Associations of combined physical activity and body mass index groups with colorectal cancer survival outcomes

Caroline Himbert; Jennifer Ose; Biljana Gigic; Richard Viskochil; Kelly Santuci; Tengda Lin; Anjelica Ashworth; Jessica N Cohan; Courtney L Scaife; Jolanta Jedrzkiewicz; Victoria Damerell; Katelyn M Atkins; Jun Gong; Matthew G Mutch; Corey Bernadt; Seth Felder; Julian Sanchez; Stacey A Cohen; Mukta K Krane; Nathan Hinkle; Elizabeth Wood; Anita R Peoples; Jane C Figueiredo; Adetunji T Toriola; Erin M Siegel; Christopher I Li; David Shibata; Kenneth Boucher; June L Round; Alexis B Ulrich; Martin Schneider; Lyen C Huang; Sheetal Hardikar; Cornelia M Ulrich

doi:10.1186/s12885-023-10695-8

Associations of combined physical activity and body mass index groups with colorectal cancer survival outcomes

BMC Cancer. 2023 Apr 3;23(1):300. doi: 10.1186/s12885-023-10695-8.

Authors

Caroline Himbert^{1

2}, Jennifer Ose^{1

2}, Biljana Gigic³, Richard Viskochil^{1

4}, Kelly Santuci², Tengda Lin^{1

2}, Anjelica Ashworth², Jessica N Cohan^{1

2}, Courtney L Scaife^{1

2}, Jolanta Jedrzkiewicz^{1

2}, Victoria Damerell³, Katelyn M Atkins⁵, Jun Gong⁵, Matthew G Mutch⁶, Corey Bernadt⁶, Seth Felder⁷, Julian Sanchez⁷, Stacey A Cohen⁸, Mukta K Krane⁸, Nathan Hinkle⁹, Elizabeth Wood⁹, Anita R Peoples^{1

2}, Jane C Figueiredo⁵, Adetunji T Toriola⁶, Erin M Siegel⁷, Christopher I Li⁸, David Shibata⁹, Kenneth Boucher^{1

2}, June L Round¹, Alexis B Ulrich¹⁰, Martin Schneider³, Lyen C Huang^{1

2}, Sheetal Hardikar^#^{1

2}, Cornelia M Ulrich^{11

12}

Affiliations

¹ University of Utah, Salt Lake City, UT, USA.
² Huntsman Cancer Institute, Salt Lake City, UT, USA.
³ Heidelberg University Hospital, Heidelberg, Germany.
⁴ University of Massachusetts Boston, Boston, MA, USA.
⁵ Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁶ Washington University School of Medicine, St. Louis, MO, USA.
⁷ H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
⁸ Fred Hutchinson Cancer Center, University of Washington, Seattle, WA, USA.
⁹ University of Tennessee Health Science Center, Memphis, TN, USA.
¹⁰ Rheinland Klinikum Neuss Lukas Krankenhaus, Neuss, Germany.
¹¹ University of Utah, Salt Lake City, UT, USA. neli.ulrich@hci.utah.edu.
¹² Huntsman Cancer Institute, Salt Lake City, UT, USA. neli.ulrich@hci.utah.edu.

^# Contributed equally.

Abstract

Background: Physical activity and BMI have been individually associated with cancer survivorship but have not yet been studied in combinations in colorectal cancer patients. Here, we investigate individual and combined associations of physical activity and BMI groups with colorectal cancer survival outcomes.

Methods: Self-reported physical activity levels (MET hrs/wk) were assessed using an adapted version of the International Physical Activity Questionnaire (IPAQ) at baseline in 931 patients with stage I-III colorectal cancer and classified into 'highly active' and'not-highly active'(≥ / < 18 MET hrs/wk). BMI (kg/m²) was categorized into 'normal weight', 'overweight', and 'obese'. Patients were further classified into combined physical activity and BMI groups. Cox-proportional hazard models with Firth correction were computed to assess associations [hazard ratio (HR), 95% profile HR likelihood confidence interval (95% CI) between individual and combined physical activity and BMI groups with overall and disease-free survival in colorectal cancer patients.

Results: 'Not-highly active' compared to 'highly active' and 'overweight'/ 'obese' compared to 'normal weight' patients had a 40-50% increased risk of death or recurrence (HR: 1.41 (95% CI: 0.99-2.06), p = 0.03; HR: 1.49 (95% CI: 1.02-2.21) and HR: 1.51 (95% CI: 1.02-2.26), p = 0.04, respectively). 'Not-highly active' patients had worse disease-free survival outcomes, regardless of their BMI, compared to 'highly active/normal weight' patients. 'Not-highly active/obese' patients had a 3.66 times increased risk of death or recurrence compared to 'highly active/normal weight' patients (HR: 4.66 (95% CI: 1.75-9.10), p = 0.002). Lower activity thresholds yielded smaller effect sizes.

Conclusion: Physical activity and BMI were individually associated with disease-free survival among colorectal cancer patients. Physical activity seems to improve survival outcomes in patients regardless of their BMI.

Keywords: Colorectal cancer; Energy balance; Obesity; Physical activity; Survivorship.

MeSH terms

Body Mass Index
Colorectal Neoplasms*
Exercise
Humans
Obesity* / complications
Overweight / complications
Overweight / epidemiology
Risk Factors

Abstract

MeSH terms

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