Can a Healthier Diet Affect Survival in Patients With Metastatic Colorectal Cancer?

A prospective study examining links between diet quality and survival of patients with metastatic colorectal cancer (CRC) found no link between diet at the initiation of first-line treatment and overall survival.

For the study, Erin Van Blarigan, ScD, of the University of California San Francisco, and colleagues assessed “validated food frequency” questionnaires completed by 1,284 of 2,334 patients (55.0%) with metastatic CRC enrolled in the Cancer and Leukemia Group B (Alliance)/Southwest Oncology Group 80405 trial. The results, published online in JAMA Network Open, found no significant association in overall survival and any of five dietary patterns:

  • Alternative Healthy Eating Index (AHEI), which is scored from 0 to 110 and is based on vegetables (excluding potatoes), fruits, whole grains, nuts and legumes, long-chain n-3 fatty acids, polyunsaturated fatty acids, sweetened beverages and juice, red and processed meat, trans fat, sodium, and alcoholic drinks
  • Alternative Mediterranean Diet (AMED), which is scored from 0 to 9 and is based on vegetables, fruits, nuts, whole grains, legumes, fish, ratio of monounsaturated to saturated fat, red and processed meat, and alcohol
  • Dietary Approaches to Stop Hypertension (DASH) diet, which is scored from 0 to 45 and is based on fruits, vegetables, nuts and legumes, low-fat dairy, whole grains, sodium, sweetened beverages, red and processed meats, and sweets and desserts
  • The Western dietary pattern, characterized by higher intake of dairy, refined grains, condiments, red meat, and sweets and desserts

“Making lifestyle changes is hard, especially when you are dealing with cancer diagnosis and treatment,” Van Blarigan told MedPage Today. “Patients may wish to focus their energy on making changes that are most likely to be helpful. Data on diet and exercise in people with metastatic colorectal cancer are very limited, but the information we have right now suggests that patients should really prioritize exercise during and after their cancer treatments.”

Overall, none of the diet scores or patterns examined were associated with survival in metastatic CRC, the investigators reported. “We observed an inverse association between the AMED score and risk of death (HR quintile 5 [Q5] vs quintile 1 [Q1] 0.83, 95% CI 0.67-1.04, P=0.04 for trend), but point estimates were not statistically significant. Additionally, the Western diet pattern was associated with longer survival in individuals with KRAS variant tumors (HR Q5 vs Q1 0.50, 95% CI 0.32-0.77) but not those with wild-type tumors (HR Q5 vs Q1 0.95, 95% CI 0.68-1.33, P=0.02 for interaction).”

“None of the other diet scores or patterns were associated with survival, overall or in subgroups, and the results did not change when patients who died within 90 days after administration of the [questionnaire] were excluded,” the team noted.

Writing in an accompanying commentary, Cindy Kin, MD, MS, of Stanford University School of Medicine in California, pointed out that although a Western diet, high in red meat and saturated fats, has been linked to the development of colorectal cancer, the new study addresses the less well-studied area of diet quality and outcomes in CRC, particularly for those with

Read more

Medical task force recommends lowering suggested age for colorectal screenings

The Task Force announced Tuesday morning their proposal to lower the suggested age for when to start colorectal screenings, moving it up five years, from 50, to 45 years old. The move may indicate a growing call for awareness and accelerate action amongst an age group that may not know they’re at risk.

“The prognosis is so much better if you catch it at an earlier stage,” Dr. Kimmie Ng, the director of the Young-Onset Colorectal Cancer Center at Dana-Farber Cancer Institute, told ABC News. “These new guidelines are hugely significant. They support and validate the alarming epidemiologic trends we’ve been seeing: This cancer is rising at about a rate of 2% per year, in people under the age of 50, since the 1990s.”

Colorectal cancer impacts the gastrointestinal system’s final segment. While lung cancer is the leading cause of cancer deaths in the U.S., colorectal cancer comes second, according to the latest data from the Centers for Disease Control and Prevention — and yet, it remains one of the most treatable, even curable cancers, when caught in its early stages.

“Way too young” were the words resounding across the globe late this summer, when news broke that actor Chadwick Boseman, at just 43 years old, had died of colon cancer. Boseman had kept his long, difficult battle mostly private, but the shock of his loss was compounded by a common misconception: that the disease only strikes older people.

Even though overall incidence and mortality rates for colorectal cancer have decreased over the past few decades, colorectal cancer deaths among younger adults continue to climb. It’s a concerning trend, experts told ABC News, pointing out the importance of testing and early intervention.

PHOTO: A doctor speaks with a patient in this stock photo.

In 2018, the American Cancer Society updated their guidelines, recommending that those at average risk of colorectal cancer begin regular screening at age 45. Experts hope the Task Force’s update shines a light on the importance of the issue.

For years prior, screening was not generally recommended for the below-50 crowd. This led to potentially vulnerable, or even sick adults putting off testing thinking their symptoms did not rise to the level of firm diagnosis. Because of this lack of awareness, pernicious, possibly cancerous growths remained undetected for too long, experts say, and now, young patients are suffering from more advanced, harder to treat cancers.

“Cancer is simply not on their radar,” Ng said, speaking more specifically about colon cancer. “They’re otherwise young and healthy. So we need to emphasize that yes, this can happen in young people.”

Nearly 25% of screening-eligible Americans have never been screened for colon cancer, and yet, it is expected to cause over 53,000 American deaths this year alone. Of the roughly 148,000 individuals who will be diagnosed with colorectal cancer in 2020, about 18,000 of

Read more

Colorectal cancer screening should start at age 45, not 50, federal task force says

The draft recommendation statement, which was released Tuesday and is now open for public comment, marks a departure from its last update to the guidelines about five years ago. (Task force recommendations are typically revisited every five years.) The panel previously concluded that data on lowering the starting age was mixed and that beginning screenings before 50 would provide only a “modest” benefit. Its position stood in contrast with the American Cancer Society’s, which updated its recommendation in 2018 to say regular screenings should start at age 45.

Now, though, Barry said a review of more recent epidemiological studies on the risk of colorectal cancer increasing in younger people, coupled with simulation modeling, which suggests additional deaths could be prevented if screenings were to start at 45, led the task force to the same conclusion as the cancer society. The draft statement will be available for public comment until Nov. 23, with final recommendations expected to be released “within a few months,” Barry said.

Outside experts say the consensus among the leading organizations could have broad implications on access to care.

“These guidelines, if finalized, eventually will change standard of care for preventive medicine and how we recommend cancer screenings for average-risk Americans,” said Kimmie Ng, director of the Young-Onset Colorectal Cancer Center at the Dana-Farber Cancer Institute in Boston.

Many insurance companies, for instance, often base their coverage on recommendations from the task force, which evaluates screening tests, counseling services and preventive medications, Ng said. As it stands, the draft statement makes regular colorectal cancer screenings for people ages 45 to 75 a service that most private insurance plans are required by law to cover with no co-pay for patients, according to the task force.

“I think the result of all of this will be that life will be saved,” Ng said.

Robert Smith, senior vice president of cancer screening for the American Cancer Society, called the proposed update a “welcome change.” Although the existing guidelines from the cancer society and the task force are “both highly respected” and used frequently by health-care providers, Smith said he hopes “removing that barrier” of insurance coverage will increase the number of referrals for people in the 45-to-49 age group.

“It may very well be that a physician, who has been shown to be sensitive to the costs of care, would choose not to recommend getting screening at age 45, because they’re concerned that the patient would get a bill that they couldn’t afford to pay,” Smith said. “We’re already seeing screening rates go up in adults at age 45, but they’ll go up a lot more now.”

“It’s been shown that in the African American community, they have higher incidence and mortality of colorectal cancer, and there’s been the question whether this is due to biology or access to care,” said Robin Mendelsohn, co-director of the Center for Young Onset Colorectal Cancer at Memorial Sloan Kettering Cancer Center in New York. “More and more, we believe that it’s likely access to

Read more