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Physical Activity Is Associated with Improved Overall Survival among Patients with Metastatic Colorectal Cancer

Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands
Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
Department of Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
GROW School for Oncology and Developmental Biology, Maastricht University, 6200 MD Maastricht, The Netherlands
Department of Surgery, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands
Department of Radiotherapy, Maastro Clinic, 6202 NA Maastricht, The Netherlands
Department of Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands
Department of Medical Oncology, Antonius Hospital, 8600 BA Sneek, The Netherlands
Department of Medical Oncology, Rivas, Banneweg 57, 4204 AA Gorinchem, The Netherlands
Department of Surgery, Reinier de Graaf Hospital, Reinier de Graafweg 5, 2600 GA Delft, The Netherlands
Department of Medical Oncology, Meander Medical Center, Maatweg 3, 3813 TZ Amersfoort, The Netherlands
Department of Medical Oncology, Ziekenhuis Gelderse Vallei, 6710 HN Ede, The Netherlands
Department of Medical Oncology, Haaglanden Medical Center, 2501 CK Den Haag, The Netherlands
Department of Medical Oncology, Northwest Clinics, 1800 AM Alkmaar, The Netherlands
Department of Medical Oncology, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609 PP Hengelo, The Netherlands
Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
Department of Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3000 AD Rotterdam, The Netherlands
Department of Medical Oncology, Canisius Wilhelmina Hospital, 6500 GS Nijmegen, The Netherlands
Department of Surgery, Viecuri Hospital, Tegelseweg 210, 5912 BL Venlo, The Netherlands
Department of Medical Oncology, St. Antonius Hospital, 3430 EM Nieuwegein, The Netherlands
Department of Medical Oncology, Medisch Spectrum Twente, 7500 KA Enschede, The Netherlands
Department of Medical Oncology, Wilhelmina Hospital, 9400 RA Assen, The Netherlands
Department of Surgery, Leiden University Medical Center, University of Leiden, Postzone K6-39 Albinusdreef 2, 2300 RC Leiden, The Netherlands
Department of Medical Oncology, Sint Jans Hospital, Vogelsbleek 5, 6001 BE Weert, The Netherlands
Department of Medical Oncology, Jeroen Bosch Hospital, 5200 ME Den Bosch, The Netherlands
Department of Medical Oncology, Haga Hospital, Els Borst-Eilersplein 275, 2545 AA Den Haag, The Netherlands
Department of Medical Oncology, Rode Kruis Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands
Department of Surgery, Diakonessenhuis Hospital, Bosboomstraat 1, 3582 KE Utrecht, The Netherlands
Department of Surgery, St. Jansdal Hospital, Wethouder Jansenlaan 90, 3844 DG Harderwijk, The Netherlands
Department of Gastroenterology and Hepatology, Bernhoven Hospital, Nistelrodeseweg 10, 5406 PT Uden, The Netherlands
Department of Medical Oncology, ZorgSaam Hospital, Wielingenlaan 2, 4535 PA Terneuzen, The Netherlands
Department of Medical Oncology, Academisch Medisch Centrum, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
Department of Medical Oncology, Flevo Hospital, Hospitaalweg 1, 1315 RA Almere, The Netherlands
Department of Surgery, Dijklander Hospital, Waterlandlaan 250, 1441 RN Purmerend, The Netherlands
Department of Surgery, Spaarne Hospital, 2000 AK Haarlem, The Netherlands
Department of Medical Oncology, Treant Hospital, 7800 RA Emmen, The Netherlands
Department of Medical Oncology, Bravis Hospital, Boerhaavelaan 25, 4708 AE Roosendaal, The Netherlands
Department of Medical Oncology, Rivierenland Hospital, 4000 HA Tiel, The Netherlands
Department of Medical Oncology, Maastricht University Medical Center, 6202 NA Maastricht, The Netherlands
Department of Medical Oncology, Tergooi Hospital, Van Riebeeckweg 212, 1213 XZ Hilversum, The Netherlands
Department of Surgery, Ikazia Hospital, Montessoriweg 1, 3083 AN Rotterdam, The Netherlands
Department of Medical Oncology, Rijnstate Hospital, Postus 9555, 6800 TA Arnhem, The Netherlands
Department of Surgery, Elkerliek Hospital, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands
Department of Surgery, Radboud University Medical Center, University of Nijmegen, 6500 HB Nijmegen, The Netherlands
Author to whom correspondence should be addressed.
Further membership of the PLCRC Study Group is provided in the Acknowledgments.
Academic Editor: Alina Vrieling
Cancers 2022, 14(4), 1001;
Received: 14 January 2022 / Revised: 8 February 2022 / Accepted: 14 February 2022 / Published: 16 February 2022
(This article belongs to the Special Issue The Role of Lifestyle-Related Factors in Cancer Survivorship)
Physical activity is linked to longer survival among non-metastasized colorectal cancer patients. It is unclear if physical activity is also beneficial for survival among patients with metastatic colorectal cancer. We researched this question in our study of 293 patients with metastatic colorectal cancer. We found that participants who reported higher levels of physical activity at diagnosis lived longer compared to patients who reported low activity levels. Furthermore, adherence to the physical activity guidelines for cancer survivors was related to prolonged survival. Our findings suggest that patients with metastatic colorectal cancer also benefit from being physically active. Future studies are needed to investigate whether improving exercise levels after diagnosis of metastasis is also beneficial and what kind of exercise interventions are most optimal for possibly improving survival time of patients with metastatic colorectal cancer.
Regular physical activity (PA) is associated with improved overall survival (OS) in stage I–III colorectal cancer (CRC) patients. This association is less defined in patients with metastatic CRC (mCRC). We therefore conducted a study in mCRC patients participating in the Prospective Dutch Colorectal Cancer cohort. PA was assessed with the validated SQUASH questionnaire, filled-in within a maximum of 60 days after diagnosis of mCRC. PA was quantified by calculating Metabolic Equivalent Task (MET) hours per week. American College of Sports and Medicine (ACSM) PA guideline adherence, tertiles of moderate to vigorous PA (MVPA), and sport and leisure time MVPA (MVPA-SL) were assessed as well. Vital status was obtained from the municipal population registry. Cox proportional-hazards models were used to study the association between PA determinants and all-cause mortality adjusted for prognostic patient and treatment-related factors. In total, 293 mCRC patients (mean age 62.9 ± 10.6 years, 67% male) were included in the analysis. Compared to low levels, moderate and high levels of MET-hours were significantly associated with longer OS (fully adjusted hazard ratios: 0.491, (95% CI 0.299–0.807, p value = 0.005) and 0.485 (95% CI 0.303–0.778, p value = 0.003), respectively), as were high levels of MVPA (0.476 (95% CI 0.278–0.816, p value = 0.007)) and MVPA-SL (0.389 (95% CI 0.224–0.677, p value < 0.001)), and adherence to ACSM PA guidelines compared to non-adherence (0.629 (95% CI 0.412–0.961, p value = 0.032)). The present study provides evidence that higher PA levels at diagnosis of mCRC are associated with longer OS. View Full-Text
Keywords: metastatic colorectal cancer; physical activity; all-cause mortality; survival metastatic colorectal cancer; physical activity; all-cause mortality; survival
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Figure 1

MDPI and ACS Style

Smit, K.C.; Derksen, J.W.G.; Beets, G.L.O.; Belt, E.J.T.; Berbée, M.; Coene, P.P.L.O.; van Cruijsen, H.; Davidis, M.A.; Dekker, J.W.T.; van Dodewaard-de Jong, J.M.; Haringhuizen, A.W.; Helgason, H.H.; Hendriks, M.P.; Hoekstra, R.; de Hingh, I.H.J.T.; IJzermans, J.N.M.; Janssen, J.J.B.; Konsten, J.L.M.; Los, M.; Mekenkamp, L.J.M.; Nieboer, P.; Peeters, K.C.M.J.; Peters, N.A.J.B.; Pruijt, H.J.F.M.; Quarles van Ufford-Mannesse, P.; Rietbroek, R.C.; Schiphorst, A.H.W.; Schouten van der Velden, A.; Schrauwen, R.W.M.; Sie, M.P.S.; Sommeijer, D.W.; Sonneveld, D.J.A.; Stockmann, H.B.A.C.; Tent, M.; Terheggen, F.; Tjin-A-Ton, M.L.R.; Valkenburg-van Iersel, L.; van der Velden, A.M.T.; Vles, W.J.; van Voorthuizen, T.; Wegdam, J.A.; de Wilt, J.H.W.; Koopman, M.; May, A.M.; on behalf of the PLCRC Study Group. Physical Activity Is Associated with Improved Overall Survival among Patients with Metastatic Colorectal Cancer. Cancers 2022, 14, 1001.

AMA Style

Smit KC, Derksen JWG, Beets GLO, Belt EJT, Berbée M, Coene PPLO, van Cruijsen H, Davidis MA, Dekker JWT, van Dodewaard-de Jong JM, Haringhuizen AW, Helgason HH, Hendriks MP, Hoekstra R, de Hingh IHJT, IJzermans JNM, Janssen JJB, Konsten JLM, Los M, Mekenkamp LJM, Nieboer P, Peeters KCMJ, Peters NAJB, Pruijt HJFM, Quarles van Ufford-Mannesse P, Rietbroek RC, Schiphorst AHW, Schouten van der Velden A, Schrauwen RWM, Sie MPS, Sommeijer DW, Sonneveld DJA, Stockmann HBAC, Tent M, Terheggen F, Tjin-A-Ton MLR, Valkenburg-van Iersel L, van der Velden AMT, Vles WJ, van Voorthuizen T, Wegdam JA, de Wilt JHW, Koopman M, May AM, on behalf of the PLCRC Study Group. Physical Activity Is Associated with Improved Overall Survival among Patients with Metastatic Colorectal Cancer. Cancers. 2022; 14(4):1001.

Chicago/Turabian Style

Smit, Karel C., Jeroen W. G. Derksen, Geerard L. O. Beets, Eric J. Th. Belt, Maaike Berbée, Peter Paul L. O. Coene, Hester van Cruijsen, Marjan A. Davidis, Jan Willem T. Dekker, Joyce M. van Dodewaard-de Jong, Annebeth W. Haringhuizen, Helgi H. Helgason, Mathijs P. Hendriks, Ronald Hoekstra, Ignace H. J. T. de Hingh, Jan N. M. IJzermans, Johan J. B. Janssen, Joop L. M. Konsten, Maartje Los, Leonie J. M. Mekenkamp, Peter Nieboer, Koen C. M. J. Peeters, Natascha A. J. B. Peters, Hans J. F. M. Pruijt, Patricia Quarles van Ufford-Mannesse, Ron C. Rietbroek, Anandi H. W. Schiphorst, Arjan Schouten van der Velden, Ruud W. M. Schrauwen, Mark P. S. Sie, Dirkje W. Sommeijer, Dirk J. A. Sonneveld, Hein B. A. C. Stockmann, Marleen Tent, Frederiek Terheggen, Manuel L. R. Tjin-A-Ton, Liselot Valkenburg-van Iersel, Ankie M. T. van der Velden, Wouter J. Vles, Theo van Voorthuizen, Johannes A. Wegdam, Johannes H. W. de Wilt, Miriam Koopman, Anne M. May, and on behalf of the PLCRC Study Group. 2022. "Physical Activity Is Associated with Improved Overall Survival among Patients with Metastatic Colorectal Cancer" Cancers 14, no. 4: 1001.

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