More than Survival – Using Lifestyle to Improve Healthspan in Colorectal Cancer: Sami Mansfield

“March is Colorectal Cancer Awareness Month. Colorectal cancer (CRC) is one of the most common – yet preventable – cancers. Colorectal cancer is on the rise among younger adults, and it is estimated that there will be 3.2 million new cases globally per year by 2040 (an increase of 63%) and 1.6 million deaths per year (an increase of 73%). (WHO)

During the last Small Steps, Big Living blog, we highlighted the importance of risk-reducing behaviors in addition to screenings.

While reducing the risk of cancer is the best prevention strategy, the reality is that the number of people diagnosed with the disease each year is increasing, and general disparities are widening. Our conversations about colorectal cancer (CRC) and lifestyle factors like nutrition and exercise often focus on early detection and treatment – but what happens after diagnosis?

Does lifestyle take a backseat to medical treatment? If you’re an oncology professional, reflect on your discussions with patients and caregivers. When the conversation shifted from treatment options to questions about nutrition, exercise, or other daily habits, how did you approach it respond?

Cancer outcomes are typically assessed by survival rates – how long someone lives, especially at the five-year mark. But what about healthspan – the years spent in good health, free from the side effects of chronic disease or physical and mental disabilities? Healthspan isn’t just about adding years; it’s about preserving physical function and cognitive health independence.

A PubMed search for quality of life in colorectal cancer yields 3,300 studies from the past five years. That sounds impressive, but what are these studies really about? Most share the well-known understanding that many cancer treatments have long-term impacts that are critically important to our patients. These studies should be digging into the most pressing question: Are we truly enhancing patients’ lives – or merely prolonging them

When searching for healthspan and colorectal cancer, only two studies emerge from the past five years. And while this may be a newer term of health, some significant data already exists in the general population.

A global study conducted by the WHO across 183 countries found that people spend an average of 9.6 years in poor health throughout their lives. Women experience a greater health gap, living 2.4 years longer in poor health than men, due to a higher burden of chronic disease. In the United States, the healthspan gap is even larger at 12.4 years – 29% worse than the global average. (Garmany, 2024)

While this data isn’t cancer-specific, it raises an urgent question: Are cancer survivors facing an even larger gap in their healthspan? Especially in populations where health disparities already exist?

Lifestyle and Colorectal Cancer: Does It Matter After Diagnosis?

While lifestyle plays a significant role in preventing colorectal cancer, its impact after diagnosis is often overlooked. Increasing evidence indicates that lifestyle directly influences survival and recurrence rates, particularly concerning the key pillars of lifestyle medicine: exercise, nutrition, and reducing unhealthy habits.

The Power of Movement

The most recent edition of the report ‘Diet, Nutrition, Physical Activity, and Body Weight for People Living with and Beyond Colorectal Cancer’ from the World Cancer Research Fund and part of the CUP Global updates published in 2024, included a review of 16 studies involving over 82,000 colorectal cancer survivors from six countries, revealing that regular physical activity was associated with a 13% to 60% lower risk of recurrence and death. (WCRF)

While the number of studies in the advanced metastatic cancer field is growing, significant research has emerged, including a 2019 study from Dana Farber, which was one of the first to demonstrate that even light exercise, such as walking for four hours a week, can slow cancer progression in patients with metastatic colorectal cancer.

Moderate daily activity reduced severe chemotherapy side effects by 27% and suggested an improvement in overall survival. Patients who exercised for at least 30 minutes each day experienced a 15% increase in overall survival, although the data was not statistically significant.

These findings support the idea of exercise as a powerful tool in cancer care, highlighting the importance of movement for both healthspan and survival outcomes. (Guercio, 2019)

The takeaway? All movement, especially planned exercise, matters. Even small increases in activity – walking, stretching, strength training – are powerful healthspan tools and prolonged sitting correlated with higher mortality from all causes. (Gao, 2024)

Nutrition’s Role in Survival

Research shows that a high-quality diet improves survival rates for colorectal cancer (CRC) survivors. The Mediterranean Diet, rich in whole grains, vegetables, and healthy fats while limiting processed foods, has consistently been linked to lower mortality. (Ratjen, 2017) A large German cohort study found that adherence to a Modified Mediterranean Diet significantly improved overall health survival.

Conversely, poor-quality diets are associated with worse outcomes. Diets high in red and processed meats, refined grains, and added sugars are linked to higher recurrence rates and lower survival. Additionally, pro-inflammatory diets, as measured by the Dietary Inflammatory Index (DII), correlate with increased overall mortality, while anti-inflammatory diets provide protective benefits.

It’s important to clearly define what a Mediterranean-style diet entails. While it emphasizes plant-based foods, it also permits moderate amounts of poultry, fish, eggs, and dairy as part of a balanced approach.

The Good News: Following cancer prevention guidelines on diet, physical activity, and weight management (WCRF/AICR) has been shown to improve prognosis in CRC survivors, reinforcing the role of lifestyle in long-term health health.

A Call to Action: Prioritizing Healthspan

Surviving cancer is one battle; thriving beyond cancer is another.

The data is clear: lifestyle choices matter – not only for preventing CRC but also for improving survival and healthspan after diagnosis.

Yet, gaps in knowledge and access remain: Many CRC survivors are unaware of how diet, exercise, and lifestyle influence their survival. Not all patients have access to registered dietitians or exercise specialists for personalized guidance.

We need to explore simple, accessible tools like apps that can help assess food quality and leverage self-led exercise including options that exist on YouTube.

Considering all these barriers that are likely to remain a part of cancer care for the foreseeable future, enhancing the importance of lifestyle habits becomes even more crucial.

This isn’t about perfection – it’s about progress. Helping our cancer survivors make small, consistent changes can help shift the conversation from just surviving to truly living.

Final Thought: The Future of Cancer Care Must Include Lifestyle Medicine

If we genuinely want to enhance outcomes for colorectal cancer survivors, we must stop considering lifestyle as an afterthought. Diet, physical activity, and the other lifestyle pillars should be integral to survivorship care.

At the end of the day, the question isn’t just ‘How long can we live?’ – it’s ‘How well can we live?’ “

written by Sami Mansfield

Sami Mansfield is an exercise oncology and lifestyle medicine consultant with endless curiosity and persistence. As the founder of Cancer Wellness for Life, Sami has dedicated her career to empowering cancer survivors and clinicians through innovative, evidence-based programs that improve health outcomes while optimizing cost-efficiency.

Sami is a contributing author to groundbreaking guidelines, including the ASCO Guidelines on Exercise, Nutrition, and Weight Management, and has helped shape numerous state cancer control plans.

She is the current chair of the Cancer Member Interest Group for the American College of Lifestyle Medicine, where she drives forward initiatives emphasizing the connection between science and implementation. Her patient-facing programs like BUILD and My Lifestyle Shift have reached global audiences, transforming lives through the pillars of lifestyle medicine.