Combined lifestyle factors on mortality and cardiovascular disease among cancer survivors: a systematic review and meta-analysis of cohort studies

Lifestyle factors in cancer survivors are frequently studied individually even though they are often interconnected. This systematic review and meta-analysis investigated the association of combined lifestyle factors on health outcomes among cancer survivors.

EMBASE, PubMed and Web of Science were searched up to March 2024. Cohort studies examining the associations of at least three combined lifestyle factors with mortality (all-cause/cancer-specific) and cardiovascular disease (CVD) among cancer survivors, were selected. Pooled hazard ratios (pHRs) and 95% confidence intervals (CIs) were estimated using random effects models. Tests for heterogeneity and publication bias were conducted.

Twenty-two studies involving 209,659 survivors with an average follow-up duration ranging from 4.1 to 29.1 years were included. pHRs(95%CI) comparing cancer survivors with the healthiest lifestyles versus those with the least healthy lifestyles were 0.57 (0.51–0.65) for all-cause mortality, 0.70 (0.61–0.80) for cancer-specific mortality, and 0.53 (0.46–0.63) for CVD incidence. These associations were largely consistent across subgroup analyses. Colorectal cancer survivors with the healthiest lifestyle experienced 37% lower all-cause mortality and 25% lower cancer-specific mortality, while breast cancer survivors had a 45% reduction in all-cause mortality. Although studies were limited, significant associations for all-cause mortality were observed among lung, liver, nasopharyngeal, gastric, kidney, gynecologic cancer survivors. However, no significant relationship between healthy lifestyles and CVD-specific mortality was detected.

Having an overall healthy lifestyle is associated with lower CVD incidence and better survival among cancer survivors. The long-term management of cancer survivors should consider encouragement for a modification of multiple lifestyles.