Healthier Prediagnosis Lifestyle and Long-term Survival in Colorectal Cancer: Evidence from the Singapore Chinese Health Study
5 affiliations
- 1Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
- 2Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- 3Cancer Epidemiology and Prevention Program, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania.
- 4Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
- 5Institute for Human Development and Potential, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.
Abstract
Background:: Evidence from Western populations suggests that healthier prediagnosis lifestyles are associated with improved relative survival after colorectal cancer. We quantified the survival differences by composite prediagnosis lifestyle.
Methods:: Incident colorectal cancer cases (n = 2,124) were identified from the Singapore Chinese Health Study via registry linkage. Deaths (all-cause and colorectal cancer–specific) through December 2022 were ascertained. Prediagnosis lifestyle (diet, physical activity, smoking, body mass index, and sleep) was assessed at enrollment (1993–1998) and combined into a composite score. Cox models estimated hazard ratios (HR); restricted mean survival time (RMST) quantified absolute differences at 10 years after diagnosis. Models were adjusted for stage, age at diagnosis, sex, education, alcohol, and the interval from enrollment to diagnosis.
Results:: During a median of 4.8 years (interquartile range 1.2–11.8 years) of follow-up, 1,557 all-cause deaths occurred, including 1,103 colorectal cancer–specific deaths. Patients with high versus low prediagnosis lifestyle scores had lower hazards of all-cause mortality [HRadjusted 0.74; 95% confidence interval (CI), 0.65–0.92]. The adjusted 10-year RMST difference (high minus low) for all-cause mortality was 0.85 years (95% CI, 0.34–1.35). In patients aged ≤70 years (n = 922), the associations were similar, with a 10-year RMST difference of 1.15 years (0.35–1.95). Stage dominated outcomes, with a 10-year RMST difference (late minus early) of −3.33 years (−3.72 to −2.93).
Conclusions:: Although stage at diagnosis remains the principal driver of survival for patients with colorectal cancer, healthier prediagnosis lifestyles are associated with modest improvements in long-term survival.
Impact:: Longitudinally collected behaviors at multiple time points will complement our findings, providing stronger evidence on the health behaviors that support better survivorship.
Related
- Prediagnosis Smoking and Survival in Lung, Bladder, Kidney, and Head and Neck Cancers: A Population-Based Data Linkage Study
- Comparative Age-Period-Cohort Analysis Reveals Divergent Temporal Trajectories of Breast and Colorectal Cancer Among Women in Singapore
- Genetic Risk, Lifestyle, and Colorectal Cancer Across Age at Onset: A Prospective UK Biobank Study.
- Lifestyle-associated gut microbiota signatures in colorectal cancer patients: a pilot case–control study
- Association between primary-site surgery and overall survival in non-metastatic and metastatic colorectal cancer: a population-based study using the Surveillance, Epidemiology, and End Results database
BibTeX
@article{ho2026healthier,
title = {{Healthier Prediagnosis Lifestyle and Long-term Survival in Colorectal Cancer: Evidence from the Singapore Chinese Health Study}},
author = {Peh Joo Ho and Aizhen Jin and Jian-Min Yuan and Woon-Puay Koh and Adeline Seow},
journal = {Cancer Epidemiology, Biomarkers \& Prevention},
year = {2026},
month = jun,
doi = {10.1158/1055-9965.epi-26-0308},
url = {https://doi.org/10.1158/1055-9965.epi-26-0308},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Healthier Prediagnosis Lifestyle and Long-term Survival in Colorectal Cancer: Evidence from the Singapore Chinese Health Study
AU - Peh Joo Ho
AU - Aizhen Jin
AU - Jian-Min Yuan
AU - Woon-Puay Koh
AU - Adeline Seow
PY - 2026
DA - 2026/06/11
JO - Cancer Epidemiology, Biomarkers & Prevention
DO - 10.1158/1055-9965.epi-26-0308
UR - https://doi.org/10.1158/1055-9965.epi-26-0308
AB - Background:: Evidence from Western populations suggests that healthier prediagnosis lifestyles are associated with improved relative survival after colorectal cancer. We quantified the survival differences by composite prediagnosis lifestyle. Methods:: Incident colorectal cancer cases (n = 2,124) were identified from the Singapore Chinese Health Study via registry linkage. Deaths (all-cause and colorectal cancer–specific) through December 2022 were ascertained. Prediagnosis lifestyle (diet, physical activity, smoking, body mass index, and sleep) was assessed at enrollment (1993–1998) and combined into a composite score. Cox models estimated hazard ratios (HR); restricted mean survival time (RMST) quantified absolute differences at 10 years after diagnosis. Models were adjusted for stage, age at diagnosis, sex, education, alcohol, and the interval from enrollment to diagnosis. Results:: During a median of 4.8 years (interquartile range 1.2–11.8 years) of follow-up, 1,557 all-cause deaths occurred, including 1,103 colorectal cancer–specific deaths. Patients with high versus low prediagnosis lifestyle scores had lower hazards of all-cause mortality [HRadjusted 0.74; 95% confidence interval (CI), 0.65–0.92]. The adjusted 10-year RMST difference (high minus low) for all-cause mortality was 0.85 years (95% CI, 0.34–1.35). In patients aged ≤70 years (n = 922), the associations were similar, with a 10-year RMST difference of 1.15 years (0.35–1.95). Stage dominated outcomes, with a 10-year RMST difference (late minus early) of −3.33 years (−3.72 to −2.93). Conclusions:: Although stage at diagnosis remains the principal driver of survival for patients with colorectal cancer, healthier prediagnosis lifestyles are associated with modest improvements in long-term survival. Impact:: Longitudinally collected behaviors at multiple time points will complement our findings, providing stronger evidence on the health behaviors that support better survivorship.
SN - 1055-9965
SN - 1538-7755
ER -