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: Completed
Researcher: Martijn Bours
  • Grant awarded in 2018


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


Colorectal cancer is one of the most common forms of cancer. More and more people survive longer after being diagnosed with colorectal cancer. Patients often experience symptoms after cancer treatment (most often surgery combined with chemotherapy and/or radiotherapy) which threaten their quality of life. Survivors are currently being advised to adhere to WCRF/AICR cancer prevention recommendations.


To investigate longitudinal associations of the WCRF/AICR lifestyle recommendations with HRQoL, fatigue, and chemo-induced peripheral neuropathy in colorectal cancer survivors up to 2 years after treatment. The research project focused in detail on the separate recommendations regarding body composition, physical activity, and diet, as well as on the WCRF/AICR recommendations as a whole lifestyle package, in relation to HRQoL and treatment-related symptoms.

How it was done

Observational data were used from a prospective cohort study in colorectal cancer survivors; the EnCoRe study. Data analysis was carried out.


Several of the lifestyle components included in the WCRF/AICR recommendations for cancer prevention were found to be related to HRQoL and fatigue but not cancer induced peripheral neuropathy in the first two years after colorectal cancer treatment. Improved HRQoL and reduced fatigue symptoms over time were observed in participants with increases in adipose tissue and muscle mass/function, moderate to vigorous physical activity, and dietary fibre, fruit and vegetable and alcohol consumption and with decreases in sedentary behaviour and fast food and sugar-sweetened drink consumption. Adherence to more of the WCRF/AICR lifestyle recommendations was associated with better physical functioning and less fatigue.


This research project has generated new evidence on the relevance of the WCRF/AICR lifestyle recommendations for post-treatment HRQoL, as well as for fatigue and CIPN as important treatment-related symptoms in the first years after colorectal cancer treatment. The project findings provide potential leads for further updating and tailoring lifestyle recommendations regarding body composition, physical activity, and diet to the specific population of colorectal cancer survivors, aimed at improving post-treatment HRQoL and alleviating symptoms. With numbers of colorectal cancer survivors continuing to rise, tailor-made lifestyle recommendations empowering survivors to increase their chances of leading a long, healthy, happy, and symptom-free life after the end of treatment can therefore have a significant impact.

Grant publications

Gielen AHC, Melenhorst J, Breukink SO, Weijenberg MP, Bours MJL. The Relation of Lifestyle with Inflammation at the Time of Diagnosis in Patients with Colorectal Cancer. Cancers (Basel). 2023 Aug 28;15(17):4307. doi: 10.3390/cancers15174307. PMID: 37686583; PMCID: PMC10486596.

Longitudinal Associations between Inflammatory Markers and Fatigue up to Two Years after Colorectal Cancer Treatment Cancer Epidemiology, Biomarkers & Prevention, 1 August 2022

Associations of the dietary World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations with patient-reported outcomes in colorectal cancer survivors 2–10 years post-diagnosis: a cross-sectional analysis (British Journal of Nutrition, May 2021)