Association Between Coffee Intake After Diagnosis of Colorectal Cancer and Reduced Mortality

Abstract

Background & aims: Few studies have examined the association between coffee intake and survival after diagnosis of colorectal cancer (CRC). We performed a prospective study to investigate the association between coffee intake after a diagnosis of CRC and mortality.

Methods: We collected data from the Nurses' Health Study (1984-2012) and Health Professionals Follow-up Study (1986-2012), following 1599 patients diagnosed with stage 1, 2, or 3 CRC. CRC was reported on questionnaires and ascertained by review of medical records and pathology reports; intake of food and beverages was determined from responses to semi-quantitative food frequency questionnaires. Participants were asked how often during the previous year that they consumed coffee, with 1 cup as the standard portion size. The first questionnaire response collected at least 6 months but not more than 4 years after diagnosis was used for assessment of post-diagnostic intake (median time from diagnosis to the dietary assessment, 2.2 years). The last semi-quantitative food frequency questionnaire prior to diagnosis was used to assess pre-diagnostic dietary intake.

Results: During a median of 7.8 years of follow-up, we documented 803 deaths, of which 188 were because of CRC. In the multivariable adjusted models, compared with nondrinkers, patients who consumed at least 4 cups of coffee per day had a 52% lower risk of CRC-specific death (hazard ratio [HR] 0.48; 95% CI, 0.28-0.83; P for trend=.003) and 30% reduced risk of all-cause death (HR, 0.70; 95% CI, 0.54-0.91; P for trend <.001). High intake of caffeinated and decaffeinated coffee (2 or more cups/day) was associated with lower risk of CRC-specific mortality and all-cause mortality. When coffee intake before vs after CRC diagnosis were examined, compared with patients consistently consuming low amounts (less than 2 cups/day), those who maintained a high intake (2 or more cups/day) had a significantly lower risk of CRC-specific death (multivariable HR, 0.63; 95% CI, 0.44-0.89) and death from any cause (multivariable HR, 0.71; 95% CI, 0.60-0.85).

Conclusions: In an analysis data from the Nurses' Health Study and Health Professionals Follow-up Study, we associated intake of caffeinated and decaffeinated coffee after diagnosis of CRC with lower risk of CRC-specific death and overall death. Studies are needed to determine the mechanisms by which coffee might reduce CRC progression.

Keywords: Colon Cancer; Diet; Post-diagnostic Coffee Intake; Rectal Cancer.

Figure 1

Joint Association of Total Coffee Intake Before and After Diagnosis and Mortality Adjusting for age at diagnosis (continuous), cancer stage (I, II, III, and unspecified), grade of differentiation (1–3, and unspecified), subsite (proximal colon, distal colon, rectum, and unspecified), post-diagnostic pack-years of smoking (0, 1–15, 16–25, 26–45, >45), alcohol consumption (<0.15, 0.15–1.9, 2.0–7.4, ≥7.5 g/d), BMI (<23, 23–24.9, 25–27.4, 27.5–29.9, ≥30 kg/m²), physical activity (women: <5, 5–11.4, 11.5–21.9, ≥22 MET-hours/week; men: <7, 7–14.9, 15–24.9, ≥25 MET-hours/week), regular use of aspirin and NSAIDs (yes or no) and postmenopausal hormone use (women only: never, current, past users), folate (quartiles), total fat (quartiles), calcium (quartiles), vitamin D (quartiles) and sugar-sweetened beverages (<1 serving/mo, 1–4 servings/mo, 2–6 servings/wk, ≥ 1 serving/d) X-axis is in logarithm scale

Figure 2

Subgroup Analyses of Association Between Post-diagnosis Total Coffee Intake Colorectal Cancer Survival Panel A: colorectal cancer-specific mortality Panel B: all-cause mortality Adjusting for the same covariates as in Table 2 and 3 except for the stratification variables. P values for interactions were evaluated using likelihood ratio test. X-axis is in logarithm scale

Figure 2

Subgroup Analyses of Association Between Post-diagnosis Total Coffee Intake Colorectal Cancer Survival Panel A: colorectal cancer-specific mortality Panel B: all-cause mortality Adjusting for the same covariates as in Table 2 and 3 except for the stratification variables. P values for interactions were evaluated using likelihood ratio test. X-axis is in logarithm scale