Persistent fatigue after colorectal cancer (CRC) treatment affects up to 40 per cent of survivors in the first five years after diagnosis, and has a negative impact on mood, work, social relationships and overall quality of life. In observational studies, low adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR)’s Recommendations [LINK NEEDS UPDATING] for cancer prevention has been found to be associated with higher levels of fatigue.
However, it is unknown whether improving adherence to WCRF/AICR’s Recommendations can diminish fatigue in CRC survivors. The biological mechanism explaining the association between adherence to WCRF/AICR’s Recommendations and fatigue is unclear. Within the data of a currently ongoing observational study, we found that increased fat infiltration within the muscle cells at time of diagnosis is associated with almost two times more risk of cancer-related fatigue six months after diagnosis in 602 CRC survivors.
Since unhealthy lifestyle behaviours like obesity, high fat diets, smoking (our preliminary data) have been found to increase fat infiltration within the muscle, and healthy lifestyle behaviours like increased physical activities (our preliminary data) and strength training decrease fat infiltration within the muscle cell, we hypothesise that increased fat infiltration within the muscle cells mediates the association between adherence to the WCRF/AICR’s Recommendations and fatigue.
Studies on the mediating effect of fat infiltration within the muscle cells on the association between adherence to the WCRF/AICR Recommendations and fatigue are currently lacking.
Aims and objectives
Our study will aim to investigate if better adherence to WCRF/AICR’s Recommendations can decrease fatigue in CRC survivors and assess if better adherence to WCRF/AICR’s Recommendations can decrease fat infiltration within the muscle cells in CRC survivors. We will also explore if changes in levels of fatigue are associated with changes in fat infiltration within the muscle cells in CRC survivors.
How it will be done
We will invite CRC survivors with fatigue reported at a recent follow-up time point from our ongoing COLON study. Survivors who are interested in participating will be enrolled in our randomised trial after signing informed consent.
Participants randomised to the intervention group will receive individualised, tailored coaching to improve adherence to WCRF/AICR’s Recommendations. Participants randomised to the control group will receive usual care, and will receive the intervention after the end of the study (wait-list control).
The duration of the intervention will be six months in which participants in the intervention group will have weekly contact with a lifestyle coach to stay motivated and improve adherence. Changes in adherence, fatigue and fat infiltration within the muscle cells will be assessed before, during and after the intervention.
Cancer-related fatigue is a very problematic long-term side effect of cancer and its treatment. This project will show whether lifestyle interventions will help to alleviate fatigue, and what possible mediators are. This can inform future research to finetune lifestyle approaches to address fatigue.