence and mortality. We conducted random-effects meta-analyses to assess the effect estimates of identified associated risk factors. We included 493 articles; 271 provided data on CRC incidence or mortality, and 222 on associated risk factors. Overall, the ASIR of CRC in China increased from 2.75 to 19.39 (per 100 000 person-years) between 1972 and 2019 with a slowed-down growth rate (APC1 = 5.75, APC2 = 0.42), while the ASMR of CRC decreased from 12.00 to 7.95 (per 100 000 person-years) between 1974 and 2020 with a slight downward trend (APC = -0.89). We analysed 62 risk factors with synthesized data; 16 belonging to the categories of anthropometrics factors, lifestyle factors, dietary factors, personal histories and mental health conditions were graded to be associated with CRC risk among the Chinese population in the meta-analysis limited to the high-quality studies. We found substantial variation of CRC burden across regions and provinces of China and identified several associated risk factors for CRC, which could help to guide the formulation of targeted disease prevention and control strategies. PROSPERO: CRD42022346558.

Novel Application of Structural Equation Modeling to Correlation Structure Analysis of CpG Island Methylation in Colorectal Cancer