Abstract A09: Adherence to the WCRF/AICR recommendations for cancer prevention is associated with all-cause and cancer mortality among elderly female cancer survivors
Authors: Inoue-Choi Maki , Lazovich DeAnn , Robien Kim 
Published: January 2014

Abstract
Background: Lifestyle recommendations to decrease risk of primary cancer such as eating a healthy diet, maintaining ideal body weight and staying physically active may also decrease risk of subsequent cancers and other chronic disease. The 2007 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) body weight, physical activity and dietary guidelines encourage cancer survivors to follow its cancer prevention recommendations. However, the quantity and quality of research available to support evidence-based recommendations specific to cancer survivors are deemed to be insufficient.
Methods: A total of 2,080 participants in the Iowa Women's Health Study who had a confirmed cancer diagnosis between 1986 and 2002 and completed the follow-up questionnaire in 2004 were included in analysis. Dietary intake, body weight, and physical activity level, as well as other demographic and lifestyle factors were collected in the 2004 survey. An adherence score to the 2007 WCRF/AICR recommendations (range: 0–8) was calculated assigning one point each of eight recommendations. Vital status and cause of deaths were collected through annual linkage with the State of Health Registry of Iowa and the National Death Index. Multivariate hazard ratios (HR) and 95% confidence intervals (CI) of cancer, cardiovascular disease (CVD), and all-cause mortality were computed for quartiles of adherence scores by Cox regression proportional hazard regression models. Mortality was also compared by body weight, physical activity, or dietary recommendation adherence scores.
Results: From 2004 through 2009, 495 deaths were identified, including 197 due to cancer and 153 due to CVD. All-cause mortality was lower for women with the highest (6-8) versus lowest (0-4) adherence scores (HR=0.63, 95%CI=0.47-0.85) after adjusting for age, number of comorbid conditions, perceived general health, current smoking, type and stage of cancer, type of cancer treatment, current cancer treatment and subsequent cancer diagnosis. When stratifying by time since diagnosis or cancer type, this inverse association was confined to women who survived 5-10 y, survivors of breast cancer, and survivors in the “other cancers” category (cancers other than breast, colorectal and endometrial cancers). Similarly, cancer mortality was lower among women with the highest versus lowest adherence scores (HR=0.55, 95%CI=0.34-0.90), but only among survivors in the “other cancers” category. CVD mortality was not different by adherence scores. Meeting the physical activity recommendation was associated with lower risk of death from any cause (ptrend&lt;0.0001), CVD (ptrend=0.045) and cancer (ptrend=0.01) after adjusting for dietary and body weight recommendation adherence scores and other covariates. Meeting the dietary recommendations was not associated with mortality after adjusting for physical activity recommendation adherence scores.
Conclusions: Adherence to lifestyle recommendations to prevent primary cancers may improve all-cause and cancer mortality among elderly female cancer survivors. Being physically active appears to have a strong and independent association with lower mortality among elderly cancer survivors.
Citation Format: Maki Inoue-Choi, DeAnn Lazovich, Kim Robien. Adherence to the WCRF/AICR recommendations for cancer prevention is associated with all-cause and cancer mortality among elderly female cancer survivors. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr A09.