Abstract
Background
Colon cancer patients have inferior overall survival than a matched general population (MGP). It is unknown if physical activity is associated with a reduction in this survival disparity.
Methods
Data were analyzed from two National Cancer Institute–sponsored postoperative treatment trials in stage III colon cancer, Cancer and Leukemia Group B (CALGB) 89803 and 80702, with 2876 patients who self-reported physical activity. Physical activity was converted to metabolic equivalents (MET-hours/week). The MGP was derived from the National Center for Health Statistics and matched on age, sex, and year.
Results
In CALGB 89803, among patients who were alive at 3 years, those with <3.0 and ≥18.0 MET-hours/week had subsequent 3-year overall survival rates that were −17.1% (95% confidence interval , −22.4 to −11.8) and −3.5% (95% CI, −7.7 to 0.3) lower than MGP, respectively. In CALGB 80702, among patients who were alive at 3 years, those with <3.0 and ≥18.0 MET-hours/week had subsequent 3-year overall survival rates that were −10.8% (95% CI, −15.4 to −6.9) and −4.4% (95% CI, −7.6 to −1.6) lower than MGP, respectively. In pooled analyses, among patients who were alive and did not have tumor recurrence by year 3 (n = 1908), those with <3.0 and ≥18.0 MET-hours/week had subsequent 3-year overall survival rates that were −3.1% (95% CI, −6.2 to −0.3) lower and 2.9% (95% CI, 1.5–4.2) higher than MGP, respectively.
Conclusions
Physical activity is associated with an attenuation of the survival disparity between patients with stage III colon cancer participating in clinical trials and MGP. Colon cancer survivors who are physically active may achieve survival that approximates the MGP.
AUTHOR CONTRIBUTIONS
Justin C. Brown: Conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, resources, supervision, validation, writing–original draft, and writing–review and editing. Chao Ma: Conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, validation, visualization, and writing–review and editing. Qian Shi: Data curation, formal analysis, investigation, methodology, project administration, resources, supervision, validation, visualization, and writing–review and editing. Leonard B. Saltz: Data curation, investigation, methodology, project administration, resources, and writing–review and editing. Anthony F. Shields: Data curation, investigation, methodology, project administration, resources, and writing–review and editing. Jeffrey A. Meyerhardt: Conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, supervision, validation, and writing–original draft, writing–review and editing. All authors had full access to all the data in the study and had final responsibility for the decision to submit for publication.
ACKNOWLEDGMENTS
Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award numbers U10CA180821 and U10CA180882 (to the Alliance for Clinical Trials in Oncology) (https://acknowledgments.alliancefound.org). Justin C. Brown is supported by R00CA218603, R01CA270274, U01CA271279, and OT2CA278684. Jeffrey A. Meyerhardt is supported by the Douglas Gray Woodruff Chair fund, the Guo Shu Shi Fund, the Project P fund, Anonymous Family Fund for Innovations in Colorectal Cancer, and the George Stone Family Foundation. The National Cancer Institute Cancer Treatment Evaluation Program and each participating site’s institutional review board approved the study protocol. All patients provided signed informed consent.
CONFLICT OF INTEREST STATEMENT
Justin C. Brown reports grants from the National Institutes of Health, the American Institute for Cancer Research, and Cancer Research UK paid to his institution. Qian Shi reports institutional grant support from Celgene–Bristol-Myers Squibb and Roche/Genentech; consulting fees from Yiviva Inc and Boehringer Ingelheim Pharmaceuticals; and stock ownership in Johnson & Johnson, Merck, and Amgen. Anthony F. Shields reports grants from the National Cancer Institute. Jeffrey A. Meyerhardt reports personal fees for serving on the advisory boards of Merck Pharmaceutical. The other authors declare no conflicts of interest. The National Cancer Institute was involved in the study's design and reviewing and approving the manuscript. However, it was not involved in the conduct of the study, collection, management, analysis, interpretation of the data, or decision to submit the manuscript for publication. The content is solely the authors' responsibility and does not necessarily represent the official views of the National Institutes of Health.
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