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The Role of Lifestyle-Related Factors in Cancer Survivorship

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Survivorship and Quality of Life".

Deadline for manuscript submissions: closed (31 October 2022) | Viewed by 30572

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Special Issue Editors

Dr. Alina Vrieling

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Guest Editor

Radboud University Nijmegen Medical Centre, Radboud Institute for Health Sciences, 6525 GA Nijmegen, The Netherlands
Interests: dietary; lifestyle factors; cancer risk; cancer recurrence; cancer survival

Dr. Renate Maria Winkels

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Guest Editor

Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
Interests: nutrition; physical activity; disease outcomes

Special Issue Information

Dear Colleagues,

Lifestyle-related factors, including following a healthy diet, avoiding excess weight, and being physically active, can decrease the risk of several types of cancer. Based on this evidence, the World Cancer Research Fund/American Institute for Cancer Research has issued 10 cancer prevention recommendations. Whether better adherence to those guidelines also results in lower risk of recurrence, lower mortality and/or better quality of life among cancer survivors is largely unknown. Yet, the lifestyles of the majority of cancer survivors are suboptimal and not in concordance with the cancer prevention recommendations.

In this Special Issue, researchers are invited to contribute their most recent results on lifestyle in relation to cancer outcomes, and on changes in lifestyle and cancer outcomes. Contributions may range from observational studies to intervention studies to systematic reviews. Examples are papers describing changes in adherence to the cancer prevention recommendations after diagnosis for a specific group of cancer survivors; papers reporting on the association of lifestyle-related factors with quality of life, survival or other clinical outcomes in cancer survivors; papers on the effect of lifestyle interventions on quality of life, clinical or other health-related outcomes in cancer survivors.

Dr. Alina Vrieling
Dr. Renate Maria Winkels
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

lifestyle
diet
physical activity
body composition
cancer survivor
observational studies
intervention studies

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Published Papers (9 papers)

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11 pages, 415 KiB

Open AccessArticle

Pre-Diagnosis Diet and Physical Activity and Risk of Cardiovascular Disease Mortality among Female Cancer Survivors

by Daphne Weikart, Dan Lin, Radha Dhingra, Laila Al-Shaar and Kathleen Sturgeon

Cancers 2022, 14(13), 3096; https://doi.org/10.3390/cancers14133096 - 23 Jun 2022

Cited by 4 | Viewed by 1826

Abstract

Sub-optimal diet and physical activity (PA) levels have been associated with increased risk of cardiovascular disease (CVD) mortality. The relationship between pre-cancer diagnosis diet quality and PA level on CVD mortality risk in cancer survivors is unclear. We examined the association between pre-cancer diagnosis diet quality and leisure-time PA and their interaction on CVD mortality in cancer survivors. Diet quality was characterized by the Alternative Mediterranean Diet Index (aMED). Leisure-time PA was converted to a metabolic equivalent of task hours per week (MET-h/wk). During a median of 6.3 years of follow-up of 18,533 female cancer survivors, we identified 915 CVD deaths. aMED score was not associated with CVD mortality. PA level was inversely associated with CVD mortality (HR_Q1-Q4 = 0.74; 95% CI: 0.61–0.88; P_trend = 0.0014). Compared to cancer survivors with the lowest pre-diagnosis aMED score and PA level, cancer survivors with higher aMED scores and higher MET-hrs/wk were at a 33% lower risk of CVD mortality (HR = 0.67; 95% CI: 0.52–0.87). Overall, this study shows PA to be a strong predictor of CVD mortality in female cancer survivors. Our observations support the importance of PA throughout the lifecycle in lowering CVD mortality risk. Full article

(This article belongs to the Special Issue The Role of Lifestyle-Related Factors in Cancer Survivorship)

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10 pages, 420 KiB

Open AccessArticle

Delay Discounting as a Potential Therapeutic Target for Weight Loss in Breast Cancer Survivors

by Jasmine S. Sukumar, Jennifer E. Vaughn, Allison Tegge, Sagar Sardesai, Maryam Lustberg and Jeffrey Stein

Cancers 2022, 14(5), 1134; https://doi.org/10.3390/cancers14051134 - 23 Feb 2022

Cited by 3 | Viewed by 2150

Abstract

Obesity in breast cancer (BC) survivors is associated with increased mortality. Delay discounting (DD) is a behavioral economic measure of how individuals value future outcomes. Higher DD correlates with obesity in the general population. Valuation of the future may be associated with obesity differently in cancer survivors. This study evaluated the relationship between DD and obesity in BC survivors. We report an exploratory analysis assessing cross-sectional associations between DD, BMI, and lifestyle behaviors (vegetable and fruit consumption, exercise) related to obesity in 89 women with hormone receptor positive non-metastatic BC. Multivariate linear regression analysis examined demographic and lifestyle behavior variables associated with both BMI and DD. Greater willingness to wait for larger, delayed rewards (lower DD) was significantly associated with lower BMI (standardized beta = −0.32; p < 0.01), independent of age, race, income, time since diagnosis, and menopausal status. There was no significant association between DD and fruit consumption or exercise frequency. Vegetable consumption was significantly associated with lower DD (standardized beta = 0.24; p < 0.05). Higher DD is associated with obesity and decreased frequency of vegetable consumption in BC survivors. Future studies should investigate DD as a therapeutic target for behavioral interventions to facilitate weight loss and promote longevity in this population. Full article

(This article belongs to the Special Issue The Role of Lifestyle-Related Factors in Cancer Survivorship)

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15 pages, 865 KiB

Open AccessArticle

Test/Retest Reliability and Validity of Remote vs. In-Person Anthropometric and Physical Performance Assessments in Cancer Survivors and Supportive Partners

by Teri W. Hoenemeyer, William W. Cole, Robert A. Oster, Dorothy W. Pekmezi, Andrea Pye and Wendy Demark-Wahnefried

Cancers 2022, 14(4), 1075; https://doi.org/10.3390/cancers14041075 - 21 Feb 2022

Cited by 22 | Viewed by 3479

Abstract

(1) Background: Anthropometric and physical performance testing is commonly done in lifestyle research and is traditionally performed in-person. To expand the scalability of lifestyle interventions among cancer survivors, in-person assessments were adapted to remote means and evaluated for feasibility, safety, validity, and reliability. (2) Methods: Cancer survivors and supportive partners were approached to participate in three anthropometric and physical performance testing sessions (two remote/one in-person). Correlations, concordance, and differences between testing modes were evaluated. (3) Results: 110-of-112 individuals approached for testing participated (98% uptake); the sample was 78% female, 64% non-Hispanic White, of mean age 58 years and body mass index = 32.4 kg/m². ICCs for remote assessments ranged from moderate (8’ walk = 0.47), to strong (8’ get-up-and-go = 0.74), to very strong (30 s chair stand = 0.80; sit-and-reach = 0.86; 2 min step test = 0.87; back scratch = 0.90; weight = 0.93; waist circumference = 0.98) (p-values < 0.001). Perfect concordance (100%) was found for side-by-side and semi-tandem balance, and 87.5–90.3% for tandem balance. No significant differences between remote and in-person assessments were found for weight, 8’ walk, and 8’ get-up-and-go. No adverse events occurred and 75% indicated no preference or preferred virtual testing to in-person. (4) Conclusions: Remote anthropometric and physical performance assessments are reliable, valid, acceptable, and safe among cancer survivors and supportive partners. Full article

(This article belongs to the Special Issue The Role of Lifestyle-Related Factors in Cancer Survivorship)

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14 pages, 758 KiB

Open AccessArticle

Physical Activity Is Associated with Improved Overall Survival among Patients with Metastatic Colorectal Cancer

by Karel C. Smit, Jeroen W. G. Derksen, Geerard L. O. Beets, Eric J. Th. Belt, Maaike Berbée, Peter Paul L. O. Coene, Hester van Cruijsen, Marjan A. Davidis, Jan Willem T. Dekker, Joyce M. van Dodewaard-de Jong, Annebeth W. Haringhuizen, Helgi H. Helgason, Mathijs P. Hendriks, Ronald Hoekstra, Ignace H. J. T. de Hingh, Jan N. M. IJzermans, Johan J. B. Janssen, Joop L. M. Konsten, Maartje Los, Leonie J. M. Mekenkamp, Peter Nieboer, Koen C. M. J. Peeters, Natascha A. J. B. Peters, Hans J. F. M. Pruijt, Patricia Quarles van Ufford-Mannesse, Ron C. Rietbroek, Anandi H. W. Schiphorst, Arjan Schouten van der Velden, Ruud W. M. Schrauwen, Mark P. S. Sie, Dirkje W. Sommeijer, Dirk J. A. Sonneveld, Hein B. A. C. Stockmann, Marleen Tent, Frederiek Terheggen, Manuel L. R. Tjin-A-Ton, Liselot Valkenburg-van Iersel, Ankie M. T. van der Velden, Wouter J. Vles, Theo van Voorthuizen, Johannes A. Wegdam, Johannes H. W. de Wilt, Miriam Koopman, Anne M. May and on behalf of the PLCRC Study Group Show full author list Hide full author list

Cancers 2022, 14(4), 1001; https://doi.org/10.3390/cancers14041001 - 16 Feb 2022

Cited by 6 | Viewed by 4757

Abstract

Regular physical activity (PA) is associated with improved overall survival (OS) in stage I–III colorectal cancer (CRC) patients. This association is less defined in patients with metastatic CRC (mCRC). We therefore conducted a study in mCRC patients participating in the Prospective Dutch Colorectal Cancer cohort. PA was assessed with the validated SQUASH questionnaire, filled-in within a maximum of 60 days after diagnosis of mCRC. PA was quantified by calculating Metabolic Equivalent Task (MET) hours per week. American College of Sports and Medicine (ACSM) PA guideline adherence, tertiles of moderate to vigorous PA (MVPA), and sport and leisure time MVPA (MVPA-SL) were assessed as well. Vital status was obtained from the municipal population registry. Cox proportional-hazards models were used to study the association between PA determinants and all-cause mortality adjusted for prognostic patient and treatment-related factors. In total, 293 mCRC patients (mean age 62.9 ± 10.6 years, 67% male) were included in the analysis. Compared to low levels, moderate and high levels of MET-hours were significantly associated with longer OS (fully adjusted hazard ratios: 0.491, (95% CI 0.299–0.807, p value = 0.005) and 0.485 (95% CI 0.303–0.778, p value = 0.003), respectively), as were high levels of MVPA (0.476 (95% CI 0.278–0.816, p value = 0.007)) and MVPA-SL (0.389 (95% CI 0.224–0.677, p value < 0.001)), and adherence to ACSM PA guidelines compared to non-adherence (0.629 (95% CI 0.412–0.961, p value = 0.032)). The present study provides evidence that higher PA levels at diagnosis of mCRC are associated with longer OS. Full article

(This article belongs to the Special Issue The Role of Lifestyle-Related Factors in Cancer Survivorship)

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15 pages, 1386 KiB

Open AccessArticle

Limited Changes in Lifestyle Behaviours after Non-Muscle Invasive Bladder Cancer Diagnosis

by Ivy Beeren, Liesbeth de Goeij, Rana Dandis, Nikoletta Vidra, Moniek van Zutphen, J. Alfred Witjes, Ellen Kampman, Lambertus A. L. M. Kiemeney and Alina Vrieling

Cancers 2022, 14(4), 960; https://doi.org/10.3390/cancers14040960 - 15 Feb 2022

Cited by 6 | Viewed by 2223

Abstract

The aim of our study was to investigate adherence to lifestyle recommendations and lifestyle changes after diagnosis in patients with non-muscle invasive bladder cancer (NMIBC). Second, we aimed to identify distinct trajectories of lifestyle change and their correlates. We analysed data of 935 patients with NMIBC from a prospective cohort study at six weeks (evaluating pre-diagnostic lifestyle), three months, and fifteen months after diagnosis. An overall lifestyle score (range 0–7) was calculated based on the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations focusing on diet, body mass index, and physical activity. Linear mixed models were used to analyse absolute lifestyle changes over time. Distinct trajectories of change were identified with latent class trajectory models. We found an overall lifestyle score of 3.3 which remained constant over time. The largest lifestyle changes were observed for the consumption of red and processed meat (−96 g/week) and fruit and vegetables (−38 g/day). Two to four trajectory groups were identified for each single lifestyle behaviour. Correlates differed per trajectory group. In conclusion, adherence to the WCRF/AICR recommendations was low. Small to moderate changes in and different trajectories of single lifestyle behaviours were observed. Effective strategies for lifestyle improvement are warranted. Full article

(This article belongs to the Special Issue The Role of Lifestyle-Related Factors in Cancer Survivorship)

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18 pages, 626 KiB

Open AccessArticle

Longitudinal Associations of Adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Lifestyle Recommendations with Quality of Life and Symptoms in Colorectal Cancer Survivors up to 24 Months Post-Treatment

by Marlou-Floor Kenkhuis, Floortje Mols, Eline H. van Roekel, José J. L. Breedveld-Peters, Stéphanie O. Breukink, Maryska L. G. Janssen-Heijnen, Eric T. P. Keulen, Fränzel J. B. van Duijnhoven, Matty P. Weijenberg and Martijn J. L. Bours

Cancers 2022, 14(2), 417; https://doi.org/10.3390/cancers14020417 - 14 Jan 2022

Cited by 16 | Viewed by 3004

Abstract

Post-treatment adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) lifestyle recommendations were associated with health-related quality of life (HRQoL), fatigue, and chemotherapy-induced peripheral neuropathy (CIPN) in colorectal cancer (CRC) survivors. In a prospective cohort among CRC survivors (n = 459), repeated home-visits were performed at 6 weeks, 6, 12, and 24 months post-treatment. Dietary intake, body composition, sedentary behaviour, and physical activity were assessed to construct a lifestyle score based on adherence to seven 2018 WCRF/AICR recommendations. Longitudinal associations of the lifestyle score with HRQoL, fatigue, and CIPN were analysed by confounder-adjusted linear mixed models. A higher lifestyle score was associated with better physical functioning and less activity-related fatigue, but not with CIPN. Adjustment for physical activity substantially attenuated observed associations, indicating its importance in the lifestyle score with regards to HRQoL. In contrast, adjustment for body composition and alcohol inflated observed associations, indicating that both recommendations had a counteractive influence within the lifestyle score. Our findings suggest that CRC survivors benefit from an overall adherence to the WCRF/AICR lifestyle recommendations in terms of HRQoL and fatigue, but not CIPN. Specific recommendations have a varying influence on these associations, complicating the interpretation and requiring further study. Full article

(This article belongs to the Special Issue The Role of Lifestyle-Related Factors in Cancer Survivorship)

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17 pages, 4400 KiB

Open AccessArticle

Identification of Lifestyle Behaviors Associated with Recurrence and Survival in Colorectal Cancer Patients Using Random Survival Forests

by Moniek van Zutphen, Fränzel J. B. van Duijnhoven, Evertine Wesselink, Ruud W. M. Schrauwen, Ewout A. Kouwenhoven, Henk K. van Halteren, Johannes H. W. de Wilt, Renate M. Winkels, Dieuwertje E. Kok and Hendriek C. Boshuizen

Cancers 2021, 13(10), 2442; https://doi.org/10.3390/cancers13102442 - 18 May 2021

Cited by 8 | Viewed by 3011

Abstract

Current lifestyle recommendations for cancer survivors are the same as those for the general public to decrease their risk of cancer. However, it is unclear which lifestyle behaviors are most important for prognosis. We aimed to identify which lifestyle behaviors were most important regarding colorectal cancer (CRC) recurrence and all-cause mortality with a data-driven method. The study consisted of 1180 newly diagnosed stage I–III CRC patients from a prospective cohort study. Lifestyle behaviors included in the current recommendations, as well as additional lifestyle behaviors related to diet, physical activity, adiposity, alcohol use, and smoking were assessed six months after diagnosis. These behaviors were simultaneously analyzed as potential predictors of recurrence or all-cause mortality with Random Survival Forests (RSFs). We observed 148 recurrences during 2.6-year median follow-up and 152 deaths during 4.8-year median follow-up. Higher intakes of sugary drinks were associated with increased recurrence risk. For all-cause mortality, fruit and vegetable, liquid fat and oil, and animal protein intake were identified as the most important lifestyle behaviors. These behaviors showed non-linear associations with all-cause mortality. Our exploratory RSF findings give new ideas on potential associations between certain lifestyle behaviors and CRC prognosis that still need to be confirmed in other cohorts of CRC survivors. Full article

(This article belongs to the Special Issue The Role of Lifestyle-Related Factors in Cancer Survivorship)

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41 pages, 1696 KiB

Open AccessSystematic Review

Psychosocial Determinants of Lifestyle Change after a Cancer Diagnosis: A Systematic Review of the Literature

by Meeke Hoedjes, Inge Nijman and Chris Hinnen

Cancers 2022, 14(8), 2026; https://doi.org/10.3390/cancers14082026 - 16 Apr 2022

Cited by 20 | Viewed by 4273

Abstract

The aim of this study is to provide a systematic overview of the scientific literature on sociodemographic, psychological and social determinants that may facilitate or hamper lifestyle change after the diagnosis cancer. Four databases (PubMed, PsychINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science) were searched for relevant papers up to October 2021. Of the 9586 references yielded by the literature search, 123 papers were included: 71 quantitative and 52 qualitative papers. Findings showed a large variety of determinants influencing lifestyle change after cancer diagnosis, with differences between lifestyle behaviors (physical activity, diet, smoking, alcohol, sun protection, and multiple lifestyle behaviors) and findings from quantitative vs. qualitative studies. Findings demonstrate the important role of oncology healthcare professionals in promoting healthy lifestyle changes in cancer survivors. In addition, findings inform researchers involved in the development of health promotion programs about the methods and strategies they can use to promote healthy lifestyle changes in cancer survivors. Favorable lifestyle changes are expected to have beneficial effects on cancer risk and overall health in cancer survivors. Full article

(This article belongs to the Special Issue The Role of Lifestyle-Related Factors in Cancer Survivorship)

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16 pages, 1122 KiB

Open AccessSystematic Review

Effect of Exercise on Sarcopenia among Cancer Survivors: A Systematic Review

by Anlan Cao, Leah M. Ferrucci, Bette J. Caan and Melinda L. Irwin

Cancers 2022, 14(3), 786; https://doi.org/10.3390/cancers14030786 - 3 Feb 2022

Cited by 23 | Viewed by 4131

Abstract

Sarcopenia is related to adverse health outcomes in cancer survivors. Previous reviews reported exercise improved muscle mass or function in cancer survivors, but thus far a systematic review examining the effect of exercise on sarcopenia in this population has not been conducted. Therefore, we systematically searched PubMed, CENTRAL (Cochrane Central Register of Controlled Trials) and ClinicalTrials.gov for publications and ongoing trials (through November 2021) that reported exercise interventions and diagnosed sarcopenia among cancer survivors. Seven exercise trials were eligible for this review. Six of seven studies showed exercise increased skeletal muscle post intervention (1.6% to 5.4% increase within intervention groups compared to baseline, p ≤ 0.07; 2.1% to 12.8% greater increase for intervention than control groups, p ≤ 0.02) and in the three studies that reported sarcopenia reversal, an improvement (18.2% to 42.9% decrease in sarcopenia in exercise groups, 5.2% increase to 16.7% decrease in sarcopenia in control groups, p = 0.04) was observed. Existing research indicates the potential for exercise to improve health outcomes for cancer survivors through building muscle and attenuating sarcopenia. More high-quality, long-term, large randomized controlled trials examining effects of different exercise types and doses to improve sarcopenia should be conducted to further explore this important topic. Full article

(This article belongs to the Special Issue The Role of Lifestyle-Related Factors in Cancer Survivorship)

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