IARC 60th Anniversary - 19-21 May 2026
Session : 20/05/26 - Posters
Physical activity, adiposity and colorectal cancer survival in the European Prospective Investigation into Cancer and Nutrition (EPIC) study.
CARIOLOU M. 1, ZAMORA-ROS R. 2, CAINI S. 3, FEDRIKO V. 4, VAN GUELPEN B. 5,6, PISCHON T. 7,8,9, JENAB M. 9, FERRARI P. 9, DAHM C. 10, PALA V. 11, CHAN D. 1, MULLER D. 1, CROSS A. 1, TSILIDIS K. 1
1 Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, White City Campus, Wood Lane, London , United Kingdom; 2 Unit of Nutrition and Cancer, Epidemiology Research Program, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; 3 Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy; 4 Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, United States; 5 Department of Radiation Sciences, Oncology Unit, Umeå University, Umea, Sweden; 6 Wallenberg Centre for Molecular Medicine, Umeå University, Umea, Sweden; 7 Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany; 8 Charité - Universitaetsmedizin Berlin, Corporate Member of Freie Universitaet , Berlin, Germany; 9 Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC-WHO), Lyon, France; 10 Department of Public Health, Aarhus University, Bartholins Alle 2, Aarhus, Denmark; 11 Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; 12 Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
Background: Physical inactivity and obesity are well-established modifiable risk factors for colorectal cancer (CRC) development. The influence of adiposity and physical activity on survival outcomes in CRC patients is emerging but inconclusive.
Objectives: This study in EPIC aimed to explore the associations between physical activity and adiposity in relation to mortality in 6351 and 1522 CRC survivors with pre- and post-diagnosis lifestyle data respectively.
Methods: Cox proportional-hazards regression models were used to investigate associations for the Cambridge Physical Activity Index (CPAI) that incorporates both recreational and occupational activity, body mass index (BMI) and waist circumference, assessed at any time pre-diagnosis or up to five years post-diagnosis in relation to all-cause and CRC-specific mortality. Restricted cubic spline models examined potential non-linearity. The associations between pre- to post-diagnosis physical activity change and physical activity across BMI strata were also explored in relation to mortality. Pre-diagnosis models were adjusted for age and year of diagnosis, sex, smoking, alcohol, red meat, fruit and vegetable intake and physical activity (in adiposity models). Post-diagnosis models were additionally adjusted for CRC stage and subsite. Physical activity change models also accounted for the time between the baseline and follow-up questionnaires. All models were stratified by country.
Results: Being physically active post-diagnosis, according to the CPAI, was inversely associated with all-cause mortality (Hazard Ratio [HR]=0.48; 95% confidence interval [CI]:0.27–0.85) as compared to being inactive. There was an indication of an inverse association for CRC-specific mortality, but the 95% CI included the null value (HR=0.56; 95% CI:0.29-1.07). An inverse association was observed for post-diagnosis recreational activity and all-cause mortality (HR per 10 MET-hours/week=0.91; 95% CI:0.85-0.98, deaths=160) but the association for CRC-specific mortality was not statistically significant (HR per 10 MET-hours/week=0.94; 95% CI:0.87-1.03, deaths=111). There were no associations for pre-diagnosis CPAI and recreational activity with both mortality outcomes. Compared to patients who were inactive both before and after diagnosis, those who were inactive before but active after diagnosis had a 58% lower rate of all-cause (HR=0.42; 95% CI: 0.22-0.82) and a 60% lower rate of CRC-specific mortality (HR=0.40; 95% CI:0.17-0.93). The association between post-diagnosis BMI and all-cause mortality (deaths=173) appeared U-shaped, and reverse J-shaped for CRC-specific mortality (deaths=115). For pre-diagnosis BMI and all-cause mortality (deaths=2571) the association appeared J-shaped and U-shaped for CRC-specific mortality (deaths=1820). J-shaped associations were found for pre-diagnosis waist circumference and all-cause (deaths=2275) and CRC-specific mortality (deaths=1605) but for post-diagnosis waist circumference, the associations were unclear. Normal-weight patients who were physically active post-diagnosis had a 53% lower rate of all-cause (HR=0.47, 95%CI:0.26-0.86) and a 52% lower rate of CRC-specific mortality (HR=0.48, 95%CI:0.25-0.92) compared to inactive normal-weight patients. No associations were observed in overweight and obese patients, but the sample size was small.
Conclusions/Implications: Being physically active post-diagnosis could improve survival outcomes in CRC patients. Elevated BMI pre- and post-diagnosis was associated with worse overall survival. Additional evidence on modifiable risk factors and CRC survival from the present and future studies, will strengthen the evidence-base and assist in the development of targeted lifestyle interventions for CRC survivors.