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Science Nook: WCRF/AICR Recommendations and Patient-Reported Outcomes in Colorectal Cancer Survivors

by Jenna Koroly, MS, RD, CSOWM, CDN

The World Cancer Research Fund and the American Institute for Cancer Research (WCRF/AICR) provide lifestyle recommendations for cancer prevention, and advise the same recommendations for cancer survivorship. These recommendations include maintaining a healthy weight, making physical activity part of a daily routine, eating vegetables, fruit, whole grains, and beans, and limiting fast food, red and processed meats, sugar-sweetened beverages, and alcohol [i,ii]. The below study looks at these recommendations as related to quality of life, fatigue, and neuropathy in colorectal cancer survivors.


Associations of the dietary World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations with patient-reported outcomes in colorectal cancer survivors 2-10 years post-diagnosis: a cross-sectional analysis

Journal: British Journal of Nutrition

This cross-sectional study involved 150 participants in the Netherlands between 2002 and 2010 from the Energy for Life after ColoRectal cancer (EnCoRe) study. Participants were colorectal cancer survivors 2-10 years post-treatment. Participants completed seven consecutive day dietary records which were reviewed by registered dietitians. In addition, participants filled out a quality of life questionnaire (the EORTC QLQ-C30) which included functioning scales (physical, role, cognitive, emotional, and social functioning), symptom scales (fatigue, pain, nausea and vomiting), a global health/QoL scale, and cancer specific components. Participants also completed a fatigue questionnaire (the CIS) and a physical activity questionnaire (the SQUASH). The authors looked at the outcomes of health-related quality of life (HRQoL), fatigue, and neuropathy [i].


The authors found:

1. Higher intake of fruit and vegetables was associated with better physical functioning, primarily due to vegetable intake

2. Higher intake of vegetables was associated with better global QoL and decreased fatigue

3. Higher intake of energy-dense food was associated with worse physical functioning

4. Higher intake of sugar-sweetened beverages was associated with lower HRQoL scores and increased fatigue

5. Those who did not drink alcohol had lower scores on the physical, role, and social functioning scales and increased fatigue compared to those with moderate alcohol intake. No associations were found for moderate compared to heavy alcohol intakes.

6. No associations between dietary recommendations and neuropathy [i]

For the Patient and Caregiver

Fatigue and CIPN (cancer-related fatigue and chemotherapy-induced peripheral neuropathy) may negatively influence physical functioning and activities of daily living up to 10 years after cancer treatment [Tofthagen, 2010, Bakitas, 2007, & Mols et al., 2013 as cited in reference i]. Although the authors of the present study did not find any associations between the WCRF/AICR recommendations and neuropathy, they did find beneficial outcomes with increased intake of vegetables and fruit and decreased intake of energy-dense food and sugar-sweetened beverages. For ideas on how to incorporate more vegetables into your eating pattern, take a look at our recipes. For more information on cancer prevention and survivorship recommendations, check out the WCRF and the AICR.

For the Healthcare Team

Encourage individuals to include a vegetable or fruit with each meal and snack, with an emphasis on vegetables. Depending on the individual’s preference, suggestions of combinations may be helpful such as a spinach egg white omelet, Greek yogurt mixed with pumpkin puree, broccoli added to pasta or grain dishes, and carrots with hummus. Additional research with larger sample sizes would be beneficial to further explore the lifestyle recommendations as they impact quality of life, fatigue, and neuropathy in survivorship of colorectal and other cancers.


[i] Kenkhuis MF, van der Linden BWA, Breedveld-Peters JJL, Koole JL, van Roekel EH, Breukink SO…Bours MJL. (2020). Associations of the dietary World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations with patient-reported outcomes in colorectal cancer survivors 2-10 years post-diagnosis: a cross-sectional analysis. British Journal of Nutrition, 1-13. doi:10.1017/S0007114520003487

[ii] Cancer Prevention Recommendations. World Cancer Research Fund International. Retrieved from https://www.wcrf.org/dietandcancer/cancer-prevention-recommendations

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