Colorectal cancer survivors only marginally change their overall lifestyle in the first 2 years following diagnosis

Moniek van Zutphen*, Hendriek C. Boshuizen, Dieuwertje E. Kok, Harm van Baar, Anne J.M.R. Geijsen, Evertine Wesselink, Renate M. Winkels, Henk K. van Halteren, Johannes H.W. de Wilt, Ellen Kampman, Fränzel J.B. van Duijnhoven

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

30 Citations (Scopus)


Purpose: A healthy lifestyle after colorectal cancer (CRC) diagnosis may improve prognosis. Data related to lifestyle change in CRC survivors are inconsistent and potential interrelated changes are unknown. Methods: We assessed dietary intake, physical activity, body mass index (BMI), waist circumference, and smoking among 1072 patients diagnosed with stages I–III CRC at diagnosis, 6 months and 2 years post-diagnosis. An overall lifestyle score was constructed based on the 2018 World Cancer Research Fund/American Institute of Cancer Research recommendations (range 0–7). We used linear mixed models to analyze changes in lifestyle over time. Results: Participants had a mean (± SD) age of 65 ± 9 years and 43% had stage III disease. In the 2 years following CRC diagnosis, largest changes were noted for sugary drinks (− 45 g/day) and red and processed meat intake (− 62 g/week). BMI (+ 0.4 kg/m2), waist circumference (+ 2 cm), and dietary fiber intake (− 1 g/day) changed slightly. CRC survivors did not statistically significant change their mean intake of fruits and vegetables, alcohol, or ultra-processed foods nor did they change their physical activity or smoking behavior. Half of participants made simultaneous changes that resulted in improved concordance with one component as well as deteriorated concordance with another component of the lifestyle score. Overall lifestyle score changed from a mean 3.4 ± 0.9 at diagnosis to 3.5 ± 0.9 2 years post-diagnosis. Conclusions: CRC survivors hardly improve their overall lifestyle after diagnosis. Implications for Cancer Survivors: Given the importance of a healthy lifestyle, strategies to effectively support behavior changes in CRC survivors need to be identified.

Original languageEnglish
Pages (from-to)956-967
Number of pages12
JournalJournal of Cancer Survivorship
Issue number6
Early online date23 Oct 2019
Publication statusPublished - Dec 2019


  • Colorectal cancer
  • Dietary changes
  • Lifestyle changes
  • Lifestyle recommendations
  • Survivorship


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