Background and aim Lifestyle factor modification (alcohol, smoking, obesity, diet, physical activity) has the potential to reduce cancer incidence and cancer survival. This study assessed the knowledge of lifestyle factors and cancer in undergraduate medical students. Methods and results A total of 218 students (7 UK universities) completed an online survey of nine questions in three areas: knowledge (lifestyle factors and cancer); information sources; clinical practice (witnessed clinical counselling). Diet, alcohol, smoking and physical activity were recognised as lifestyle factors by 98% of responders, while only 69% reported weight. The links of lung cancer/smoking and alcohol/liver cancer were recognised by >90%, while only 10% reported weight or physical activity being linked to any cancer. University teaching on lifestyle factors and cancer was reported by 78%: 34% rating it good/very good. GPs were witnessed giving lifestyle advice by 85% of responders. Conclusions Most respondents were aware of a relationship between lifestyle factors and cancer, mainly as a result of undergraduate teaching. Further work may widen the breadth of knowledge, and potentially improve primary and secondary cancer prevention.

The problemWith the increasing incidence and heavy disease burden of colorectal cancer, there is a new need to improve the quality and length of survivorship in patients with this illness. The management of colorectal cancer involves multi-disciplinary working through multimodal treatment pathways and in itself has significant effects on the physical and psychological health of patients. Major surgery, adjuvant and neo-adjuvant chemotherapy and radiotherapy, and the possibility of a stoma are included in the list of challenges patients must overcome in their journey through the treatment of this illness.One such strategy to improve the quality and length of survivorship is lifestyle interventions. Modification of lifestyle factors has been shown to play a role in reducing the risk of developing colorectal cancer, including modifications in excess weight, poor diet, smoking, alcohol excess and physical inactivity [1][2][3][4][5][6]. However, given the difficulty in performing randomised controlled trials in lifestyle interventions in colorectal cancer, there is doubt about the feasibility of such interventions [7,8]. With this in mind, we have recently published a systematic review [9] which sought to collate the evidence for the feasibility of performing lifestyle factor interventions in patients with colorectal cancer, allowing conclusions on the short and long-term health benefits to be drawn. FeasibilityWe identified 14 randomised controlled trials investigating either physical activity or diet/excess body weight, or both, in patients with colorectal cancer -there were no randomised controlled trials investigating smoking or alcohol consumption [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. The interventions consisted mainly of telephone-prompted walking or cycling interventions and were mostly in the adjuvant setting. Dietary interventions focused on low-fat, high-fibre diets and were mostly part of multi-modal lifestyle interventions. We noted a low drop-out rate among these interventions, suggesting they are feasible. Although the majority were performed in the adjuvant setting, we also noted interventions being performed in the neo-adjuvant setting (including pre-habilitation) and even many years after completion of treatment. Short-term outcomes and crossover benefitsIn addition to a low drop-out rate among these randomised controlled trials we also noted shortterm improvements in both physical health (dietary quality, physical fitness) and quality of life. It should also be mentioned that many of these trials recruited from populations of patients with no one individual cancer, i.e. not specifically colorectal cancer. These findings reinforce the importance of correcting lifestyle factors not solely in colorectal cancer, but in many other cancers. Furthermore, given the well-documented and widely accepted role of lifestyle factors in the development of many other widespread diseases (cardiovascular disease, cerebrovascular disease, diabetes) [26], any lifestyle interventions to improv...