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@ARTICLE{Zhu:308658,
      author       = {C. Zhu$^*$ and M. Thong$^*$ and D. Doege$^*$ and L.
                      Koch-Gallenkamp$^*$ and H. Bertram and A. Eberle and B.
                      Holleczek and A. Nennecke and A. Waldmann and S. R. Zeißig
                      and R. Pritzkuleit and H. Brenner$^*$ and V. Arndt$^*$},
      title        = {{L}ifestyle factors and all-cause mortality in long-term
                      cancer survivors: a population-based prospective cohort
                      study.},
      journal      = {European journal of epidemiology},
      volume       = {nn},
      issn         = {0393-2990},
      address      = {[Cham]},
      publisher    = {Springer Nature Switzerland AG},
      reportid     = {DKFZ-2026-00191},
      pages        = {nn},
      year         = {2026},
      note         = {#EA:C071#LA:C071# / epub},
      abstract     = {The association between healthy lifestyles and mortality in
                      cancer survivors remains inconclusive with few evidence
                      among long-term cancer survivors (LTCS, survived ≥ 5 years
                      post-diagnosis). Our study aims to investigate the
                      association between individual and combined healthy
                      lifestyle factors and mortality in LTCS. We included 6,057
                      LTCS of breast, colorectal or prostate cancer from a
                      multiple regions study in Germany. A healthy lifestyle score
                      (HLS) comprising alcohol consumption, body mass index (BMI),
                      physical activity and smoking was created and was classified
                      into tertiles with higher tertile indicating healthier
                      lifestyle. We used Cox proportional hazards regression to
                      examine the associations of individual lifestyle factors and
                      HLS with all-cause mortality among LTCS. A total of 2,015
                      death events occurred over a maximum follow-up period of
                      12.3 years. Compared with the lowest tertile, participants
                      in the middle and highest tertile experienced a $27\%$ and
                      $32\%$ lower mortality (middle [hazard ratio (HR), 0.73;
                      $95\%$ CI 0.65-0.83]; highest [HR, 0.68, $95\%$ CI
                      0.61-0.76]). A significant dose-response relationship was
                      observed (p- trend < 0.001). These associations were
                      consistent across different demographic and clinical
                      characteristics. In addition, full adherence to lifestyle
                      recommendations for smoking (HR, 0.51, $95\%$ CI 0.44-0.59),
                      physical activity (HR, 0.78, $95\%$ CI 0.70-0.86) and BMI
                      (HR, 0.87, $95\%$ CI 0.77-0.99) were significantly related
                      to a lower mortality, after full adjustment. Adherence to an
                      overall healthy lifestyle was associated with significantly
                      lower all-cause mortality in LTCS, emphasizing the
                      importance of maintaining and promoting a healthier
                      lifestyle among LTCS.},
      keywords     = {All-cause mortality (Other) / Cancer survivors (Other) /
                      Life style (Other) / Prospective study (Other)},
      cin          = {C071 / M320},
      ddc          = {610},
      cid          = {I:(DE-He78)C071-20160331 / I:(DE-He78)M320-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41579289},
      doi          = {10.1007/s10654-025-01350-6},
      url          = {https://inrepo02.dkfz.de/record/308658},
}