Cancer
Adherence to the WCRF/AICR Guidelines Among Cancer Survivors and Mortality: A Cohort Study Based on the KoGES-HEXA Donghyun Won* Donghyun Won Jeeyoo Lee Sooyoung Cho Aesun Shin
The growing number of cancer survivors is a global concern, with over 32 million estimated worldwide. The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) has suggested that all cancer survivors follow cancer prevention recommendations to improve quality of life and survival. This study aims to investigate the effect of adherence to the guidelines among cancer survivors on mortality. The scoring logic incorporates two body fatness, physical activity and six dietary factors, yielding a total score ranging from 0 to 7, where higher scores refer to the better adherence. All eight factors are self-reported, and participants were categorized into five groups (<3, 3-4, 4-5, 5-6, >6). A chi-squared test was conducted to identify features associated with the adherence. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to estimate the association between adherence scores and all-cause mortality using a Cox proportional hazards model. Among 173,195 individuals who recruited between 2004 and 2013 in the Health Examinees study, 3,967 participants at baseline and 1,518 participants at the follow-up were identified as cancer survivors. Over a median follow-up of 10.5 years, 443 deaths occurred. Women, older age, non-smoker, lower education level, lower income and diabetes patients were more likely to adhere to guidelines. Overall, higher adherence did not show an association with mortality among the cancer survivors. However, among survivors with diabetes, adherence was associated with the lower mortality after adjusting for age and sex (3-4: HR = 0.28, CI: 0.11-0.70; 4-5: HR = 0.24, CI: 0.10-0.59; 5-6: HR = 0.58, CI: 0.24-1.37; >6: HR =0.41, CI: 0.13-1.31) when compared to the lowest score group (<3). Adherence to the WCRF/AICR guidelines is advised for cancer survivors, with a specific focus on those who also have diabetes.