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ORIGINALARTICLEAdherencetotheWorldCancerResearchFund/AmericanInstituteforCancerResearchrecommendationsforcancerpreventionisassociatedwithbetterhealth–relatedqualityoflifeamonglong-termcolorectalcancersurvivors:resultsofthePROFILESregistryMerelR.
vanVeen1,2&FloortjeMols3&MartijnJ.
L.
Bours4&MattyP.
Weijenberg4&EllenKampman2&SandraBeijer1Received:24September2018/Accepted:5March2019#TheAuthor(s)2019AbstractSincecolorectalcancer(CRC)survivorsoftensufferfromlong-termadversehealtheffectsofthecanceranditstreatment,havinganegativeimpactontheirhealth-relatedqualityoflife(HRQL),thisstudyfocusesontheassociationbetweenadherencetoWCRF/AICRrecommendationsandHRQLamongCRCsurvivors.
Inacross-sectionalPROFILESregistrystudyin1096CRCsurvivors(meantimesincediagnosis8.
1years),WCRF/AICRadherencescores(range0–8,withahigherscoreforbetteradherence)werecalculated,andHRQLwasassessedusingtheEORTCQLQ-C30.
AssociationsbetweenadherencescoresandHRQLscoreswereinvestigatedusinglinearregressionanalyses.
Additionally,associationswithadherencetoguidelinesforbodymassindex(BMI)(normalweight,overweightandobese),physicalactivity(PA)(score0/1)anddiet(score4)wereevaluatedseparately.
Meanadherencescorewas4.
81±1.
04.
HigherWCRF/AICRscoreswereassociatedwithbetterglobalhealthstatus(β1.
64;95%CI0.
69/2.
59),physicalfunctioning(β2.
71;95%CI1.
73/3.
68),rolefunctioning(β2.
87;95%CI1.
53/4.
21),cognitivefunctioning(β1.
25;95%CI0.
19/2.
32),socialfunctioning(β2.
01;95%CI0.
85/3.
16)andfatigue(β2.
81;95%CI4.
02/1.
60).
Adherenceversusnon-adherencePAwassignificantlyassociatedwithbetterphysical,role,emotionalandsocialfunctioning,globalhealthstatusandlessfatigue.
Exceptfortheassociationbetweenbeingobeseandphysicalfunctioning(β4.
15;95%CI47.
16/1.
15),nostatisticallysignificantassociationswithphysicalfunctioningwereobservedcomparingadherencetonon-adherencetoBMIanddietaryrecommendations.
BetteradherencetotheWCRF/AICRrecommendationswaspositivelyassociatedwithglobalhealthstatus,mostfunctioningscalesandlessfatigueamongCRCsurvivors.
PAseemedtobethemaincontributor.
KeywordsColorectalcancersurvivors.
Health-relatedqualityoflife.
WCRFguidelines.
Dietaryguidelines.
Physicalactivity.
BodycompositionIntroductionIn2007,theWorldCancerResearchFund/AmericanInstituteforCancerResearch(WCRF/AICR)launchedthedietandphysicalactivityrecommendationsforcancerprevention[1].
Cancersurvivors,definedaspeoplewhoarelivingwithadiagnosisofcancer,includingthosewhohaverecoveredfromthedisease[1],orinotherwordsthosewhofinishedtreatmentandaredisease-free,areencouragedtofollowtheserecom-mendationstoreduceriskofrecurrenceandimprovesurvival.
Colorectalcancer(CRC)survivorsoftensufferfromlong-termadversehealtheffectsofcanceranditstreatment[2].
Thiscanhaveanegativeimpactonhealth-relatedqualityoflife(HRQL).
TwosystematicreviewsshowedthatCRCsurvivors*MerelR.
vanVeenmerelrvanveen@gmail.
com1DepartmentofResearch&Development,NetherlandsComprehensiveCancerOrganisation(IKNL),IKNL,P.
O.
Box19079,3501DBUtrecht,TheNetherlands2DivisionofHumanNutritionandHealth,WageningenUniversity,P.
O.
Box17,6700AAWageningen,TheNetherlands3CoRPS-CenterofResearchonPsychologyinSomaticdiseases,DepartmentofMedicalandClinicalPsychology,TilburgUniversity,POBox90153,5000LETilburg,TheNetherlands4DepartmentofEpidemiology,GROW–SchoolforOncologyandDevelopmentalBiology,MaastrichtUniversity,P.
O.
Box616,6200MDMaastricht,TheNetherlandshttps://doi.
org/10.
1007/s00520-019-04735-y/Publishedonline:29March2019SupportiveCareinCancer(2019)27:4565–4574hadalowerphysicalfunctioningandmorefatigueandpsy-chologicalproblems,includingdepression,anxietyanddis-tressthanthegeneralpopulation[3,4].
Becauseoftheincreas-ingnumbersofCRCsurvivors,investigatingpossibilitiestoincreaseHRQLisveryimportant.
Severalstudiesshowedanassociationbetweenadherencetogeneralnon-cancer-specificdietaryguidelines,suchastheHealthyEatingIndexortheMediterraneandiet,andhigherlevelsofHRQLincancersurvivors,includingCRCsurvivors[5–7].
Inaddition,previousstudieshavedemonstratedthatCRCsurvivorswhometthepublichealthexerciseguidelinesreportedbetterqualityoflife(QL)andfatiguescoresthanCRCsurvivorswhodidnotmeettheseguidelines[8,9].
AlthoughadherencetogeneraldietaryorexerciseguidelinesshowedpositiveassociationswithHRQL,theassociationbe-tweenadherencetothecancer-specificWCRF/AICRrecom-mendationsondiet,physicalactivityandbodyweight/compositionandHRQLhaveonlybeeninvestigatedinfemalecancersurvivorsingeneral[10],inbreastcancersurvivors[11]andinasmallcross-sectionalstudy(N=145)inCRCsurvivors[12].
ThesestudiesshowedthatbetteradherencetotheWCRF/AICRrecommendationswasassociatedwithbetterHRQL[10–12].
However,duetotherelativelysmallnumbersinthesestudies,itwasnotpossibletoevaluatewhichspecificrecommendationshadthehighestimpactamongCRCsurvivors(diet,physicalactivityorbodycomposition).
TheaimofthepresentstudywastoinvestigatetheassociationbetweenadherencetotheWCRF/AICRrecommendationsandHRQLforallrecommendationstogetherandforphysicalactivity,bodycompositionanddietseparatelyinalargecohortofCRCsurvivors.
SubjectsandmethodsStudydesignThisstudywaspartofanongoinglongitudinalstudyinvesti-gatingHRQLinCRCpatients.
AllCRCpatientsstageI–IV,diagnosedbetweenJanuary2000andJune2009fromthesouthernareaoftheNetherlands,weresampledviatheNetherlandsCancerRegistry(NCR).
ThePatientReportedOutcomesFollowingInitialTreatmentandLong-termEvaluationofSurvivorship(PROFILES)registrywasusedtocollectthedata[13].
EthicalapprovalforthestudywasobtainedfromthelocalcertifiedMedicalEthicsCommitteeoftheMaximaMedicalCentreVeldhoven,theNetherlands(approvalnumber0822).
Allparticipantsgaveinformedconsent.
Datafromthislongitudinalstudyare(partly)availableonlinefornon-commercialscientificresearch,subjecttostudyquestion,privacyandconfidentialityrestrictions,andregistration(www.
profilesregistry.
nl).
DatacollectionCRCpatientswereinvitedforparticipationviaaletterfromtheir(former)attendingphysician.
Theletterincludedalinktoasecurewebsite,aloginnameandapassword,sothatinter-estedpatientscouldprovideconsentandcompletequestion-nairesonline.
Thosewhopreferredwrittencommunicationcouldreturnapostcardafterwhichtheyreceivedourpaper-and-pencilinformedconsentformandquestionnaire.
Non-respondentsweresentareminderletterandpaper-and-pencilquestionnairewithin2months.
Patientswerereassuredthatnonparticipationhadnoconsequencesfortheirfollow-upcareortreatment.
TheNCRprovidedinformationoncancerdiag-nosisandcancertreatmenthistory,suchasyearofdiagnosis,stageandlocalizationofcancerandhavingastoma.
StudypopulationTheCRCstudystartedinDecember2010andrespon-dentsreceivedsubsequentHRQLquestionnairesinDecember2011,December2012andJanuary2014.
InAugust2013,dataontheadherencetoWCRF/AICRrec-ommendationswerecollectedonce.
Acompleteoverviewoftheselectionofpatientscanbefoundonourwebsiteunder'data&documentation';https://www.
dataarchive.
profilesregistry.
nl/study_units/view/22.
Inthecurrentpaper,wepresentdataontheadherencetoWCRF/AICRrecommendationsanddataregardingHRQLofthesubse-quentmeasurementinJanuary2014.
Patientswithunver-ifiableaddresses,withcognitiveimpairment,whodiedpriortothestartofthestudyorwereterminallyill,withstage0/carcinomainsituandthosealreadyincludedinour2009CRCstudyoranotherstudy(n=169),wereexcluded[14].
Onethousandsixhundredtwenty-fivepar-ticipantswereinvitedforthedatacollectioninAugust2013,seeFig.
1.
BetweenAugust2013andJanuary2014,78(4.
8%)participantsdiedordiscontinuedpartic-ipation,resultingin1547survivorswhowereinvitedforthequestionnaireonHRQLinJanuary2014.
Figure1givesanoverviewofthenumberofnon-respondersandexcludedpatients.
Ofthe1625CRCsurvivorswhowereinvitedinAugust2013,1096wereincludedinthepresentstudy(67.
4%ofinvitedparticipantsinAugust2013)(Fig.
1).
Health-relatedqualityoflifeThevalidatedEuropeanOrganizationforResearchandTreatmentofCancer–QualityofLifeQuestionnaire(EORTCQLQ)-C30wasusedtoassessHRQLandfatigue[15,16].
ForCRCpatients,previousresearchconcludesthatahealthylife-styleismainlyassociatedwithfunctioningscales(i.
e.
physi-cal,emotional,social,cognitiveandrolefunctioning)and–45744566SupportCareCancer(2019)27:4565fatigue[5,17].
Therefore,onlyfunctioningscales,fatigueandglobalhealthstatuswereincludedintheanalysis.
Allitemswerescoredona4-pointLikertscalerangingfrom'notatall'to'verymuch',exceptfortheitemsregardingglobalhealthFig.
1FlowchartofthestudypopulationSupportCareCancer(2019)27:4565–45744567statuswhichwerescoredfrom1(verypoor)to7(excellent).
Allscoreswerelinearlytransformedtoascalerangingfrom0to100points[15,18].
Higherscoresonfunctioningscalesrepresentbetterfunctioning,whileahigherscoreonthefa-tiguescalecorrespondstomorefatigue.
Changesinscoreswereconsideredclinicallyrelevantifthemeandifferencewas5–14pointsforphysicalfunctioning,5–11pointsforsocialfunctioning,3–9pointsforcognitivefunc-tioning,6–19pointsforrolefunctioningand5–13pointforfatigue[19].
Foremotionalfunctioningnocut-offswerede-fined[19].
AdherencetotheWCRF/AICRrecommendationsAdherencetotheeightWCRF/AICRrecommendationswasdetermined,sixrecommendationsabouthealthydiet,oneaboutbodyfatnessandoneaboutphysicalactivity.
Thescor-ingofadherencetotheWCRF/AICRrecommendationsisdescribedextensivelybyWinkelsetal.
[20]andRomagueraetal.
[21].
Withregardtoahealthydiet,in2007,theWCRF/AICRpublishedthefollowingrecommendations:'foodsanddrinksthatpromoteweightgain:avoidhigh-caloriefoodsandsugarydrinks','plant-basedfoods:eatmoregrains,vegetables,fruitandbeans','animalfoods:limitredmeatandavoidprocessedmeat','alcoholicdrinks:forcancerprevention,don'tdrinkalcohol','preservation,processing&preparation:eatlesssaltandavoidmouldygrains&cereals'and'dietarysupplementuse:forcancerpreven-tion,don'trelyonsupplements'.
Toassessadherencetotherecommendationsconcerninghealthydiet,theDutchHealthyDiet-FoodFrequencyQuestionnaire(DHD-FFQ)wasused[22].
TheoriginalDHD-FFQconsistsof34items.
TocompensateforitemsthatweremissingintheDHD-FFQbutareincorporatedintheWCRF/AICRrec-ommendations,additionalquestionsonintakeofmeat,processedmeatandsugarybeverageswereaddedtothequestionnaire,fromnowoncalledWCRF/DHD-FFQ.
TheWCRF/DHD-FFQconsistsof40itemsonintakesofbread,fruit,vegetable,potatoes,milk,cheese,meatprod-ucts,fish,cookies,pastries,crisps,soup,fatsandoils,take-awayfood,pizza,sugarydrinks,alcoholicbeveragesanddiscretionarysalt.
Adherencetotherecommendationregardingbodyfatnesswasdeterminedbasedonbodymassindex(BMI)bycalcu-latingweight(kg)/height(m)2.
Weightandheightwereself-reported.
BMIwascategorisedasnormalweight(18.
5BMI30kg/m2).
PhysicalactivitywasassessedusingtheShortQuestionnairetoAssessHealth-EnhancingPhysicalActivity(SQUASH)whichcontainsquestionsaboutmul-tipleactivitiesreferringtoanormalweekinthepastmonth.
Resultswereconvertedtotimespentinlight,moderateandvigorousactivities,whichwerethencon-vertedtoactivityscores[23].
Whenthistotalactivityscorewas5ormore,representingthenumberofactivitiesofatleast30minperweek,personswerecategorisedasadherenttothephysicalactivityrecommendation.
Ifoneoftherecommendationswasmet,participantsreceived1pointforthatrecommendation.
Whenarecommendationwasnotmet,0or0.
5pointswereallottedaccordingtotheavailablecut-offvalues.
Thetotalscorehadarangeof0–8;ahigherscoremeansbetteradher-encetotherecommendations[20].
AnalysisandstatisticalmethodsResponderswerecomparedtonon-responders.
TheCRCsur-vivorswerecategorisedintothreegroups,basedontertilesofWCRF/AICRadherencescoresfollowingthesampledistribu-tion.
Chi-square(categoricalvariables)andone-wayANOVA(continuousvariables)wereusedtotestfordifferencesinbaselinecharacteristics.
ToassesstheassociationbetweenWCRFadherencescoresandHRQL,linearregressionmodelswereusedbothforthetertilesandforthecontinuousadherencescores.
Thefollow-ingvariablesweretestedwhethertheychangedtheregressioncoefficientbyatleast10%[24]:gender,age,comorbidities,smokingstatus,yearssincediagnosis,tumourlocalization,tumourstage,havingastoma,chemotherapyandradiothera-py;andfortheanalysesoftheindividualcomponentsdiet,physicalactivityandBMI.
Gender(male/female),age(con-tinuous),comorbidities(nocomorbidities,1comorbidity,>2comorbidities)andsmoking(current,former,never)changedtheregressioncoefficient≥10%andwereincludedinthemul-tivariablemodel.
Fortheanalysesoftheindividualcompo-nents,dietandBMIchangedby>10%whenphysicalactivitywasaddedtothemodel,thereforephysicalactivitywasaddedtothemultivariablemodel.
DummyvariableswerecreatedforWCRF/AICRadherencescoretertiles,smokingstatusandcomorbidities.
Functioningscales,globalhealthstatusandfatiguewerealsoexaminedseparatelyinrelationtoeachofthethreecom-ponentsoftheadherencescore(BMI(normalweight,over-weightandobese),physicalactivity(score0/1)anddiet(lowadherence(score4points)).
Toevaluatetheeffectoftheseparatecomponentsofadherencescoresonthefunctioningscales,globalhealthstatusandfatiguebeyondtheeffectsoftheothercomponents,theanalysisofeachcompo-nentwasadjustedfortheothercomponents.
Apvalue65yearsold,hadtwoormorecomorbidities,wereformersmokers,hadameantimesincediagnosisof8.
1years,hadacolontumour,stageII,anddidnotreceivechemotherapyorradiotherapy(Table1).
Whencomparingthenon-respondentsandexcludedrespondentstotheincludedrespondents,non-respondentsandexcludedrespondentsdidnotdifferfromrespondents(datanotshown).
ThemeantotalWCRF/AICRadherencescorewas4.
81±1.
04ofatotalof8points(range1.
33–8.
00).
HigherWCRF/AICRadherencescoresweremorecom-monamongwomencomparedtomen.
ThehighestWCRF/AICRadherencescoreswerefoundamongsurvivorswhoneversmoked,amongolderparticipantsandamongTable1SociodemographicandclinicalcharacteristicsforthethreetertilesofWCRF/AICRadherencescores(N=1096)TotalpopulationTertile1WCRFadherencescore5.
33pointsN(%)N(%)N(%)N(%)N1096(100%)360(33%)365(33%)371(34%)Gender*Male635(58%)227(63%)229(63%)179(48%)Female461(42%)133(37%)136(37%)192(52%)Missing0000Age*Meanage(years+SD)70.
8+9.
269.
7+9.
570.
9+9.
171.
7+8.
965years832(76%)258(72%)276(76%)298(80%)Missing0000Comorbidities0261(24%)76(21%)85(23%)100(27%)1306(28%)96(27%)102(28%)108(29%)>2495(45%)183(51%)163(45%)149(40%)Missing34(3%)5(1%)15(4%)14(4%)Smoking*Current85(8%)33(9%)26(7%)26(7%)Former667(61%)237(66%)224(61%)206(56%)Never322(29%)83(23%)106(29%)133(36%)Missing22(2%)7(2%)9(3%)6(2%)YearssincediagnosisMeantimesincediagnosis(SD)8.
1+2.
88.
1+2.
88.
2+2.
87.
9+2.
85years980(89%)321(89%)333(30%)326(88%)Missing0000TumourlocalizationColon634(58%)204(57%)211(58%)219(59%)Rectum462(42%)156(43%)154(42%)152(41%)Missing0000TumourstageStageI348(32%)111(31%)112(31%)125(34%)StageII372(34%)108(30%)129(35%)135(37%)StageIII318(29%)119(33%)101(28%)98(26%)StageIV26(2%)10(3%)12(3%)4(1%)Missing31(3%)12(3%)11(3%)8(2%)StomaYes168(15%)58(16%)46(13%)64(17%)No928(85%)302(84%)319(87%)307(83%)Missing0000Chemotherapy*Yes329(30%)128(36%)113(31%)88(24%)No767(70%)232(64%)252(69%)283(76%)Missing0000RadiotherapyYes370(34%)125(35%)119(33%)126(34%)No726(66%)235(65%)246(67%)245(66%)Missing0000*p400g/dayanddietaryfibre>17g/day,8%to'meatproducts:peoplewhoeatredmeattoconsumelessthan500g/week,verylittle,ifany,tobeprocessed'withadherence=red/processedmeat5.
25points)hadthehighestmeanphysicalfunc-tioningscores(84.
8+17.
2vs.
78.
3+21.
3)androlefunction-ingscores(86.
5+21.
7vs.
78.
3+27.
7)andthelowestmeanscoresonfatigue(16.
6+19.
7vs.
24.
7+23.
7),comparedtosurvivorswiththelowestWCRF/AICRadherencescores(tertile1;5.
25points)oftheWCRF/AICRadherencescoreweresignificantlyassociatedwithhigherscoresonphysical,roleandsocialfunctioningandalowerleveloffatigue.
Thehighesttertileoftheadher-encescorewassignificantlyassociatedwithhigherscoresonemotionalfunctioning,cognitivefunctioningandglobalhealthstatuscomparedtothelowesttertile.
ForanincreaseinthecontinuousscoreofadherencetotheWCRF/AICRrecommendations,significantassociationswerefoundforbet-terphysicalfunctioning,rolefunctioning,cognitivefunction-ing,socialfunctioningandglobalhealthstatusandlessfatigue.
Multivariablelinearregressionmodelsshowedthatadher-encetothephysicalactivityrecommendationwasassociatedwithbetterphysical,role,emotionalandsocialfunctioning,betterglobalhealthstatusandlessfatigue(Table3).
BeingoverweightwasnotsignificantlyassociatedwithdifferentFig.
2HRQLscoresbyWCRF/AICRadherencescores(N=1096).
Asingleasteriskdenotessmallclinicallyrelevantdifferencebetweentertile1andtertile34570–4574SupportCareCancer(2019)27:4565HRQLandfatiguescorescomparedtoparticipantswithahealthyweight.
However,beingobesewassignificantlyasso-ciatedwithlowerphysicalfunctioningcomparedtohealthyweightrespondents.
Adherencetothedietaryrecommenda-tionswasnotassociatedwiththedifferentfunctioningscales,globalhealthstatusorfatigue.
DiscussionHigheradherencetotheWCRF/AICRrecommendationswasassociatedwithbetterphysicalfunctioning,rolefunctioning,socialfunctioningandglobalhealthstatusandlessfatigueamongCRCsurvivors.
PhysicalactivityseemedtobethemaincomponentoftheWCRF/AICRrecommendationscontributingtotheobservedassociations.
Beingobesewasassociatedwithworsephysicalfunctioning.
Dietwasnotassociatedwiththedifferentfunctioningscales,globalhealthstatusandfatigue.
Previousstudiesshowedanassociationbetweenhigherad-herencetothenon-cancer-specificHealthyEatingIndexortheMediterraneandietandhigherlevelsofHRQLincancersur-vivors,includingCRCsurvivors[5–7].
OurstudydidnotshowanassociationbetweenthespecificdietaryrecommendationsoftheWCRF/AICRandHRQL,howeverwhenlookingatthetotaladherenceWCRF/AICRrecommendationsscore,anas-sociationbetweenlevelofadherenceandHRQLwasfoundinCRCsurvivorssimilartotheassociationwiththeHealthyEatingIndexortheMediterraneandiet[5–7].
Ourstudyonlyfoundaninverseassociationbetweenbeingobeseandphysicalfunctioning.
OurfindingsareinlinewiththeresultsofInoue-ChoiwhoshowedthathigheradherencetotheWCRF/AICRrecommendations,especiallytothephysicalactivityrecom-mendations,wassignificantlyassociatedwithhigherphysicalandmentalcomponentsummaryscores(SF-36)inapopula-tionoffemalecancersurvivorswithdifferentcancertypes[10].
OurresultsarealsoinlinewiththeresultsofBreedveld-Petersetal.
whofoundthathigheradherencetothetotalsetofWCRF/AICRrecommendationswasassociatedwithbetterphysicalfunctioningandlessfatigueinasmallgroup(N=145)ofCRCsurvivorsintheNetherlands[12].
Ofallrecommendations,physicalactivitywasmoststronglyassociatedwithmostfunctioningscales:physical,role,emotion-alandsocialfunctioning;globalhealthstatusandfatigueinourstudy.
Wheninvestigatingthecrudemodel,dietwasassociatedwithphysicalfunctioning.
However,whenweadjustedforphysicalactivity,asdiscussedintheBSubjectsandMethods^section,theassociationwasnolongersignificant.
ThisindicatesthatphysicalactivityindeedwasthemaincomponentoftheWCRF/AICRassociatedwithabetterHRQLandnotdiet.
Forfatigue,thereisampleevidencethatphysicalactivityhasapositiveinfluence[25].
ThisisalsoinlinewiththeUSNationalComprehensiveCancerNetworkguidelinesforman-agingfatigue[26].
TwoobservationalstudiesrecommendedthatCRCsurvivorsshouldmeetthepublichealthexerciseguideline(>150minofmoderatetostrenuousintensityexer-ciseor>60minofstrenuousintensityexerciseperweek),sinceCRCsurvivorswhomeetthesestandardshadahigherqualityoflifethanothersurvivorswhodidnotmeettheseexerciseguidelines[8,14].
However,tobeabletobephysi-callyactive,ahealthydietandbodyweightareimportant.
Thisissupportedbyourfindingthatbeingobesewasnega-tivelyassociatedwithphysicalfunctioning.
Therefore,itre-mainsimportanttofocusonthetriadofphysicalactivity,dietandbodyweightwhentargetingCRCsurvivors,aswasalsosuggestedbyBlanchardetal.
[27].
Thedifferencesfoundinfunctioningscaleswhencompar-ingrespondentswiththehighestWCRF/AICRadherencescores(>5.
25)tothosewiththelowestscores(5.
25pointsContinuousPhysicalfunctioningREF3.
88(4.
42,6.
33)*6.
94(4.
46,9.
42)*2.
71(1.
73,3.
68)*RolefunctioningREF4.
76(1.
40,8.
12)*7.
49(4.
09,10.
89)*2.
87(1.
53,4.
21)*EmotionalfunctioningREF2.
35(0.
06,4.
75)3.
34(0.
90,5.
77)*0.
85(0.
11,1.
81)CognitivefunctioningREF1.
90(0.
77,4.
57)3.
48(0.
78,6.
17)*1.
25(0.
19,2.
32)*SocialfunctioningREF3.
56(0.
67,6.
44)*6.
12(3.
21,9.
04)*2.
01(0.
85,3.
16)*Globalhealthstatus/QLREF1.
68(0.
70,4.
07)4.
33(1.
92,6.
74)*1.
64(0.
69,2.
59)*fatigueREF3.
87(6.
90,0.
84)*7.
65(10.
72,4.
59)*2.
81(4.
02,1.
60)*Resultsareexpressedasβ(95%confidenceinterval(CI)).
Allmodelswereadjustedforage,gender,comorbiditiesandsmoking.
AnincreaseinfunctioningscoresandglobalhealthstatusindicatesanimprovementinHRQL.
Adecreaseinfatiguescoresindicatesanimprovementinfatigue*p40.
09(2.
45;2.
64)0.
38(3.
17;3.
92)0.
39(2.
18;2.
96)1.
71(1.
14;4.
55)0.
70(2.
37;3.
77)0.
26(2.
25;2.
78)3.
12(6.
34;0.
10)BMINormalweightREFREFREFREFREFREFREFOverweight0.
24(2.
46;1.
98)0.
29(2.
80;3.
37)0.
97(1.
27;3.
20)0.
58(3.
06;1.
90)0.
22(2.
45;2.
89)1.
74(0.
45;3.
93)0.
49(3.
23;2.
32)Obese4.
15(7.
16;1.
15)*1.
73(5.
91;2.
46)0.
92(3.
95;2.
11)2.
80(6.
15;0.
55)1.
93(5.
54;1.
69)0.
29(3.
25;2.
67)2.
81(0.
98;6.
60)Resultsareexpressedasβ(95%confidenceinterval(CI)).
Allmodelswereadjustedforage,gender,comorbiditiesandsmoking.
AnincreaseinfunctioningscoresandglobalhealthstatusindicatesanimprovementinHRQL.
Adecreaseinfatiguescoresindicatesanimprovementinfatigue*p<0.
054572–4574SupportCareCancer(2019)27:4565ConclusionHigheradherencetotheWCRF/AICRrecommendationswasassociatedwithbetterphysical,role,cognitiveandsocialfunctioning,betterglobalhealthstatusandlessfatigueamongCRCsurvivors.
Physicalactivityseemedtobethemaincon-tributortohigherscoresonmostfunctioningscalesandglobalhealthstatusandlowerscoresonfatigueinCRCsurvivors.
BecauseCRCsurvivorswiththehighestadherencetotheWCRF/AICRrecommendationsalsoreportthehighestHRQL,werecommendtoinvestigatewhetherincreasingtheadherenceinCRCsurvivorsindeedresultsinbetterHRQL.
However,previousresearchaswellasthepresentstudyhasshownthatitisverydifficulttomotivatecancersurvivorstopositivelychangetheirlifestyle[12,20].
EvenLynchsyndromecarriers,withaveryhighinheritedriskofdevelopingCRC[33],fromwhomwehopedthattheywouldbeextremelymotivatedtochangetheirlifestyle,wereshowntoadheretothoserecom-mendationsonlyinaslightlybettermannerthanCRCsurvi-vorswithoutLynchsyndrome.
AdheringtotheWCRF/AICRrecommendationscanbechallengingforCRCsurvivors.
Thus,trialsaimingtoincreaseadherenceshouldnotonlyfocusontheeffectsbetteradherencehasoncanceroutcomesbutalsoontoolstostimulateandmotivateCRCsurvivorstofollowtherecommendationstothebestoftheirabilities.
AcknowledgementsTheauthorsthanktheregistrationteamsoftheNetherlandsComprehensiveCancerOrganisationforthecollectionofdatafortheNetherlandsCancerRegistryandmembersofthePROFILESregistryfordistributionandhandlingofthequestionnaires.
Weareverygratefulfortheparticipationofallpatientsandtheirdoctorsinthestudy.
SpecialthanksgotoDr.
M.
vanBommel,whowaswillingtofunctionasanindependentadvisorandtoanswerquestionsofpatients.
Wealsowanttothankthefollowinghospitalsfortheircooperation:Amphiahospital,Breda;BernhovenHospital,Uden;Catharinahospital,Eindhoven;Elisabeth-TweeStedenhospital,TilburgandWaalwijk;ElkerliekHospital,Helmond;JeroenBoschhospital,'sHertogenbosch;MaximaMedicalCentre,EindhovenandVeldhoven;SintAnnahospital,Geldrop;VieCuryhospital,VenloandVenray.
FundingThepresentstudywassupportedbyagrantfromtheAlped'HuZesFoundationwithintheresearchprogramme'Levenmetkanker'oftheDutchCancerSociety(grantno.
UM-2012-5653).
Inaddition,thepresentstudywassupportedbyaVENIgrant(#451-10-041)fromtheNetherlandsOrganizationforScientificResearchawardedtoFM.
MVissupportedbyagrantfromAlped'HuZes/DutchCancerSociety,intheproject'Ataskforceonnutritionandcancer'(IKZ2012-5426)andMJBissupportedbyagrantfromKankeronderzoekfondsLimburgaspartofHealthFoundationLimburg(grantno.
00005739).
CompliancewithethicalstandardsConflictofinterestTheauthorsdeclarethattheyhavenoconflictofinterest.
ResearchinvolvinghumanparticipantsEthicalapprovalforthestudywasobtainedfromthelocalcertifiedMedicalEthicsCommitteeoftheMaximaMedicalCentreVeldhoven,theNetherlands(approvalnumber0822).
InformedconsentInformedconsentwasobtainedfromallindividualparticipantsincludedinthestudy.
DataWehavecontroloverallprimarydata,weagreetoallowthejournaltoreviewourdataifrequested.
OpenAccessThisarticleisdistributedunderthetermsoftheCreativeCommonsAttribution4.
0InternationalLicense(http://creativecommons.
org/licenses/by/4.
0/),whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedyougiveappro-priatecredittotheoriginalauthor(s)andthesource,providealinktotheCreativeCommonslicense,andindicateifchangesweremade.
References1.
WorldCancerResearchFundandAmericanInstituteforCancerResearch(2007)Food,nutrition,physicalactivity,andthepreven-tionofcancer:aglobalperspective.
AICR,WashingtonDC2.
MillerKD,SiegelRL,LinCC,MariottoAB,KramerJL,RowlandJH,SteinKD,AlteriR,JemalA(2016)Cancertreatmentandsur-vivorshipstatistics,2016.
CACancerJClin66(4):271–2893.
MarventanoS,ForjazM,GrossoG,MistrettaA,GiorgianniG,PlataniaA,GangiS,BasileF,BiondiA(2013)Healthrelatedqual-ityoflifeincolorectalcancerpatients:stateoftheart.
BMCSurg13(2):S154.
JansenL,KochL,BrennerH,ArndtV(2010)Qualityoflifeamonglong-term(5years)colorectalcancersurvivors–systematicre-view.
EurJCancer46(16):2879–28885.
SchlesingerS,WalterJ,HampeJ,vonSchnfelsW,HinzS,KüchlerT,JacobsG,SchafmayerC,NthlingsU(2014)Lifestylefactorsandhealth-relatedqualityoflifeincolorectalcan-cersurvivors.
CancerCausesControl25(1):99–1106.
SánchezPHetal(2012)AdherencetotheMediterraneandietandqualityoflifeintheSUNProject.
EurJClinNutr66(3):360–3687.
MosherCE,SloaneR,MoreyMC,SnyderDC,CohenHJ,MillerPE,Demark-WahnefriedW(2009)Associationsbetweenlifestylefactorsandqualityoflifeamongolderlong-termbreast,prostate,andcolorectalcancersurvivors.
Cancer115(17):4001–40098.
PeddleCJ,AuH-J,CourneyaKS(2008)Associationsbetweenexercise,qualityoflife,andfatigueincolorectalcancersurvivors.
DisColonRectum51(8):1242–12489.
CourneyaKetal(2003)Arandomizedtrialofexerciseandqualityoflifeincolorectalcancersurvivors.
EurJCancerCare12(4):347–35710.
Inoue-ChoiM,LazovichD,PrizmentAE,RobienK(2013)AdherencetotheWorldCancerResearchFund/AmericanInstituteforCancerResearchrecommendationsforcancerpreven-tionisassociatedwithbetterhealth-relatedqualityoflifeamongelderlyfemalecancersurvivors.
JClinOncol31(14):1758–176611.
LeiY-Y,HoSC,ChengA,KwokC,LeeCKI,CheungKL,LeeR,LoongHHF,HeYQ,YeoW(2018)AdherencetotheWorldCancerResearchFund/AmericanInstituteforCancerResearchGuidelineisassociatedwithbetterhealth-relatedqualityoflifeamongChinesepatientswithbreastcancer.
JNatlComprCancerNetw16(3):275–28512.
Breedveld-Peters,J.
J.
,etal.
,Colorectalcancerssurvivors'adher-encetolifestylerecommendationsandcross-sectionalassociationswithhealth-relatedqualityoflife.
BrJNutr,2018:p.
1–1013.
vandePoll-FranseLVetal(2011)ThePatientReportedOutcomesFollowingInitialtreatmentandLongtermEvaluationofSurvivorshipregistry:scope,rationaleanddesignofanSupportCareCancer(2019)27:4565–45744573infrastructureforthestudyofphysicalandpsychosocialoutcomesincancersurvivorshipcohorts.
EurJCancer47(14):2188–219414.
HussonO,MolsF,EzendamNPM,SchepG,vandePoll-FranseLV(2015)Health-relatedqualityoflifeisassociatedwithphysicalactiv-itylevelsamongcolorectalcancersurvivors:alongitudinal,3-yearstudyofthePROFILESregistry.
JCancerSurviv9(3):472–48015.
AaronsonNK,AhmedzaiS,BergmanB,BullingerM,CullA,DuezNJ,FilibertiA,FlechtnerH,FleishmanSB,HaesJCJM,KaasaS,KleeM,OsobaD,RazaviD,RofePB,SchraubS,SneeuwK,SullivanM,TakedaF(1993)TheEuropeanOrganizationforResearchandTreatmentofCancerQLQ-C30:aquality-of-lifeinstrumentforuseininternationalclinicaltrialsinoncology.
JNatlCancerInst85(5):365–37616.
WhistanceR,ConroyT,ChieW,CostantiniA,SezerO,KollerM,JohnsonCD,PilkingtonSA,ArrarasJ,Ben-JosefE,PullyblankAM,FayersP,BlazebyJM,EuropeanOrganisationfortheResearchandTreatmentofCancerQualityofLifeGroup(2009)ClinicalandpsychometricvalidationoftheEORTCQLQ-CR29questionnairemoduletoassesshealth-relatedqualityoflifeinpa-tientswithcolorectalcancer.
EurJCancer45(17):3017–302617.
VissersPAetal(2016)ProspectivelymeasuredlifestylefactorsandBMIexplaindifferencesinhealth-relatedqualityoflifebetweencolorectalcancerpatientswithandwithoutcomorbiddiabetes.
SupportCareCancer24(6):2591–260118.
Fayers,P.
M.
,etal.
,EORTCQLQ-C30scoringmanual.
200119.
CocksK,KingMT,VelikovaG,MartynSt-JamesM,FayersPM,BrownJM(2011)Evidence-basedguidelinesfordeterminationofsamplesizeandinterpretationoftheEuropeanOrganisationfortheResearchandTreatmentofCancerQualityofLifeQuestionnaireCore30.
JClinOncol29(1):89–9620.
WinkelsRM,vanLeeL,BeijerS,BoursMJ,vanDuijnhovenFJB,GeelenA,HoedjesM,MolsF,deVriesJ,WeijenbergMP,KampmanE(2016)AdherencetotheWorldCancerResearchFund/AmericanInstituteforCancerResearchlifestylerecommen-dationsincolorectalcancersurvivors:resultsofthePROFILESregistry.
CancerMed5(9):2587–259521.
RomagueraD,VergnaudAC,PeetersPH,vanGilsCH,ChanDSM,FerrariP,RomieuI,JenabM,SlimaniN,Clavel-ChapelonF,FagherazziG,PerquierF,KaaksR,TeucherB,BoeingH,vonRüstenA,TjnnelandA,OlsenA,DahmCC,OvervadK,QuirósJR,GonzalezCA,SánchezMJ,NavarroC,BarricarteA,DorronsoroM,KhawKT,WarehamNJ,CroweFL,KeyTJ,TrichopoulouA,LagiouP,BamiaC,MasalaG,VineisP,TuminoR,SieriS,PanicoS,MayAM,Bueno-de-MesquitaHB,BüchnerFL,WirfltE,ManjerJ,JohanssonI,HallmansG,SkeieG,BenjaminsenBorchK,ParrCL,RiboliE,NoratT(2012)IsconcordancewithWorldCancerResearchFund/AmericanInstituteforCancerResearchguidelinesforcancerpreventionrelatedtosubsequentriskofcancerResultsfromtheEPICstudy.
AmJClinNutr96(1):150–16322.
vanLeeLetal(2012)TheDutchHealthyDietindex(DHD-index):aninstrumenttomeasureadherencetotheDutchGuidelinesforaHealthyDiet.
NutrJ11(1):4923.
Wendel-VosGWetal(2003)Reproducibilityandrelativevalidityoftheshortquestionnairetoassesshealth-enhancingphysicalac-tivity.
JClinEpidemiol56(12):1163–116924.
SullivanLM(2011)Essentialsofbiostatisticsinpublichealth.
Jones&BartlettPublishers,Burlington,p21225.
CormieP,ZopfEM,ZhangX,SchmitzKH(2017)Theimpactofexerciseoncancermortality,recurrence,andtreatment-relatedad-verseeffects.
EpidemiolRev39(1):71–9226.
BergerAM,MooneyK,Alvarez-PerezA,BreitbartWS,CarpenterKM,CellaD,CleelandC,DotanE,EisenbergerMA,EscalanteCP,JacobsenPB,JankowskiC,LeBlancT,LigibelJA,LoggersET,MandrellB,MurphyBA,PaleshO,PirlWF,PlaxeSC,RibaMB,RugoHS,SalvadorC,WagnerLI,Wagner-JohnstonND,ZachariahFJ,BergmanMA,SmithC,Nationalcomprehensivecancernet-work(2015)Cancer-relatedfatigue,version2.
2015.
JNatlComprCancerNetw13(8):1012–103927.
BlanchardCM,SteinKD,BakerF,DentMF,DennistonMM,CourneyaKS,NehlE(2004)Associationbetweencurrentlifestylebehaviorsandhealth-relatedqualityoflifeinbreast,colorectal,andprostatecancersurvivors.
PsycholHealth19(1):1–1328.
Krebs-SmithSM,HeimendingerJ,SubarAF,PattersonBH,PivonkaE(1995)Usingfoodfrequencyquestionnairestoestimatefruitandvegetableintake:associationbetweenthenumberofques-tionsandtotalintakes.
JNutrEduc27(2):80–8529.
FeskanichD,ZieglerRG,MichaudDS,GiovannucciEL,SpeizerFE,WillettWC,ColditzGA(2000)Prospectivestudyoffruitandvegetableconsumptionandriskoflungcanceramongmenandwomen.
JNatlCancerInst92(22):1812–182330.
SkenderS,OseJ,Chang-ClaudeJ,PaskowM,BrühmannB,SiegelEM,SteindorfK,UlrichCM(2016)Accelerometryandphysicalactivityquestionnaires-asystematicreview.
BMCPublicHealth16(1):51531.
PusatciogluC,BraunschweigC(2011)Movingbeyonddietandcolorectalcancer.
JAmDietAssoc111(10):1476–147832.
DijkstraW,SmitJH,ComijsHC(2001)Usingsocialdesirabilityscalesinresearchamongtheelderly.
QualQuant35(1):107–11533.
HowladerNetal(2011.
AlsoavailableonlineLastac,2011)SEERCancerStatisticsReview,1975–2008.
NationalCancerInstitute,Bethesda,pp140–143Publisher'snoteSpringerNatureremainsneutralwithregardtojurisdic-tionalclaimsinpublishedmapsandinstitutionalaffiliations.
4574–4574SupportCareCancer(2019)27:4565

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