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Diet dramatically affects the outcome for patients with stage-III colon cancer.

Reference: Meyerhardt JA, Niedzwiecki D, Hollis D, et al. Association of dietary patterns with cancer recurrence and survival in patients with stage III colon cancer. JAMA 2007;298:754-64.

Design: Observational prospective study

Participants: 1009 patients with stage III colon cancer (CA) who were receiving chemotherapy and consuming self-selected diets

Primary Outcome Measures: On the basis of diet diaries compiled during the time they were receiving chemotherapy and six months later, subjects were divided into those consuming a predominantly "prudent" diet and those consuming a predominantly "Western" diet. The prudent diet was characterized as being high in produce, poultry, and fish, while the Western diet was characterized as being high meat, fat, refined carbohydrate, and dessert. Disease-free survival (DFS) and overall survival (OS) were tracked for a median of 5.3 years.

Key Findings: 324 recurrences and 223 colon CA-related deaths occurred during follow-up. Those in the top quintile of adherence to the Western diet had over three times the risk of not retaining their disease-free baseline status by the end of follow-up, compared with those in the bottom quintile (hazard ratio=3.25; 95% CI, 2.0-5.2; p for trend<0.001). Similarly, the risk of dying from all causes was over twice as great in the top quintile of adherence to the Western diet versus those in the bottom quintile (hazard ratio=2.32; 95% CI, 1.35-3.96; P for trend<0.001). Adjusting for gender, age, body mass index, exercise level, etc. did not alter these associations significantly.

Practice Implications: Much previous research has implicated meat consumption as a primary culprit in the high risk of colon CA seen in Western societies, particularly when the meat is well cooked and particularly in genetically susceptible subsets of the population. A relationship between whole grains or insoluble fiber consumption and protection against colon CA has held up in some studies but not most. This report, surprisingly in JAMA, takes a less reductionistic perspective by hunting for the effects of diet from a more global perspective.

Basically the more stereotypically "American" the diet was, the higher was the risk of recurrence from colon CA and death. These findings fit well with previous epidemiologic evidence showing that societies that generally eat more healthful diets than Americans do suffer less from colon CA.

However, the big news here is not the confirmation of such associations, but rather that this study focused on secondary prevention. That primary prevention and secondary prevention are related is accepted by most health care professionals regarding most chronic diseases. The major exception is conventional medicine's view of CA, which historically has assumed diet has little to do with survival or recurrence--at least post diagnosis. These new findings strongly suggest that people who are already diagnosed with colon CA (at least through stage-III disease) stand a good chance of improving their chances of survival by simply changing their diet in ways that would be obvious to most practitioners of natural medicine. These findings greatly underscore the need for colon CA patients to be working with such practitioners, as they are most unlikely to receive such advice from their oncologists.

Author: Steve Austin, N.D.

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Author:Austin, Steve
Publication:Original Internist
Article Type:Clinical report
Date:Mar 1, 2008
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