Adherence to the 2018 world cancer research fund/American institute for cancer research cancer prevention recommendations and mortality among blood cancer survivors

Abstract Background: Survivors of hematologic malignancies face elevated mortality risk, yet the impact of modifiable lifestyle factors on their survival remains understudied. The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) developed evidence-based cancer prevention recommendations encompassing healthy body weight (BMI 18.5-24.9 kg/m²), engaging in regular physical activity (≥150 minutes/week moderate-vigorous), and increasing plant-based food intake (≥400g fruits/vegetables, ≥30g fiber daily), and limiting ultra-processed foods, red/processed meat (≤500g red meat, <21g processed meat weekly), sugar-sweetened beverages, and alcohol. Hence, association between adherence to these WCRF/AICR recommendations and all-cause mortality among survivors of hematologic malignancies was explored. Methods: We analyzed data from hematologic malignancy survivors (N=275) using the 2010 and 2015 National Health Interview Survey (NHIS), a nationally representative cohort study with linked mortality follow-up through 2019 to compare tertiles of WCRF/AICR adherence (high/moderate/low). The WCRF/AICR score (0-7 scale) awarded 1, 0.5, or 0 points for meeting, partially meeting, or not meeting each recommendation component. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for all-cause mortality across crude and age/sex-adjusted models. Results: During mean follow-up of 6.5 years, 80 deaths occurred (26.6%). The mean WCRF/AICR score was 3.8. In age/sex-adjusted models, survivors with low versus high WCRF/AICR adherence demonstrated elevated mortality risk (HR=1.40, 95% CI: 1.05-1.86, p=0.022). Each 1-unit increase in WCRF/AICR score was associated with 17% lower mortality (HR=0.83, 95% CI: 0.75-0.91, p=0.0002). Among individual components, physical activity (HR=0.67, 95% CI: 0.49-0.92, p=0.017), limited sugar-sweetened beverages (HR=0.54, 95% CI: 0.31-0.95, p=0.002), and alcohol abstinence (HR=0.10, 95% CI: 0.03-0.31, p=0.0008) showed protective associations, supporting targeted lifestyle interventions. Conclusions: Higher adherence to WCRF/AICR recommendations was associated with improved survival among survivors of hematologic malignancy. These findings support a potential role for evidence-based lifestyle interventions incorporating exercise and dietary modifications in improving outcomes for survivors of hematologic malignancies.