Physical activity and diet impact survival in colon cancer patients

Prof Dr Eric Van Cutsem, digestive oncologist at the University Hospitals, Leuven presented results from two pivotal studies at the recent ASCO annual meeting, both examining the role of lifestyle factors—specifically physical activity and diet—in patients with colon cancer. One of these studies was concurrently published in The New England Journal of Medicine, highlighting the clinical relevance and rigor of its findings.

The first study evaluated the impact of a structured, long-term exercise intervention on DFS and OS in patients with high-risk stage 2 and stage 3 colon cancer following adjuvant chemotherapy. A total of 889 patients were randomised into two groups: one received health education on physical activity and lifestyle, while the other underwent an intensive exercise program in addition to health education. The exercise program comprised 12 mandatory supervised sessions within the first six months, followed by behavioural coaching and continued structured sessions over a three-year period, aiming to increase metabolic equivalent tasks (METs) for each patient. 

The results demonstrated that the exercise intervention significantly improved cardiorespiratory fitness, six-minute walking test performance, and maximal oxygen consumption. Most notably, the study reported a statistically significant improvement in DFS and OS with long-term follow-up. At five years, DFS increased from 74% in the control group to over 80% in the exercise group (HR 0.72), and at eight years, OS improved from 83% to 90% (HR 0.63). These findings are particularly important as they demonstrate that, beyond surgery and adjuvant chemotherapy, intensive, supervised exercise programs can substantially improve oncological outcomes, reducing both cancer recurrence and mortality.

The second study investigated the influence of dietary inflammatory potential on clinical outcomes in patients with stage 3 colon cancer treated with adjuvant chemotherapy. Using data from prior randomised trials examining adjuvant chemotherapy regimens with or without aspirin or celecoxib, researchers assessed dietary habits via validated food-frequency questionnaires completed within six weeks and again 14–16 months post-randomisation. The empirical dietary inflammatory pattern (EDIP) score was employed to quantify the inflammatory potential of each patient’s diet.

Findings indicated that patients adhering to a low-inflammatory diet—characterised by reduced intake of red and processed meats, organ meats, and high-energy beverages, and increased consumption of vegetables and other anti-inflammatory foods—exhibited a clinically meaningful trend toward improved DFS. While not statistically significant for DFS alone, a significant improvement in OS was observed in patients following an anti-inflammatory dietary pattern. Neither aspirin nor celecoxib exerted a modifying effect on these outcomes within this analysis. Importantly, the study also confirmed that higher levels of physical activity, combined with an anti-inflammatory diet, were associated with the most favourable prognoses.

Together, these two studies represent the first large-scale, randomised data establishing the independent and combined influence of physical activity and dietary patterns on survival outcomes in colon cancer patients. They underscore the necessity of integrating structured exercise programs and dietary counselling into the routine post-treatment care of these patients. These findings are anticipated to shape future clinical guidelines and promote the systematic implementation of lifestyle modification strategies in oncology care pathways.