Chronic Systemic inflammation has been implicated in the development of colon cancer as well as the progression of colon cancer.* A recent study found that higher systemic inflammation after diagnosis was associated with poorer survival among patients with stage III colon cancer. Now, results from a large, prospective cohort study show that eating a less inflammatory diet may reduce the risk of death for patients with stage III colon cancer.**
This is the conclusion from study results presented at the annual meeting of the American Society of Clinical Oncology (ASCO), held May 30-June 3, 2025, in Chicago, Illinois.
Common Questions
“One of the most common questions that patients ask is what diet they should be following to maximally reduce their risk of cancer recurrence and improve survival. While there have been many studies examining dietary factors and the risk of developing colorectal cancer, there is significantly less known about how diet impacts colon cancer outcomes after diagnosis, noted lead study author Sara K. Char, MD, Dana-Farber Cancer Institute in Boston, Massachusetts.
“This study sheds light on the relationship between dietary patterns and survival in patients with stage III colon cancer,” Char added.
To assess the effects of diet on the risk of colon cancer recurrence, the diet habits of a subset of patients enrolled in the phase 3 CALGB/SWOG 80702 clinical trial were analyzed in a prospective cohort study.
The CALGB/SWOG 80702 clinical trial tested 3 months vs. 6 months of adjuvant chemotherapy, with or without celecoxib (Celebrex®; Viatris), an anti-inflammatory medication. A prospective cohort study follows patients with similar characteristics who differ in a key factor over time to see if that factor impacts outcomes.
Study design
Of the approximately 2,500 patients enrolled in CALGB/SWOG 80702, there were 1,625 patients followed as part of this study.
The patients all had stage III colon cancer that had been removed with surgery. The average age of the participants was 60.9 years. The patients reported their diet and exercise habits at six weeks after being randomly assigned to a treatment group in the CALGB/SWOG 80702 study and again 14 to 16 months after random assignment. Their diets were scored using the empirical dietary inflammatory pattern (EDIP) tool.
The EDIP tool is a weighted sum of 18 food groups: 9 pro-inflammatory and 9 anti-inflammatory. Examples of pro-inflammatory foods include red meat, processed meats, refined grains and sugary drinks.
Examples of anti-inflammatory foods include coffee, tea, dark yellow vegetables, and leafy green vegetables. A high EDIP score indicates a pro-inflammatory diet. A low EDIP score represents a less inflammatory diet.
Major Findings
- Patients who consumed the most pro-inflammatory diets and had the highest EDIP scores were:
- Generally more likely to be younger (average age 58.7 vs. 61.3)
- More likely to be female (64% vs. 48.9%)
- Have an ECOG score of 1 or 2, indicating a lesser ability to perform daily activities (35.7% vs. 19.4%)
- Less likely to be White (76.6% vs. 92.0%)
- More likely to be Black (15.4% vs. 3.7%)
- Pro-inflammatory diets were associated with worse outcomes. Patients with the highest EDIP scores and very pro-inflammatory diets had an 87% higher risk of death than those who ate highly anti-inflammatory diets.
- Exercise habits, another modifiable factor associated with systemic inflammation, also impacted overall survival. Patients who consumed less inflammatory diets and exercised more often (9 or more metabolic equivalent [MET] hours per week) had the best overall survival, with 63% lower risk of death compared to patients who ate pro-inflammatory diets and exercised less (less than 9 MET hours per week).
- There was no significant difference in disease-free survival between the patients who ate a pro-inflammatory diet and those who ate an anti-inflammatory diet.
- Low-dose aspirin use and which treatment regimen the patients received as part of the CALGB/SWOG 80702 trial were not significantly different between the groups.
What’s Next
Based on these outcomes, researchers will continue to study how diet and inflammation, as well as exercise, affect outcomes for patients with colorectal cancer.
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Note: * Chronic systemic inflammation is a known risk factor for developing colon cancer as well as colon cancer progression. There are many possible causes, including certain chronic conditions such as diabetes and inflammatory bowel disease. In addition, dietary, lifestyle, and environmental factors may also play a role.
** Stage III colon cancer is characterized by the spread of cancer cells to nearby lymph nodes, but not to distant areas of the body. Most patients with stage III colon cancer will undergo surgery to remove tumors in their colon and affected lymph nodes. This approach aims for a cure. However, 25% to 35% of patients with stage III colon cancer will see their cancer come back within 5 years of completing treatment.
Clinical trials
Oxaliplatin, Leucovorin Calcium, and Fluorouracil With or Without Celecoxib in Treating Patients With Stage III Colon Cancer Previously Treated With Surgery – ClinicalTrials.gov ID NCT01150045
Highlights of prescribing information
Celecoxib (Celebrex®; Viatris) [Prescribing Information]
Reference
[1] Shi Q, Zemla T, Ma C, Cheng E, Kumthekar P, Guthrie KA, Couture F, Kuebler JP, Kumar P, Tan BR, Krishnamurthi SS, Wolpin BM, Geoffroy FJ, Tabung F, Shields AF, O’Reilly EM, Meyerhardt JA, Yuan C, Ng K. Association between empirical dietary inflammatory pattern (EDIP) and survival in patients with stage III colon cancer: Findings from CALGB/SWOG 80702 (Alliance). Journal of Clinical Oncology 2025 43:17_suppl, LBA3509
Featured image by Mordo Bilman on Unsplash. Used with permission.
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