Colorectal cancer is the fourth most common cancer in the UK and its incidence is increasing. However, survival rates are also increasing. In Scotland, age-standardised, five year survivorship rates have increased from 42.9% in 1987-91 to 64.7% in 2007-11. More people surviving after a bowel cancer diagnosis is fantastic news, but there is considerable room for improvement in both quantity and quality of years; multi-modal treatment pathways, risk of complications and the possibility of a stoma can cause prolonged physical and psychological recovery.
One strategy for improving quality and duration of survivorship might be through lifestyle interventions. However, conducting trials of lifestyle can be complex, especially if more than one health behaviour is being targeted and a number of long term multi-modal treatment options are utilised. Research funders query the feasibility of undertaking trials in this patient group and demonstrating clinically relevant outcomes.
For a great overview of current randomised control trial (RCT) interventions in this area, a recent paper by Moug et al provides a sharp view of work to date. The review team collated evidence from fourteen peer reviewed papers relating to physical activity and six relating to diet and excess weight. The results demonstrate that interventions on physical activity and/or diet and weight are feasible and acceptable to patients and provide a platform for optimising and advancing work in this area.
The evidence suggests that there is scope for interventions to be performed pre-operatively, post-operatively and even many years later to help improve the lives of survivors. The effects of interventions on psychological, physical, dietary and weight improvements have, however, mostly been studied in the short term. Long term trials need to be developed in order to collect robust evidence to influence policy makers.
Here is an understudied area, yet one that deserves more attention, more support and more funding.