We spoke to Dr Renate Winkels (pictured) and Dr Laura Winkens, at Wageningen University & Research, to discover more about their studies in bowel (also known as colorectal) cancer.
Your team looked at what influences people’s health behaviours after they’ve been treated for bowel cancer. What do you mean by health behaviours and what did you find out?
Health behaviours are the everyday choices people make that affect their health. In this study, we focused on 2 things:
- healthy eating (more fruit, vegetables, whole grains and beans; and less fast food, red meat, processed meat, sugary drinks and alcohol)
- physical activity
For people who’ve had bowel cancer, healthy behaviour may be associated with living longer, feeling better and having fewer problems like fatigue.
However, in previous studies, we found that many bowel cancer survivors don’t make big changes after treatment. Survivors are dealing with side-effects from the cancer or its treatment (such as gastrointestinal problems, fatigue or body image distress), which can make it hard to eat well and stay active.
Our study looked at what helps or gets in the way of healthy behaviour for people who have finished treatment for bowel cancer. We found:
Personal factors matter
How much time people have, their motivation, what they believe about healthy habits, what they know, and the skills they have can all influence whether they eat well and stay active.
Support helps
Encouragement and support from family and friends, or feeling like healthy habits are normal in their social circle, can make a big difference.
Environment plays a role
Access to gyms, parks, or even just good weather can affect how easy it is to be active.
Cancer symptoms can get in the way
Ongoing physical issues after cancer treatment, like fatigue or bowel problems, often make it harder for people to stick to healthy habits. But if someone is feeling physically well, they’re more likely to eat better and stay active.
Mental health may be important
Depression or being unhappy with one’s body seem to be linked with less healthy behaviour.
In short, to help people with bowel cancer lead healthier lives after treatment, we need to focus on motivation, knowledge, support, and overcoming the challenges they face physically and emotionally.
Towards a more complete picture
Your team conducted a “systematic review”. What is that and why is it important?
We wanted to find out what other scientists had studied, so we could build our study on the latest evidence. Moreover, we wanted to provide an overview of the topic. We looked at 21 papers, but we started with around 800 publications, and had to sift through them to identify the relevant ones.
You divided the studies into quantitative or qualitative. Why did you choose to look at both?
Quantitative studies collected a lot of numbers and measurements. The studies used standardised questionnaires to collect data on dietary intake and other aspects of lifestyle. Those studies answer questions like “how many” or “how much”.
Qualitative studies focus more on experiences. Such studies are mostly interviews to better understand why people do what they do, or how people behave.
Together, they provide a richer, more complete picture of the challenges and motivations colorectal cancer survivors face.
Were you surprised that people find it hard to change their behaviour?
Not really. Most people will recognise how challenging it can be to always make healthy choices. After cancer, when you’re rebuilding your life, that can be even harder.
How important is mental health for people living with and beyond bowel cancer?
Mental health is a very broad topic. People who have had bowel cancer may have a stoma, or be suffering from fatigue, or from bowel functioning problems. These can have a real impact on your life, and it’s important to address them. Some care teams really have an eye on this, but it’s not always the case. One patient told me that she did not dare to discuss her feelings of severe fatigue with her oncologist, as the oncologist told her that “fatigue was not a thing” for people with bowel cancer. We need more awareness and integrated care that addresses both mental and physical health to truly support survivors’ wellbeing.
You’ve also looked at whether following our Cancer Prevention Recommendations can reduce fatigue for people with bowel cancer.
We set up a study to assess whether following the Recommendations would help people to feel less fatigue. Cancer-related fatigue is a symptom that many bowel cancer patients experience during treatment and after completion. What is disturbing is that this type of persistent, overwhelming sense of physical, emotional or mental fatigue is not proportional to activity nor relieved by resting or sleeping.
We recruited participants for the trial who were experiencing cancer-related fatigue. In a randomised study, half of the group received lifestyle coaching to improve their adherence to the Recommendations, while the control group did not.
The coaching really helped the participants to adopt a healthier lifestyle: over time, this group reported eating more fruit and vegetables, and less processed meat and sugar-sweetened beverages. Also, physical activity levels went up more in the group that received coaching than in the control group.
Nevertheless, those changes didn’t result in less fatigue. This suggests that while these changes have many benefits, managing fatigue may require additional, targeted interventions.
This grant was funded by Wereld Kanker Onderzoek Fonds based in the Netherlands, as part of the World Cancer Research Fund International network.
Eating a wide variety of food may reduce the risk of gastrointestinal cancers, according to research funded by the World Cancer Research Fund network* and published in the European Journal of Cancer.
Little is known about how eating a wide variety of food species, also known as food biodiversity, may benefit our health or affect our cancer risk. Food species refer to a distinct type of plant or animal, such as wheat, chicken, or salmon. For example, salmon, mackerel, and tuna are all separate food species, even though they share some biological traits and belong to the same food group. Similarly, rocket, lettuce and spinach count as separate food species, even though they are all leafy green vegetables. However, chicken and a chicken’s egg belong to the same food species even though they are different types of food.
This study is the first to examine how the number of different food types consumed, measured as Dietary Species Richness (the number of species an individual consumes per year) affects the risk of the following gastrointestinal cancers:
- Oesophagus
- Throat
- Stomach
- Bowel
- Colon
- Rectum
- Gallbladder
- Pancreas
- Liver
The study followed 450,111 cancer-free adults in 9 European countries from the European Prospective Investigation into Cancer and Nutrition cohort for 14 years. The researchers, from the International Agency for Research on Cancer, found that individuals with the most diverse diets, by including more food species in their diet, had a 23% lower risk of developing gastrointestinal cancers compared with those with the least variety. The risk decreased by 6% for every 10 extra species per year added to their diet. People can do this by including more variety in the types of fruit and vegetables they eat, for example, choosing to eat local and seasonal fruit and vegetables of different colours.
Food biodiversity includes eating different types of food that provide the necessary nutrients for maintaining health. Investigating food biodiversity is important because it has the potential to benefit public health and sustainable food systems.
Dr Helen Croker, our Assistant Director of Research and Policy, said: “Diets have become more limited in the types of foods eaten and they are often high in fat, sugar and salt. However, for cancer prevention, it’s important to eat a healthy, balanced and varied diet with plenty of wholegrains, pulses, vegetables and fruit.”
Dr Helen Croker
This study is particularly interesting because it looks at the number of different foods people eat and the impact it can have on their cancer risk, in particular gastrointestinal cancers. More research is now needed to confirm these findings and further explore the link between dietary diversity and cancer prevention.
Dr Inge Huybrechts
This study shows how a more diverse diet, including a large variety of species, could lower the risk of gastrointestinal cancers, emphasising the importance of eating a wide variety of foods. The idea behind a diverse diet consisting of many types of plants and animals species may provide essential nutrients for the body while also strengthening ecosystems, making them more resilient, productive, and sustainable.
Another study from this grant looked at how food biodiversity is measured. Methods such as Hill numbers estimate the number of species, but it wasn’t clear whether these numbers could be compared across different study settings.
The findings showed that Dietary Species Richness is the most feasible way to measure and evaluate food biodiversity across various contexts, and considering high-, middle- and low-income countries. Regardless of which Hill number was used, however, all measures indicated that greater food biodiversity was associated with better micronutrient sufficiency and with lower rates of all-cause mortality, this latter association yet being strongest for Dietary Species Richness.
This grant was funded by Wereld Kanker Onderzoek Fonds based in the Netherlands, as part of the World Cancer Research Fund International network.
> More on this grant: Will a balanced diet also save the planet?
A bowel cancer diagnosis during lockdown shocked our supporter Claire Burlison to the core. But following surgery, she’s now living beyond cancer and trying to follow our Recommendations.
A cancer diagnosis can be devastating for anyone. But when you’re young, energetic – and the world is in the grip of a global pandemic – it’s even harder.
“I was diagnosed with bowel cancer in 2020,” says Claire, “which came as a shock as I’m only in my 40s. Before that, I assumed my irritable bowel syndrome was just getting worse. It was only when I got sharp stomach pains and ended up in A&E that I found out I needed surgery.
“I was expecting bad news, but it still knocked me for six when they phoned and told me I had bowel cancer,” she adds.
Although bowel cancer – like most cancers – is more prevalent in older adults, it’s sadly increasingly common in younger people. Researchers are trying to find out why. Fortunately for Claire, doctors found that the cancer hadn’t spread. Now, having been cancer-free for over 2 years, she’s trying to follow our Recommendations in her daily life to reduce the risk of cancer returning.
Conscious eating
Claire limits alcohol and is much more aware of what she eats – checking food labels to see what’s really in the food she’s buying, and dramatically reducing how much red and processed meat she eats, because of the strong links to bowel cancer.
Exercise is also important for people living beyond cancer – with both physical and mental benefits. For Claire, staying active comes naturally as she is the founder of the international dance phenomenon Clubbercise. Blending simple but effective dance, toning and combat moves, Clubbercise is a workout with a difference aimed at all abilities. The atmosphere is more nightclub than gym, as people dance together in a darkened room with low lighting and flashing LED glow sticks.
Know the symptoms of bowel cancer
Claire says she’s “proud to still be here supporting Bowel Cancer Awareness Month”, which takes place in April every year.
“Thankfully, my cancer was caught early and I’m fine now but many people aren’t so lucky. I’ve lost friends to this terrible disease and I’m keen to raise awareness to help others. If you notice any changes to your bowel habits that last more than a couple of weeks please see your doctor straight away – it could save your life!”
Get the lowdown on bowel cancer
What does our research say about how you can prevent the disease?
