A retrospective cohort study of the influence of lifestyle factors on survival of patients undergoing surgery for colorectal cancer.

Article English OPEN
Alexander, Dayna ; Allardice, Gwen M. ; Moug, Susan J. ; Morrison, David S. (2017)

Aim: \ud \ud Several modifiable and non-modifiable health related behaviours are associated with the incidence of Colorectal Cancer (CRC), but there is little research on their association with survival. The project aimed to investigate possible relationships between modifiable behavioural factors and outcomes on a study cohort of CRC patients undergoing potentially curative surgery.\ud Method: \ud \ud A retrospective cohort study was carried out of patients diagnosed with non-metastatic CRC undergoing elective curative surgery (January 2011 - December 2012), residing in the NHS Greater Glasgow & Clyde (NHSGGC) area, UK. Data were obtained from the Scottish Cancer Registry, National Scottish Death Records. Pre-operative assessment of smoking, alcohol consumption, nurse-measured body mass index (BMI) and exercise levels were recorded and patients were followed until death or censorship. Survival analysis was carried out and proportional hazards assumptions were assessed graphically using plots and were then formally tested using the PHTEST procedure in STATA.\ud Results: \ud \ud Of the initial 527 patients, 181 (34%) satisfied the inclusion criteria. The total duration of follow up was 480 person-years. At the pre-operative assessment, 75% were overweight or obese, 10.6% were current smokers, 13.1% recorded excess alcohol consumption and 8.5% had physical difficulty climbing stairs. Age, BMI, histopathological stage and physical capacity all independently affected survival (P<0.05). Overweight patients (HR 2.81) and those who had difficulty climbing stairs (HR 3.31) had a significantly poorer survival.\ud Conclusion: \ud \ud The study found evidence that pre-operative exercise capacity and BMI are important independent prognostic factors of survival in patients undergoing curative surgery for CRC.
  • References (9)

    Washington DC: AICR, 2007.

    Cancer Research UK; Bowel cancer mortality Statistics Last updated: 22/01/2014.

    Accessed: 25/09/2015.

    Haggar FA, Boushey RP. Colorectal cancer epidemiology: incidence, mortality, survival, and risk factors. Clin Colon Rectal Surg 2009; 22: 191-7.

    NHS National Services Scotland. Information Services Division Scotland; Cancer Statistics: Colorectal Cancer 2010. Accessed on 03/04/2014.

    Van Blarigan EL, Meyerhardt JA. Role of physical activity and diet after colorectal cancer diagnosis. J Clin Oncol 2015; 33: 1825-34.

    Boyle T, Fritschi L, Platell C, Heyworth J. Lifestyle factors associated with survival after colorectal cancer diagnosis. Br J Cancer 2013; 109: 814-22.

    International Statistical Classification of Diseases and Related Health Problems; 10th Revision. World Health Organisation, 2010. Accessed on 25/09/2015.

    0.72 Stage A,B 1 Stage C <0.001 6.32 (2.69 , 14.8) 0.17 BMI normal 1 Overweight/ obese 0.013 2.81 (1.24 , 6.35) 0.19 able to climb stairs Exercise without testing 1 unable to stairs without resting 0.03 3.31 (1.13 , 9.66) 0.44 * p-value of proportional hazards; P(PH) is the P_value associated with the formal test of the proportionality of the hazards.

  • Metrics
    No metrics available
Share - Bookmark