Physical Activity in Stage III Colon Cancer: CALGB/SWOG 80702 (Alliance)

Abstract

Purpose: To determine the specific types, durations, and intensities of recreational physical activity associated with the greatest improvements in disease-free survival (DFS) of patients with colon cancer.

Methods: We conducted a prospective cohort study nested within a randomized multicenter trial of stage III colon cancer that compared 3 versus 6 months of fluorouracil, leucovorin, and oxaliplatin with or without celecoxib. We measured recreational physical activity in the first 3 months of chemotherapy and again 6 months after completion of chemotherapy. The primary end point was DFS.

Results: During a median follow-up of 5.9 years, 457 of 1,696 patients experienced disease recurrence or death. For total recreational physical activity volume, the 3-year DFS was 76.5% with < 3.0 metabolic equivalent task hours per week (MET-h/wk) and 87.1% with ≥ 18.0 MET-h/wk (risk difference [RD], 10.6%; 95% CI, 4.7 to 19.4; P < .001). For light-intensity to moderate-intensity activities, the 3-year DFS was 65.7% with 0.0 h/wk and 87.1% with ≥ 1.5 h/wk (RD, 21.4%; 95% CI, 9.2 to 37.1; P < .001). For vigorous-intensity activity, the 3-year DFS was 76.0% with 0.0 h/wk and 86.0% with ≥ 1.0 h/wk (RD, 10.0%; 95% CI, 4.5 to 18.9; P < .001). For brisk walking, the 3-year DFS was 81.7% with < 1.0 h/wk and 88.4% with ≥ 3.0 h/wk (RD, 6.7%; 95% CI, 3.0 to 13.8; P < .001). For muscle strengthening activity, the 3-year DFS was 81.8% with 0.0 h/wk and 88.8% for ≥ 0.5 h/wk (RD, 7.0%; 95% CI, 3.1 to 14.2; P = .003).

Conclusion: Among patients with stage III colon cancer enrolled in a trial of postoperative treatment, larger volumes of recreational physical activity, longer durations of light- to moderate-intensity aerobic physical activity, or any vigorous-intensity aerobic physical activity were associated with the greatest improvements in DFS.

FIG 1.

Derivation of the study cohort. MET-h/wk, metabolic equivalent total physical activity energy expenditure; Q1, questionnaire 1; Q2, questionnaire 2.

FIG 2.

Subgroup analyses of the association of DFS and OS end points with total recreational physical activity volume. Adjusted for age, sex, race, extent of invasion through the bowel wall, nodal stage, tumor location, ECOG performance status, low-dose aspirin use, smoking history, body mass index (time-varying), western dietary pattern (time-varying), prudent dietary pattern (time-varying), chemotherapy random assignment, and pharmacotherapy random assignment. BMI, body mass index; DFS, disease-free survival; ECOG, Eastern Cooperative Oncology Group; HR, hazard ratio; MET-h/wk, metabolic equivalent total physical activity energy expenditure; OS, overall survival.