Abstract
Background
Plant-based diets have many health benefits, including a lower risk of fatal prostate cancer, and greater environmental sustainability. However, less is known regarding the impact of plant-based diets on quality of life among individuals diagnosed with prostate cancer. The authors' objective was to examine the relationship between plant-based diet indices postdiagnosis with quality of life.
Methods
This prospective cohort study included 3505 participants in the Health Professionals Follow-Up Study (1986–2016) with nonmetastatic prostate cancer. Food-frequency questionnaires were used to calculate overall and healthful plant-based diet indices. Quality-of-life scores were calculated using the Expanded Prostate Cancer Index Composite. Generalized estimating equations were used to examine associations over time between plant-based diet indices and quality-of-life domains (sexual functioning, urinary irritation/obstruction, urinary incontinence, bowel functioning, hormonal/vitality), adjusted for demographics, oncologic history, body mass index, caloric intake, health-related behaviors, and comorbidities.
Results
The median age at prostate cancer diagnosis was 68 years; 48% of patients underwent radical prostatectomy, and 35% received radiation as primary therapy. The median time from diagnosis/treatment to first the quality-of-life questionnaire was 7.0 years. A higher plant-based diet index was associated with better scores for sexual function, urinary irritation/obstruction, urinary incontinence, and hormonal/vitality. Consuming more healthful plant-based foods was also associated with better sexual and bowel function, as well as urinary incontinence and hormonal/vitality scores in the age-adjusted analysis, but not in the multivariable analysis.
Conclusions
This prospective study provides supportive evidence that greater consumption of healthful plant-based foods is associated with modestly higher scores in quality-of-life domains among patients with prostate cancer.
AUTHOR CONTRIBUTIONS
Stacy Loeb: Conceptualization, funding acquisition, methodology, project administration, writing–original draft, and writing–review and editing. Qi Hua: Conceptualization, data curation, formal analysis, methodology, writing–original draft, and writing–review and editing. Scott R. Bauer: Conceptualization, methodology, and writing–review and editing. Stacey A. Kenfield: Conceptualization, methodology, and writing–review and editing. Alicia K. Morgans: Conceptualization, methodology, and writing–review and editing. June M. Chan: Conceptualization, methodology, and writing–review and editing. Erin L. Van Blarigan: Conceptualization, methodology, and writing–review and editing. Alaina H. Shreves: Conceptualization, methodology, and writing–review and editing. Lorelei A. Mucci: Conceptualization, data curation, funding acquisition, methodology, resources, supervision, and writing–review and editing.
ACKNOWLEDGMENTS
We thank the participants of the Health Professionals Follow-Up Study for their long-term valuable contributions as well as the research staff, including Betsy Frost-Hawes, Ruifeng Li, Bailey Vaselkiv, Margaret Bristol, and Ann Fisher. We acknowledge the contribution to this study from central cancer registries supported through the Centers for Disease Control and Prevention's National Program of Cancer Registries and/or the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program. Central registries may also be supported by state agencies, universities, and cancer centers. Participating central cancer registries include the following: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Maine, Maryland, Michigan, Mississippi, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Puerto Rico, Rhode Island, Seattle SEER Registry, South Carolina, Tennessee, Texas, Utah, Virginia, West Virginia, Wyoming. Stacy Loeb is supported by the New York State Department of Health and by Tricia and Michael Berns. Stacy Loeb and Lorelei A. Mucci are supported by the Prostate Cancer Foundation, which did not have any role in the design, implementation, analysis, or interpretation of the data. This work was supported by a grant from the National Institutes of Health (U01 CA167552). Scott R. Bauer is supported by Grant 1K12DK111028 from the National Institute of Diabetes, Digestive, and Kidney Disorders. Stacey A. Kenfield is supported by the Helen Diller Family Chair in Population Science for Urologic Cancer. June M. Chan was supported by the Steven and Christine Burd Safeway Distinguished Professorship. Alaina H. Shreves is supported by the National Institutes of Health’s Intramural Research Program and the National Institutes of Health's Oxford Cambridge Scholars Program.
CONFLICT OF INTEREST STATEMENT
Lorelei A. Mucci reports research support from Astra Zeneca, Veracyte, and Janssen; personal/consulting fees from Bayer; and has equity in Convergent Therapeutics and serves on their Scientific Advisory Board, all outside the submitted work. Scott R. Bauer reports personal/consulting fees from Myovant Sciences, Inc., outside the submitted work. June M. Chan collaborates with Veracyte/GenomeDx on research (receives no direct support) outside the submitted work. Alicia K. Morgans reports consulting fees/honoraria from Astellas, AstraZeneca, Bayer, Exelixis, Janssen, Lantheus, Myriad Genetics, Myovant, Merck, Novartis, Pfizer, Sanofi, and Telix; and research support from Astellas, Bayer, Myovant, Pfizer, and Sanofi outside the submitted work. Stacey A. Kenfield reports consulting fees from Fellow Health, Inc., outside the submitted work. The remaining authors disclosed no conflicts of interest.
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