Physical Activity Is Associated with Improved Overall Survival among Patients with Metastatic Colorectal Cancer

Karel C Smit^{1

2}, Jeroen W G Derksen¹, Geerard L O Beets^{3

4}, Eric J Th Belt⁵, Maaike Berbée⁶, Peter Paul L O Coene⁷, Hester van Cruijsen⁸, Marjan A Davidis⁹, Jan Willem T Dekker¹⁰, Joyce M van Dodewaard-de Jong¹¹, Annebeth W Haringhuizen¹², Helgi H Helgason¹³, Mathijs P Hendriks¹⁴, Ronald Hoekstra¹⁵, Ignace H J T de Hingh¹⁶, Jan N M IJzermans¹⁷, Johan J B Janssen¹⁸, Joop L M Konsten¹⁹, Maartje Los²⁰, Leonie J M Mekenkamp²¹, Peter Nieboer²², Koen C M J Peeters²³, Natascha A J B Peters²⁴, Hans J F M Pruijt²⁵, Patricia Quarles van Ufford-Mannesse²⁶, Ron C Rietbroek²⁷, Anandi H W Schiphorst²⁸, Arjan Schouten van der Velden²⁹, Ruud W M Schrauwen³⁰, Mark P S Sie³¹, Dirkje W Sommeijer^{32

33}, Dirk J A Sonneveld³⁴, Hein B A C Stockmann³⁵, Marleen Tent³⁶, Frederiek Terheggen³⁷, Manuel L R Tjin-A-Ton³⁸, Liselot Valkenburg-van Iersel³⁹, Ankie M T van der Velden⁴⁰, Wouter J Vles⁴¹, Theo van Voorthuizen⁴², Johannes A Wegdam⁴³, Johannes H W de Wilt⁴⁴, Miriam Koopman², Anne M May¹, On Behalf Of The Plcrc Study Group

Affiliations

¹ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands.
² Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands.
³ Department of Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
⁴ GROW School for Oncology and Developmental Biology, Maastricht University, 6200 MD Maastricht, The Netherlands.
⁵ Department of Surgery, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands.
⁶ Department of Radiotherapy, Maastro Clinic, 6202 NA Maastricht, The Netherlands.
⁷ Department of Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands.
⁸ Department of Medical Oncology, Antonius Hospital, 8600 BA Sneek, The Netherlands.
⁹ Department of Medical Oncology, Rivas, Banneweg 57, 4204 AA Gorinchem, The Netherlands.
¹⁰ Department of Surgery, Reinier de Graaf Hospital, Reinier de Graafweg 5, 2600 GA Delft, The Netherlands.
¹¹ Department of Medical Oncology, Meander Medical Center, Maatweg 3, 3813 TZ Amersfoort, The Netherlands.
¹² Department of Medical Oncology, Ziekenhuis Gelderse Vallei, 6710 HN Ede, The Netherlands.
¹³ Department of Medical Oncology, Haaglanden Medical Center, 2501 CK Den Haag, The Netherlands.
¹⁴ Department of Medical Oncology, Northwest Clinics, 1800 AM Alkmaar, The Netherlands.
¹⁵ Department of Medical Oncology, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609 PP Hengelo, The Netherlands.
¹⁶ Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands.
¹⁷ Department of Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3000 AD Rotterdam, The Netherlands.
¹⁸ Department of Medical Oncology, Canisius Wilhelmina Hospital, 6500 GS Nijmegen, The Netherlands.
¹⁹ Department of Surgery, Viecuri Hospital, Tegelseweg 210, 5912 BL Venlo, The Netherlands.
²⁰ Department of Medical Oncology, St. Antonius Hospital, 3430 EM Nieuwegein, The Netherlands.
²¹ Department of Medical Oncology, Medisch Spectrum Twente, 7500 KA Enschede, The Netherlands.
²² Department of Medical Oncology, Wilhelmina Hospital, 9400 RA Assen, The Netherlands.
²³ Department of Surgery, Leiden University Medical Center, University of Leiden, Postzone K6-39 Albinusdreef 2, 2300 RC Leiden, The Netherlands.
²⁴ Department of Medical Oncology, Sint Jans Hospital, Vogelsbleek 5, 6001 BE Weert, The Netherlands.
²⁵ Department of Medical Oncology, Jeroen Bosch Hospital, 5200 ME Den Bosch, The Netherlands.
²⁶ Department of Medical Oncology, Haga Hospital, Els Borst-Eilersplein 275, 2545 AA Den Haag, The Netherlands.
²⁷ Department of Medical Oncology, Rode Kruis Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands.
²⁸ Department of Surgery, Diakonessenhuis Hospital, Bosboomstraat 1, 3582 KE Utrecht, The Netherlands.
²⁹ Department of Surgery, St. Jansdal Hospital, Wethouder Jansenlaan 90, 3844 DG Harderwijk, The Netherlands.
³⁰ Department of Gastroenterology and Hepatology, Bernhoven Hospital, Nistelrodeseweg 10, 5406 PT Uden, The Netherlands.
³¹ Department of Medical Oncology, ZorgSaam Hospital, Wielingenlaan 2, 4535 PA Terneuzen, The Netherlands.
³² Department of Medical Oncology, Academisch Medisch Centrum, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
³³ Department of Medical Oncology, Flevo Hospital, Hospitaalweg 1, 1315 RA Almere, The Netherlands.
³⁴ Department of Surgery, Dijklander Hospital, Waterlandlaan 250, 1441 RN Purmerend, The Netherlands.
³⁵ Department of Surgery, Spaarne Hospital, 2000 AK Haarlem, The Netherlands.
³⁶ Department of Medical Oncology, Treant Hospital, 7800 RA Emmen, The Netherlands.
³⁷ Department of Medical Oncology, Bravis Hospital, Boerhaavelaan 25, 4708 AE Roosendaal, The Netherlands.
³⁸ Department of Medical Oncology, Rivierenland Hospital, 4000 HA Tiel, The Netherlands.
³⁹ Department of Medical Oncology, Maastricht University Medical Center, 6202 NA Maastricht, The Netherlands.
⁴⁰ Department of Medical Oncology, Tergooi Hospital, Van Riebeeckweg 212, 1213 XZ Hilversum, The Netherlands.
⁴¹ Department of Surgery, Ikazia Hospital, Montessoriweg 1, 3083 AN Rotterdam, The Netherlands.
⁴² Department of Medical Oncology, Rijnstate Hospital, Postus 9555, 6800 TA Arnhem, The Netherlands.
⁴³ Department of Surgery, Elkerliek Hospital, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands.
⁴⁴ Department of Surgery, Radboud University Medical Center, University of Nijmegen, 6500 HB Nijmegen, The Netherlands.

PMID: 35205748
PMCID: PMC8870120
DOI: 10.3390/cancers14041001

Physical Activity Is Associated with Improved Overall Survival among Patients with Metastatic Colorectal Cancer

Karel C Smit et al. Cancers (Basel). 2022.

. 2022 Feb 16;14(4):1001.

doi: 10.3390/cancers14041001.

Authors

Affiliations

¹ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands.
² Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands.
³ Department of Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
⁴ GROW School for Oncology and Developmental Biology, Maastricht University, 6200 MD Maastricht, The Netherlands.
⁵ Department of Surgery, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands.
⁶ Department of Radiotherapy, Maastro Clinic, 6202 NA Maastricht, The Netherlands.
⁷ Department of Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands.
⁸ Department of Medical Oncology, Antonius Hospital, 8600 BA Sneek, The Netherlands.
⁹ Department of Medical Oncology, Rivas, Banneweg 57, 4204 AA Gorinchem, The Netherlands.
¹⁰ Department of Surgery, Reinier de Graaf Hospital, Reinier de Graafweg 5, 2600 GA Delft, The Netherlands.
¹¹ Department of Medical Oncology, Meander Medical Center, Maatweg 3, 3813 TZ Amersfoort, The Netherlands.
¹² Department of Medical Oncology, Ziekenhuis Gelderse Vallei, 6710 HN Ede, The Netherlands.
¹³ Department of Medical Oncology, Haaglanden Medical Center, 2501 CK Den Haag, The Netherlands.
¹⁴ Department of Medical Oncology, Northwest Clinics, 1800 AM Alkmaar, The Netherlands.
¹⁵ Department of Medical Oncology, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609 PP Hengelo, The Netherlands.
¹⁶ Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands.
¹⁷ Department of Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3000 AD Rotterdam, The Netherlands.
¹⁸ Department of Medical Oncology, Canisius Wilhelmina Hospital, 6500 GS Nijmegen, The Netherlands.
¹⁹ Department of Surgery, Viecuri Hospital, Tegelseweg 210, 5912 BL Venlo, The Netherlands.
²⁰ Department of Medical Oncology, St. Antonius Hospital, 3430 EM Nieuwegein, The Netherlands.
²¹ Department of Medical Oncology, Medisch Spectrum Twente, 7500 KA Enschede, The Netherlands.
²² Department of Medical Oncology, Wilhelmina Hospital, 9400 RA Assen, The Netherlands.
²³ Department of Surgery, Leiden University Medical Center, University of Leiden, Postzone K6-39 Albinusdreef 2, 2300 RC Leiden, The Netherlands.
²⁴ Department of Medical Oncology, Sint Jans Hospital, Vogelsbleek 5, 6001 BE Weert, The Netherlands.
²⁵ Department of Medical Oncology, Jeroen Bosch Hospital, 5200 ME Den Bosch, The Netherlands.
²⁶ Department of Medical Oncology, Haga Hospital, Els Borst-Eilersplein 275, 2545 AA Den Haag, The Netherlands.
²⁷ Department of Medical Oncology, Rode Kruis Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands.
²⁸ Department of Surgery, Diakonessenhuis Hospital, Bosboomstraat 1, 3582 KE Utrecht, The Netherlands.
²⁹ Department of Surgery, St. Jansdal Hospital, Wethouder Jansenlaan 90, 3844 DG Harderwijk, The Netherlands.
³⁰ Department of Gastroenterology and Hepatology, Bernhoven Hospital, Nistelrodeseweg 10, 5406 PT Uden, The Netherlands.
³¹ Department of Medical Oncology, ZorgSaam Hospital, Wielingenlaan 2, 4535 PA Terneuzen, The Netherlands.
³² Department of Medical Oncology, Academisch Medisch Centrum, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
³³ Department of Medical Oncology, Flevo Hospital, Hospitaalweg 1, 1315 RA Almere, The Netherlands.
³⁴ Department of Surgery, Dijklander Hospital, Waterlandlaan 250, 1441 RN Purmerend, The Netherlands.
³⁵ Department of Surgery, Spaarne Hospital, 2000 AK Haarlem, The Netherlands.
³⁶ Department of Medical Oncology, Treant Hospital, 7800 RA Emmen, The Netherlands.
³⁷ Department of Medical Oncology, Bravis Hospital, Boerhaavelaan 25, 4708 AE Roosendaal, The Netherlands.
³⁸ Department of Medical Oncology, Rivierenland Hospital, 4000 HA Tiel, The Netherlands.
³⁹ Department of Medical Oncology, Maastricht University Medical Center, 6202 NA Maastricht, The Netherlands.
⁴⁰ Department of Medical Oncology, Tergooi Hospital, Van Riebeeckweg 212, 1213 XZ Hilversum, The Netherlands.
⁴¹ Department of Surgery, Ikazia Hospital, Montessoriweg 1, 3083 AN Rotterdam, The Netherlands.
⁴² Department of Medical Oncology, Rijnstate Hospital, Postus 9555, 6800 TA Arnhem, The Netherlands.
⁴³ Department of Surgery, Elkerliek Hospital, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands.
⁴⁴ Department of Surgery, Radboud University Medical Center, University of Nijmegen, 6500 HB Nijmegen, The Netherlands.

PMID: 35205748
PMCID: PMC8870120
DOI: 10.3390/cancers14041001

Abstract

Regular physical activity (PA) is associated with improved overall survival (OS) in stage I-III colorectal cancer (CRC) patients. This association is less defined in patients with metastatic CRC (mCRC). We therefore conducted a study in mCRC patients participating in the Prospective Dutch Colorectal Cancer cohort. PA was assessed with the validated SQUASH questionnaire, filled-in within a maximum of 60 days after diagnosis of mCRC. PA was quantified by calculating Metabolic Equivalent Task (MET) hours per week. American College of Sports and Medicine (ACSM) PA guideline adherence, tertiles of moderate to vigorous PA (MVPA), and sport and leisure time MVPA (MVPA-SL) were assessed as well. Vital status was obtained from the municipal population registry. Cox proportional-hazards models were used to study the association between PA determinants and all-cause mortality adjusted for prognostic patient and treatment-related factors. In total, 293 mCRC patients (mean age 62.9 ± 10.6 years, 67% male) were included in the analysis. Compared to low levels, moderate and high levels of MET-hours were significantly associated with longer OS (fully adjusted hazard ratios: 0.491, (95% CI 0.299-0.807, p value = 0.005) and 0.485 (95% CI 0.303-0.778, p value = 0.003), respectively), as were high levels of MVPA (0.476 (95% CI 0.278-0.816, p value = 0.007)) and MVPA-SL (0.389 (95% CI 0.224-0.677, p value < 0.001)), and adherence to ACSM PA guidelines compared to non-adherence (0.629 (95% CI 0.412-0.961, p value = 0.032)). The present study provides evidence that higher PA levels at diagnosis of mCRC are associated with longer OS.

Keywords: all-cause mortality; metastatic colorectal cancer; physical activity; survival.

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Conflict of interest statement

M.K. reports institutional financial interests with Amgen, Bayer, BMS, Merck-Serono, Nordic Pharma, Roche, Servier, Sirtex, and Sanofi-Aventis. M.K. reports the following non-financial interests: an advisory role for ZON-MW, membership of the scientific board of the Dutch Cancer Society (KWF), chairmanship of the Dutch Colorectal Cancer Group (DCCG), and principal investigator (PI) of the Prospective Dutch Colorectal Cancer (PLCRC) cohort. All other authors declare no conflicts of interest.

Figures

**Figure 1**
Kaplan–Meier survival curves, stratified by the following physical activity determinants: tertiles of Metabolic equivalent of task (MET) hours; tertiles of moderate and vigorous physical activity (MVPA); tertiles of sport and leisure time moderate and vigorous physical activity (MVPA-SL); and American College of Sports and Medicine (ACSM) physical activity (PA) guideline adherence. Dotted lines represent median survival time when reached.

See this image and copyright information in PMC

References

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Physical Activity Is Associated with Improved Overall Survival among Patients with Metastatic Colorectal Cancer

Affiliations

Physical Activity Is Associated with Improved Overall Survival among Patients with Metastatic Colorectal Cancer

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources

Miscellaneous