open access publication

Article, 2024

Post‐diagnosis adiposity, physical activity, sedentary behaviour, dietary factors, supplement use and colorectal cancer prognosis: Global Cancer Update Programme (CUP Global) summary of evidence grading

International Journal of Cancer, ISSN 0020-7136, 1097-0215, Volume 155, 3, Pages 471-485, 10.1002/ijc.34904

Contributors

Tsilidis, Konstantinos K 0000-0002-8452-8472 [1] [2] Markozannes, Georgios 0000-0001-8481-579X [1] [2] Becerra-Tomás, Nerea 0000-0002-4429-6507 [2] Cariolou, Margarita 0000-0003-2660-7866 [2] Balducci, Katia [2] Vieira, Rita [2] Kiss, Sonia [2] Aune, Dagfinn 0000-0002-4533-1722 [2] [3] [4] Greenwood, Darren C [5] Dossus, Laure 0000-0003-2716-5748 [6] González‐Gil, Esther M. [6] Gunter, Marc James 0000-0001-5472-6761 [2] [6] Allen, Kate J 0000-0002-3045-1238 [7] Brockton, Nigel T 0000-0002-5434-2490 [8] Croker, Helen A 0000-0002-7247-6599 [7] Gordon-Dseagu, Vanessa L Z 0000-0003-1867-2238 [7] Mitrou, Panagiota N 0009-0008-7315-6918 [7] Musuwo, Nicole [7] Wiseman, Martin J 0000-0001-7545-8161 [7] Copson, Ellen [9] Renehan, Andrew G. [10] Bours, Martijn [11] Demark-Wahnefried, Wendy 0000-0001-5241-932X [12] Hudson, Melissa M. [13] May, Anne Maria 0000-0003-0643-3790 [14] [15] Odedina, Folakemi T 0000-0003-3796-1385 [16] Skinner, Roderick [17] Steindorf, Karen 0000-0001-5215-5651 [18] Tjønneland, Anne Marie 0000-0003-4385-2097 [19] [20] Velikova, Galina [5] Baskin, Monica L [21] Chowdhury, Rajiv 0000-0003-4881-5690 [22] Hill, Lynette [7] Lewis, Sarah J. [23] Seidell, Jaap C 0000-0002-9262-9062 [24] Weijenberg, Matty P 0000-0003-1695-4768 [11] Krebs, John [25] Cross, Amanda Jane [2] Chan, Doris S M (Corresponding author) [2]

Affiliations

  1. [1] University of Ioannina
    2. [NORA names: Greece; Europe, EU; OECD];
  2. [2] Imperial College London
    3. [NORA names: United Kingdom; Europe, Non-EU; OECD];
  3. [3] Cancer Registry of Norway
    4. [NORA names: Norway; Europe, Non-EU; Nordic; OECD];
  4. [4] Oslo Nye Høyskole
    5. [NORA names: Norway; Europe, Non-EU; Nordic; OECD];
  5. [5] University of Leeds
    6. [NORA names: United Kingdom; Europe, Non-EU; OECD];

Abstract

Based on the World Cancer Research Fund Global Cancer Update Programme, we performed systematic reviews and meta-analyses to investigate the association of post-diagnosis adiposity, physical activity, sedentary behaviour, and dietary factors with colorectal cancer prognosis. We searched PubMed and Embase until 28th February, 2022. An independent expert committee and expert panel graded the quality of evidence. A total of 167 unique publications were reviewed, and all but five were observational studies. The quality of the evidence was graded conservatively due to the high risk of several biases. There was evidence of non-linearity in the associations between body mass index and colorectal cancer prognosis. The associations appeared reverse J-shaped, and the quality of this evidence was graded as limited (likelihood of causality: limited-no conclusion). The evidence on recreational physical activity and lower risk of all-cause mortality (relative risk [RR] highest vs. lowest: 0.69, 95% confidence interval [CI]: 0.62-0.77) and recurrence/disease-free survival (RR: 0.80, 95% CI: 0.70-0.92) was graded as limited-suggestive. There was limited-suggestive evidence for the associations between healthy dietary and/or lifestyle patterns (including diets that comprised plant-based foods), intake of whole grains and coffee with lower risk of all-cause mortality, and between unhealthy dietary patterns and intake of sugary drinks with higher risk of all-cause mortality. The evidence for other exposures on colorectal cancer outcomes was sparse and graded as limited-no conclusion. Analyses were conducted excluding cancer patients with metastases without substantial changes in the findings. Well-designed intervention and cohort studies are needed to support the development of lifestyle recommendations for colorectal cancer patients.

Keywords

Committee, Embase, Global, J-shaped, PubMed, activity, adipose, all-cause mortality, analysis, association, behavior, bias, body, body mass index, cancer, cancer outcomes, cancer patients, cancer prognosis, coffee, cohort, cohort study, colorectal cancer outcomes, colorectal cancer patients, colorectal cancer prognosis, cup, development, dietary factors, dietary patterns, drinking, evidence, evidence grading, evidence of non-linearity, expert committee, expert panel, exposure, factors, findings, grade, grain, high risk, higher risk of all-cause mortality, independent expert committee, index, intake, intake of sugary drinks, intake of whole grains, intervention, lifestyle, lifestyle patterns, lifestyle recommendations, limited-suggestive, low risk, lowest risk of all-cause mortality, mass index, meta-analyses, metastasis, mortality, non-linear, observational study, outcomes, panel, patients, patterns, physical activity, prognosis, programme, publications, quality, quality of evidence, recommendations, recreational physical activity, reverse J-shaped, review, risk, risk of all-cause mortality, sedentary behavior, study, sugary drinks, supplement use, supplementation, survival, systematic review, unhealthy dietary patterns, unique publications, update programmes, use, well-designed interventions, whole grains, world

Funders

  • World Cancer Research Fund Netherlands
  • World Health Organization
  • World Cancer Research Fund UK
  • American Institute for Cancer Research

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