What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Cancer survivors (n=209659). Intervention: Healthiest combined lifestyle factors vs. Least healthy combined lifestyle factors. Primary outcome: All-cause mortality (HR 0.57, 95% CI 0.51-0.65).

December 1, 2024Open Access

Combined lifestyle factors on mortality and cardiovascular disease among cancer survivors: a systematic review and meta-analysis of cohort studies

Q: What does this research mean for the field?

Adhering to a combination of healthy lifestyle factors significantly reduces all-cause mortality, cancer-specific mortality, and cardiovascular disease incidence among cancer survivors. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

CZChunsu ZhuGerman Cancer Research Center ZLZengling LianGerman Cancer Research Center VAVolker ArndtUniversity of North Carolina at Chapel Hill

Key Result

Cancer survivors with the healthiest combined lifestyle factors had a 43% lower risk of all-cause mortality compared to those with the least healthy lifestyles (HR 0.57).

Study Design

Type

Meta-Analysis (n=209,659)

Structured PICO

Does adherence to a combined healthy lifestyle reduce mortality and cardiovascular disease incidence in cancer survivors?

Population

209,659 cancer survivors from 22 cohort studies, followed for an average of 4.1 to 29.1 years, to assess the association of combined lifestyle factors with mortality and cardiovascular disease.

Exposure

Healthiest lifestyle pattern (combination of at least three lifestyle factors including diet, physical activity, body weight, cigarette smoking, and alcohol consumption)

Comparator

Least healthy lifestyle pattern

Outcome

All-cause mortality, cancer-specific mortality, and cardiovascular disease (CVD) incidencehard clinical

Adherence to an overall healthy lifestyle pattern is associated with significantly lower risks of all-cause mortality, cancer-specific mortality, and cardiovascular disease incidence among cancer survivors.

Main Result

Hazard Ratio: 0.57 (95% CI 0.51–0.65)

Limitations

Heterogeneity across studies due to differences in study characteristics, methodologies, and definitions of healthy lifestyles
Most studies were conducted in high-income countries, limiting generalizability to low- and middle-income countries
Few publications were available for CVD incidence in cancer survivors
Only three studies examined the associations between changes in combined lifestyles and all-cause mortality
Only one study on childhood cancer survivors was available
Potential residual bias despite adjustment for a wide range of confounders

Abstract

PURPOSE: Lifestyle factors in cancer survivors are frequently studied individually even though they are often interconnected. This systematic review and meta-analysis investigated the association of combined lifestyle factors on health outcomes among cancer survivors. METHODS: EMBASE, PubMed and Web of Science were searched up to March 2024. Cohort studies examining the associations of at least three combined lifestyle factors with mortality (all-cause/cancer-specific) and cardiovascular disease (CVD) among cancer survivors, were selected. Pooled hazard ratios (pHRs) and 95% confidence intervals (CIs) were estimated using random effects models. Tests for heterogeneity and publication bias were conducted. RESULTS: Twenty-two studies involving 209,659 survivors with an average follow-up duration ranging from 4.1 to 29.1 years were included. pHRs(95%CI) comparing cancer survivors with the healthiest lifestyles versus those with the least healthy lifestyles were 0.57 (0.51-0.65) for all-cause mortality, 0.70 (0.61-0.80) for cancer-specific mortality, and 0.53 (0.46-0.63) for CVD incidence. These associations were largely consistent across subgroup analyses. Colorectal cancer survivors with the healthiest lifestyle experienced 37% lower all-cause mortality and 25% lower cancer-specific mortality, while breast cancer survivors had a 45% reduction in all-cause mortality. Although studies were limited, significant associations for all-cause mortality were observed among lung, liver, nasopharyngeal, gastric, kidney, gynecologic cancer survivors. However, no significant relationship between healthy lifestyles and CVD-specific mortality was detected. CONCLUSIONS: Having an overall healthy lifestyle is associated with lower CVD incidence and better survival among cancer survivors. The long-term management of cancer survivors should consider encouragement for a modification of multiple lifestyles.

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