Cancer Diagnosis: Study of Outcomes in Colorectal Cancer Survivors (SOCCS) ... FACT-G: functional assessment of cancer therapy-general (total score=PW-.
Racial Differences in Dietary Changes and Quality of Life after a Colorectal Cancer Diagnosis: Study of Outcomes in Colorectal Cancer Survivors (SOCCS) Cari Lewis, PhD ; W. Asher Wolf, MD, PhD ; Pengcheng Xun, MD, PhD ; Robert S. Sandler, MD, MPH ; Ka He, MD, ScD 1
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Department of Epidemiology and Biostatistics, School of Public Health - Bloomington, Indiana University, Bloomington, Indiana 2 Division of Gastroenterology and Hepatology, Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina 1
BACKGROUND
Colorectal cancer (CRC) is the fourth most prevalent cancer in the U.S., with significant racial disparities (1). Evidence suggests making dietary changes after diagnosis may influence survival (2). While research indicates cancer survivors are motivated to make positive changes in diet (3), little has been done to address differences in the types of changes made, how dietary changes affect quality of life (QoL), and whether these differences account for CRC disparities in survival. We assessed the racial differences between Caucasians and African Americans (AAs) in changes in dietary choices and QoL 24 months after stage II CRC diagnosis. Risk of recurrence and survival was explored in relation to race and dietary quality.
Figure 1. Dietary change by race over a 24-month follow-up in Study of Outcomes in Colorectal Cancer Survivors (SOCCS)
Regular ice cream Nuts Hamburgers and other fast foods Grilled foods Fried foods Whole grain Soy products Fruit including juices
Table 1. Beneficial and harmful food items included in the dietary quality index. • BENEFICIAL FOOD ITEMS HARMFUL FOOD ITEMS Reduced-fat milk Reduced-fat cheese Fish Vegetables Fruit including juices Soy products Whole grains Nuts
Whole milk products Red meat Fried foods Hamburgers and other fast foods Full fat/full sugar ice cream Cakes and sweet desserts Fat added to cooked food (butter, margarine, oil)
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Vegetables Fish (not including shellfish) Poultry Reduced-fat cheese
• A total of 453 newly diagnosed patients were enrolled from the North Carolina Central Cancer Registry. • Eligible participants were incident cases of stage II adenocarcinoma of the colorectum diagnosed between September 2009 and March 2011. • Data on demographic variables, treatment, and health behaviors were collected by interview at diagnosis, 12 months post-diagnosis, and 24 months post-diagnosis. • Diet assessed using modified Diet History Questionnaire developed by the National Cancer Institute. • Dietary index based on dietary changes in 15 items (Table 1) based on recommendations from the American Cancer Society. • Quality of life was measured using the Functional Assessment of Cancer Treatment-Colorectal and Medical Outcomes Short Form-12 questionnaires. • Generalized estimating equations and logistic regression models were used to explore associations.
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Tomatoes and tomato products
Red meat
METHODS
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Fat( butter, margarine, oil) additives Cakes and sweet desserts
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Cheese (not including reduced-fat) Reduced-fat milk products Whole milk products (not including cheese)
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-80% -60% -40% -20% African Americans (n=81) denoted by red bars, Caucasians (n=184) denoted by gray bars Bars showing “beneficial” direction based on American Cancer Society recommendations P-value obtained using Wilcoxon rank-sum test; significant at alpha = 0.05 denoted by asterisk
No change
+20%
+40%
+60%
Table 2. Multivariable-adjusted association between race (AAs vs. Caucasians) and QoL assessed by FACT-C and SF-12, Study of Outcomes in Colorectal Cancer Survivors (SOCCS) (AAs: n=81, Caucasians: n=184) MODEL 1
FACT-C FACT-G PWB SWB EWB FWB CCS FACT-C TOI-PFC SF-12 PCS MCS
MODEL 2
β coefficent
95% CI
P-value β coefficent
-1.94 0.01 -1.48 0.19 -0.66 0.51 -1.43 -0.14
-4.83, 0.95 -0.86, 0.88 -2.34, -0.61 -0.48, 0.87 -1.76, 0.44 -0.23, 1.26 -4.87, 2.01 -2.51, 2.24
0.19 0.98
