Change Toward Healthier Lifestyles Is Associated With Better Health-Related Quality of Life in Long-Term Colorectal Cancer Survivors

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  • 1 Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany;
  • | 2 Stuttgart Cancer Center—Tumorzentrum Eva Mayr-Stihl, Klinikum Stuttgart, Stuttgart, Germany;
  • | 3 Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany;
  • | 4 Division of Chronic Disease and Aging, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia;
  • | 5 Unit of Genetic Epidemiology, Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany;
  • | 6 Cancer Epidemiology Group, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;
  • | 7 Division of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany; and
  • | 8 German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany.

Background: Little is known about how changes in a constellation of lifestyle factors affect health-related quality of life (HRQoL) in colorectal cancer (CRC) survivors. Our study aimed to investigate the association between changes in healthy lifestyle and HRQoL over time in survivors of stage I–IV CRC. Methods: We included 2,283 long-term (≥5 years postdiagnosis) survivors. A healthy lifestyle score (HLS) comprising smoking, alcohol consumption, diet, physical activity, and body fatness was derived at diagnosis and 5-year follow-up (5YFU) and categorized as low, moderate, or high. We assessed HRQoL with the EORTC Quality of Life Questionnaire-Core 30 at 5YFU and 10-year follow-up. We used multivariable linear regression and linear mixed models to explore associations between changes in HLS and HRQoL over follow-up. Results: A low baseline HLS was associated with poorer functioning and global health/QoL and a higher symptom burden at 5YFU compared with a high baseline HLS. An improved HLS from baseline to 5YFU was associated with better functioning, higher global health/QoL, and fewer symptoms at 5YFU than a maintained-high HLS. In longitudinal analyses, improved HLS was associated with better functioning at follow-up. Survivors with a maintained-high or an improved HLS reported generally less fatigue, pain, and dyspnea at follow-ups compared with survivors with a maintained-low or decreased HLS. Conclusions: Change toward a healthier lifestyle since diagnosis was associated with better HRQoL in long-term CRC survivors. Our results support the importance of maintaining and/or promoting a healthier lifestyle among CRC survivors postdiagnosis.

Submitted January 25, 2022; final revision received June 26, 2022; accepted for publication June 28, 2022.

Author contributions: Conceptualization: Eyl-Armbruster, Thong, Carr, Arndt. Conceptualization of DACHS and IMPACT studies: Chang-Claude, Hoffmeister, Brenner. Formal analysis: Eyl-Armbruster, Thong. Data curation: Jansen. Funding acquisition: Chang-Claude, Hoffmeister, Brenner, Arndt. Writing—Original draft: Eyl-Armbruster, Thong. Writing—review and editing: All authors.

Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: This study was funded by the German Research Council (BR 1704/6-1, BR 1704/6-3, BR 1704/6-4, CH 117/1-1) and the German Federal Ministry of Education and Research (01KH0404, 01ER0814, 01ER0815, 01ER1505A, 01ER1505B).

Disclaimer: The funding source was neither involved in the collection, interpretation, and analysis of the data nor involved in the decision for the writing and submission of this report for publication.

Correspondence: Melissa S.Y. Thong, PhD, Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany. Email: m.thong@dkfz-heidelberg.de

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