Associations of adherence to the World Cancer Research Fund lifestyle recommendations with health-related quality of life and fatigue in Adolescent and Young Adult (AYA) cancer survivors: results from the SURVAYA study

Purpose: Adolescents and young adults (AYAs) with cancer face unique long-term social and health challenges that impact their health-related quality of life (HRQoL). This study explores the association between lifestyle behaviors (physical activity, body composition, and nutrition) and HRQoL as well as fatigue in AYA cancer survivors. Methods: The cross-sectional SURVAYA study analyzed data from long-term AYA cancer survivors (5–20 years post diagnosis, aged 18–39 at diagnosis) in The Netherlands. Adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) lifestyle guidelines was assessed through self-reported questionnaires. HRQoL and fatigue were measured using the EORTC QLQ-C30 questionnaire. Multivariable linear regression was performed to examine associations between lifestyle adherence and HRQoL and fatigue outcomes. Results: The mean adherence to WCRF/AICR recommendations was low to moderate (3.2 ± 1.2, range:0.5–6.0; n = 3,668). Adherence rates varied, with 61% of participants limiting the consumption of sugar-sweetened drinks, 28% having a healthy body composition, 25% meeting fruit and vegetable intake recommendations, and 31% limiting alcohol consumption. Better adherence to lifestyle recommendations, particularly in physical activity, healthy body composition, and fruit and vegetable intake, was significantly associated with better physical functioning, global quality of life and less fatigue and pain. Chemotherapy and time since diagnosis were significant moderators of these associations. Conclusion: These findings highlight that better adherence to the WCRF/AICR recommendations is associated with better HRQoL and less fatigue in long-term AYA cancer survivors. Future research should focus on developing targeted interventions to enhance lifestyle adherence and evaluating the long-term effects of these behaviors on survivorship outcomes.