Adherence to the world cancer research fund/ american institute for cancer research cancer prevention recommendations and colorectal cancer survival

Rui Song, Joshua Petimar, Molin Wang, Fred K. Tabung, Mingyang Song, Li Liu, Dong Hoon Lee, Edward L. Giovannucci, Xuehong Zhang, Stephanie A. Smith-Warner

Research output: Contribution to journalArticlepeer-review


Background: Patients with cancer are recommended to follow cancer prevention guidelines due to inadequate evidence for specific recommendations for cancer survivors. Methods: We examined whether diet and lifestyle scores measuring adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention guidelines were associated with colorectal cancer–specific and overall mortality among 1,491 patients with colorectal cancer in two prospective cohorts. Cox proportional hazards regression models were used to calculate the multivariable-adjusted HRs and 95% confidence intervals (CI). Results: During a median follow-up of 7.92 years, there were 641 deaths (179 colorectal cancer–specific deaths). Patients in the highest quartile of the post-diagnostic WCRF/AICR lifestyle score including diet, body mass index (BMI), and physical activity had a 24% lower risk (HR ¼ 0.76, 95% CI: 0.49–1.18) of colorectal cancer–specific mortality and a 37% lower risk (HR ¼ 0.63, 95% CI: 0.50–0.78) of overall mortality compared with the lowest quartile. When BMI was not included in the lifestyle score due to potential disease-related weight loss, stronger inverse associations were observed for both colorectal cancer–specific and overall mortality for the same comparison (colorectal cancer–specific: HR ¼ 0.50, 95% CI: 0.32–0.79; overall: HR ¼ 0.59, 95% CI: 0.47–0.75). The post-diagnostic WCRF/AICR diet score was not statistically significantly associated with either colorectal cancer–specific or overall mortality. Conclusions: Greater adherence to the WCRF/AICR cancer prevention recommendations was associated with improved survival in patients with colorectal cancer. Impact: This study provides support for patients with colorectal cancer to follow cancer prevention recommendations after diagnosis. Future studies on cancer survivors will continue to contribute to evidence-based diet and lifestyle recommendations for patients with cancer.

Original languageEnglish
Pages (from-to)1816-1825
Number of pages10
JournalCancer Epidemiology Biomarkers and Prevention
Issue number10
Publication statusPublished - 2021 Oct

Bibliographical note

Funding Information:
R. Song reports grants from NIH during the conduct of the study. J. Petimar reports grants from NIH during the conduct of the study, as well as grants from NIH outside the submitted work. S.A. Smith-Warner reports grants from NIH during the conduct of the study. No disclosures were reported by the other authors.

Funding Information:
We would like to thank the participants and staff of the NHS and HPFS for their valuable contributions and the following state cancer registries for their help: AL, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, NE, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WY. The authors assume full responsibility for analyses and interpretation of these data. This work was supported by the NCI of the NIH under award numbers UM1 CA186107 (MPI: Meir Stampfer and A. Heather Eliassen; NHS), U01 CA167552 (MPI: Walter C. Willett and Lorelei Mucci; HPFS), and R03 CA249027 (PI: D.H. Lee). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.

Publisher Copyright:
©2021 American Association for Cancer Research

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Oncology


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