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The role of physical activity, sedentary behaviour, diet, adiposity and body composition on health-related quality of life and cancer-related fatigue after diagnosis of colorectal cancer: a global cancer update programme (CUP Global) systematic literature review and meta-analysis

Markozannes, G.
; 
Cividini, S.
; 
Aune, D.
; 
Becerra-Tomás, N.
; 
Kiss, S.
; 
Balducci, K.
; 
Vieira, R.
; 
Cariolou, M.
; 
Jayedi, A.
; 
Greenwood, D. C.
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Abstract
BACKGROUND: The impact of physical activity, sedentary behaviour, diet, adiposity, and body composition on health-related quality of life (HRQoL) and cancer-related fatigue among colorectal cancer survivors remains uncertain. METHODS: PubMed, Embase, and CENTRAL were systematically searched until April 2023 for relevant randomised controlled trials (RCTs) and cohort studies. Random-effects meta-analyses or descriptive syntheses were conducted depending on the number of studies. The evidence was interpreted and graded by an independent World Cancer Research Fund Expert Committee and Expert Panel. RESULTS: We included 31 RCTs (18 exercise, 14 diet) and 30 cohort studies (8 physical activity, 3 sedentary behaviour, 13 diet, 9 adiposity and body composition). Meta-analyses were possible for exercise RCTs that showed non-significant effects but indicative of improved HRQoL (overall four trials for global HRQoL, physical and emotional well-being) and fatigue (five trials). These studies were rated at a high risk of bias (RoB), and evidence was graded as 'very low certainty of an effect'. Descriptive synthesis of interventions to improve diet quality suggested small improvements in global HRQoL and physical well-being, but with a high RoB rating leading to a 'low certainty' grading. Evidence from RCTs on probiotics and supplements and evidence from observational studies on sedentary behaviour, and various dietary and body composition factors was generally inconsistent and too scarce to draw conclusions. CONCLUSIONS: Exercise and diet quality interventions might improve HRQoL and fatigue outcomes in colorectal cancer survivors. The evidence overall was limited and should be strengthened by larger, well-designed RCTs across the cancer continuum.
Authors
Markozannes, G.
Cividini, S.
Aune, D.
Becerra-Tomás, N.
Kiss, S.
Balducci, K.
Vieira, R.
Cariolou, M.
Jayedi, A.
Greenwood, D. C.
Brockton, N. T.
Croker, H.
Mitrou, P.
Copson, E.
Renehan, A. G.
Bours, M.
Demark-Wahnefried, W.
Hudson, M. M.
May, A. M.
Odedina, F. T.
Skinner, R.
Steindorf, K.
Tjønneland, A.
Velikova, G.
Baskin, M. L.
Chowdhury, R.
Hill, L.
Lewis, S. J.
Seidell, J.
Weijenberg, M. P.
Krebs, J.
Cross, A. J.
Tsilidis, K. K.
Chan, D. S. M.
Affiliation
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Department of Nutrition, Oslo New University College, Oslo, Norway; Department of Research, The Cancer Registry of Norway, Oslo, Norway. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Department of Basic Medical Sciences, Faculty of Medicine and Health Sciences, Rovira i Virgili University, Reus, Spain. Leeds Institute for Data Analytics, Faculty of Medicine and Health, University of Leeds, Leeds, UK. American Institute for Cancer Research, Washington, USA. World Cancer Research Fund International, London, UK. Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK. The Christie NHS Foundation Trust, Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK. Department of Epidemiology, GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands. O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Alabama, USA. Department of Oncology, St Jude Children's Research Hospital, Memphis, USA. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands. Mayo Clinic Comprehensive Cancer Center, Jacksonville, Florida, USA. Department of Paediatric and Adolescent Haematology and Oncology, Great North Children's Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, and Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK. Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany. Danish Cancer Institute, Diet, Cancer and Health, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark. Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Cancer Centre, St James's University Hospital, Leeds, UK. UPMC Hillman Cancer Center, Pittsburgh, USA. Department of Global Health, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, USA. Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, The Netherlands. Department of Zoology, University of Oxford, Oxford, UK. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK. Electronic address: d.chan@imperial.ac.uk.
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2025
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All Christie Publications
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Markozannes G, Cividini S, Aune D, Becerra-Tomás N, Kiss S, Balducci K, et al. The role of physical activity, sedentary behaviour, diet, adiposity and body composition on health-related quality of life and cancer-related fatigue after diagnosis of colorectal cancer: a Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis. ESMO open. 2025 Apr;10(4):104301. PubMed PMID: 40086399. Pubmed Central PMCID: PMC11952013. Epub 2025/03/15. eng.
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https://christie.openrepository.com/handle/10541/628187
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