Colorectal cancer survivors and following WCRF/AICR Recommendations

Martijn Bours’s research study looks at whether adherence to World Cancer Research Fund/American Institute for Cancer Research lifestyle recommendations for cancer prevention are associated with a better quality of life in survivors of colorectal cancer

  • Topic: Colorectal cancer
  • Institution: Maastricht University
  • Country: Netherlands
  • Status: Ongoing
Researcher: Martijn Bours


Dr Floortje Mols, Tilburg University, The Netherlands
Dr José Breedveld-Peters, Maastricht University, The Netherlands
Prof Matty Weijenberg, Maastricht University, The Netherlands

Scientific abstract

(View plain language abstract)


WCRF/AICR currently advises cancer survivors to follow the lifestyle recommendations for cancer prevention, which are presumed to be beneficial for preventing recurrence and improving survival. Though these cancer outcomes related to quantity of life are important, the quality of life (QOL) of cancer survivors is also a well-recognised patient-reported outcome to consider in cancer survivorship research.

QOL refers to the way cancer survivors perceive their health and functioning in different dimensions, including physical health, psychological well-being, level of independence, and societal participation. It is still unclear, however, whether the WCRF/AICR recommendations regarding diet, physical activity, and body composition are valid for cancer survivors and whether they apply equally to survivors of different types of cancer.

Colorectal cancer (CRC) is a prevalent type of cancer and the number of CRC survivors continues to rise. In the years post-diagnosis, CRC survivors frequently report decreased QOL and persisting cancer treatment-related problems, such as fatigue and chemotherapy-induced peripheral neuropathy (CIPN). These important patient-reported outcomes are likely to be influenced by lifestyle behaviours of CRC survivors.

Previous studies observed that poor diet quality, low physical activity level, high sedentary behaviour, and an unfavourable body composition were associated with decreased QOL and increased fatigue in CRC survivors. However, most of these studies were cross-sectional and did not look at lifestyle behaviour as a whole, which is what the WCRF/AICR recommendations aim to target.

Because many cancer survivors express the need for lifestyle advice and are open to lifestyle changes, it is important to evaluate whether adhering to the WCRF/AICR recommendations is associated over time with QOL and other relevant patient-reported outcomes, including fatigue and CIPN. Longitudinal studies are therefore highly warranted.

Hypothesis and objectives

The main objective is to test the hypothesis that adherence to the WCRF/AICR lifestyle recommendations is longitudinally associated with QOL, fatigue and CIPN as primary patient-reported outcomes in CRC survivors up to two years post-treatment.

We will analyse longitudinal associations of:

  • The overall level of adherence to the WCRF/AICR recommendations
  • Adherence to the individual sub-recommendations regarding diet, physical activity and body composition, with the primary patient-reported outcomes

Settings and methods

Data from the ongoing EnCoRe (Energy for life after ColoRectal cancer) study will be used. In this prospective cohort study in stage I-III CRC survivors, data is collected at 6 weeks (expected sample size N~418), 6 months (N~329), 1 year (N~276), and 2 years (N~173) post-treatment. Several patient-reported outcomes are assessed by validated questionnaires, including global QOL; physical, role, and social functioning; fatigue; and CIPN.

Dietary intake is measured by 7-day dietary records and dietary supplement use is recorded in detail. Physical activity is measured by a validated questionnaire and 7-day accelerometry. Body composition is assessed through detailed anthropometric measurements.


The potential impact of the proposed research is to provide new evidence based on high-quality prospective data for the value of the WCRF/AICR lifestyle recommendations for important patient-reported outcomes in stage I-III CRC survivors. The findings can help improve the WCRF/AICR recommendations for CRC survivors.

Plain language abstract


Worldwide, over 3.5 million people were living in 2012 with a diagnosis of colorectal cancer (cancer of the large bowel). This population of survivors of colorectal cancer is expected to grow even larger in the future due to general population ageing, improved treatments and implementation of national screening programs.

Many of these colorectal cancer survivors are concerned not only with how long they will survive after the diagnosis and treatment, but also about their quality of life. Colorectal cancer survivors frequently report long-lasting health problems related to a cancer diagnosis and treatment, for instance, fatigue and peripheral neuropathy (nerve damage) following chemotherapy, which have a negative impact on daily functioning and quality of life.

Importantly, the quality of life of colorectal cancer survivors is likely to be influenced by factors related to their lifestyle behaviour, such as their dietary and exercise habits and body fatness.

World Cancer Research Fund (WCRF) currently advises cancer survivors to follow the lifestyle recommendations developed for cancer prevention, which include practical advice on diet, physical activity, and body fatness. However, it is not clear whether adhering to these lifestyle recommendations has a positive effect on the quality of life of colorectal cancer survivors. More research is needed.

Aims and objectives

The main objective of this project is to study whether colorectal cancer survivors who follow the lifestyle recommendations of WCRF report an increase in quality of life over time.

Effects of adhering to the lifestyle recommendations as a whole as well as the specific recommendations regarding diet, physical activity and body fatness will be evaluated in the period up to two years after the end of colorectal cancer treatment. Next to quality of life, effects on fatigue and peripheral neuropathy will also be evaluated.

How it will be done

This research will make use of data from an ongoing study in colorectal cancer survivors: the Energy for life after ColoRectal cancer (EnCoRe) study. The EnCoRe study was initiated in 2012 at the Maastricht University Medical Center+ in the Netherlands to study the influence of lifestyle factors on the health and quality of life of colorectal cancer survivors.

Colorectal cancer survivors who participate in the EnCoRe study are followed up from the moment of diagnosis until two years after the end of treatment. At different time points during this period, study measurements are performed at the participants’ homes by trained dieticians. Quality of life, fatigue and peripheral neuropathy are measured in detail by questionnaires. Dietary intake is measured by 7-day food diaries.

Physical activity is measured by a questionnaire and also by means of so-called accelerometers that accurately measure physical activity over a 7-day period. Body height and weight, waist and hip circumference, and skinfold thickness are measured to assess body fatness.

Potential impact

The findings of this project can help improve the lifestyle recommendations of WCRF/AICR for colorectal cancer survivors, enabling them to better make well-informed decisions about making changes in diet, physical activity, and body fatness for the benefit of their quality of life.