Does adherence to cancer prevention guidelines before diagnosis associate with improved cancer survival?

10582 Background: The American Institute for Cancer Research and American Cancer Society regularly publish cancer prevention recommendations for decreasing cancer risk. Which lifestyles, or whether they work together to impact cancer survival is not well established. We examined associations of adherence to cancer prevention recommendations with mortality in 5,766 patients enrolled in the Data Bank and BioRepository at Roswell Park. Methods: Patients were newly diagnosed between 2003 and 2016 with a variety of pathologically confirmed invasive malignancies. Detailed epidemiological data including lifestyles one year prior to diagnosis were linked with Tumor Registry data. The primary analytic exposure was a composite Lifestyle Index Score (LIS) created in accordance with previously published standardization guidance; the primary analytic outcome was all-cause mortality. The LIS comprised seven lifestyles including: physical activity (PA); body mass index (BMI); fruit and vegetable (FV) intake; red and processed meat (RPM) intake; sugar sweetened beverage (SSB) consumption; alcohol consumption; and smoking status. Kaplan Meier analyses were used to compare survival experience according to LIS tertiles. Multivariable Cox proportional hazard models adjusted for age, tumor type, stage, and sex were used to estimate the associations of the LIS and each lifestyle factor with mortality in the overall study population and according to tumor stage. Results: During follow-up through April 2022, we observed 2,316 deaths (median follow-up 6.9 years). Patients reporting strongest adherence to prevention recommendations (highest LIS tertile) had significantly improved survival compared to patients with the lowest LIS (93.0 vs. 75.0 months, respectively; log-rank p < 0.0001). In multivariable analyses, the highest versus lowest LIS tertile was associated with a 17% reduction in mortality in the overall study population (HR = 0.83, 95% CI: 0.74-0.93). Significant mortality reductions were observed in patients diagnosed with both early- and late-stage disease (HR = 0.73, 95% CI: 0.59-0.90 and HR = 0.85, 95% CI: 0.73-0.99, respectively). Being a never smoker (HR = 0.54, 95% CI: 0.47-0.62), meeting the PA Guidelines (HR = 0.74, 95% CI: 0.66-0.83), and highest FV intake (HR = 0.82, 95% CI: 0.73-0.91) were the only independent factors associated with significant reductions in mortality. Conclusions: Strongest adherence to the cancer prevention recommendations before diagnosis was associated with significant reductions in mortality. These findings provide additional evidence that modifiable lifestyle factors can impact cancer survival, even among patients diagnosed with advanced-stage disease. Confirmatory studies examining post-diagnosis lifestyles are needed so that lifestyle assessment tools, education, and intervention can be clinically leveraged to improve patient outcomes.