The role of physical activity, sedentary behaviour, diet, adiposity and body composition on health-related quality of life and cancer-related fatigue after diagnosis of colorectal cancer: a Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis

Abstract

Background: The impact of physical activity, sedentary behaviour, diet, adiposity, and body composition on health-related quality of life (HRQoL) and cancer-related fatigue among colorectal cancer survivors remains uncertain.

Methods: PubMed, Embase, and CENTRAL were systematically searched until April 2023 for relevant randomised controlled trials (RCTs) and cohort studies. Random-effects meta-analyses or descriptive syntheses were conducted depending on the number of studies. The evidence was interpreted and graded by an independent World Cancer Research Fund Expert Committee and Expert Panel.

Results: We included 31 RCTs (18 exercise, 14 diet) and 30 cohort studies (8 physical activity, 3 sedentary behaviour, 13 diet, 9 adiposity and body composition). Meta-analyses were possible for exercise RCTs that showed non-significant effects but indicative of improved HRQoL (overall four trials for global HRQoL, physical and emotional well-being) and fatigue (five trials). These studies were rated at a high risk of bias (RoB), and evidence was graded as 'very low certainty of an effect'. Descriptive synthesis of interventions to improve diet quality suggested small improvements in global HRQoL and physical well-being, but with a high RoB rating leading to a 'low certainty' grading. Evidence from RCTs on probiotics and supplements and evidence from observational studies on sedentary behaviour, and various dietary and body composition factors was generally inconsistent and too scarce to draw conclusions.

Conclusions: Exercise and diet quality interventions might improve HRQoL and fatigue outcomes in colorectal cancer survivors. The evidence overall was limited and should be strengthened by larger, well-designed RCTs across the cancer continuum.

Keywords: adiposity; colorectal cancer survivors; diet; fatigue; physical activity; quality of life.

Figure 1

Flowchart of the search. HRQoL, health-related quality of life; RCT, randomised controlled trial.

Figure 2

Summary results of meta-analyses on physical activity interventions and health-related quality of life (HRQoL) and cancer-related fatigue. To allow for direct comparison across outcomes, the scales of fatigue scores were reversed, where needed, so that higher scores consistently indicate better HRQoL and less cancer-related fatigue. BFI, Brief Fatigue Inventory; CI, confidence interval; FACIT-F, Functional Assessment of Chronic Illness Therapy—Fatigue; FACT-C, Functional Assessment of Cancer Therapy-Colorectal; FACT-F, Functional Assessment of Cancer Therapy Scale—Fatigue; FACT-G, Functional Assessment of Cancer Therapy-General; MFI, Multidimensional Fatigue Inventory; SMD, standardised mean difference; WMCD, weighed mean change difference; WMD, weighed mean difference.

Figure 3

Summary results of meta-analyses on alcohol consumption and health-related quality of life (HRQoL) and cancer-related fatigue. To allow for direct comparison across outcomes, the scales of fatigue scores were reversed, where needed, so that higher scores consistently indicate better HRQoL and less cancer-related fatigue. CI, confidence interval; EORTC-QLQ-C30, European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30.

Figure 4

Summary matrix of the evidence conclusions for physical activity, sedentary behaviour, diet, adiposity and body composition and health-related quality of life (HRQoL) and cancer-related fatigue after diagnosis of colorectal cancer.^aIncludes a priori- and a posteriori-defined patterns and ultra-processed foods. ^bEnergy density of diet, red meat, processed meat, sugary drinks, dietary fibre, fruits and vegetables, vegetables, fruits, vitamin D intake (foods/supplements).