Combined lifestyle, mental health, and mortality in US cancer survivors: a national cohort study

Abstract

Background Adopting healthy lifestyles and staying mentally health are two cost-effective modifiable strategies that cancer survivors can implement in self-management. We aimed to evaluate the independent, mediation, interaction, and joint associations of combined lifestyle and mental health with mortality in cancer survivors. Methods We performed a cohort study including 3145 cancer survivors from National Health and Nutrition Examination Survey (2005–2018). A healthy lifestyle score was constructed based on post-diagnosis body mass index, physical activity, diet, smoking, and drinking. Post-diagnosis mental health was assessed by Patient Health Questionnaire (PHQ-9). Hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause, cancer, and non-cancer mortality were computed using Cox proportional hazards regression models. Results After 20,900 person-years of follow-up (median, 6.3 years), cancer survivors with higher lifestyle score had decreased mortality, independent of mental health. Compared to participants with lower lifestyle score (0–1), HRs (95% CIs) for all-cause and non-cancer mortality among those with higher lifestyle score (3–5) were 0.68 (0.52–0.89) and 0.69 (0.56–0.85), respectively. 6.2–10.3% of the associations were mediated by mental health. Similar trends were observed among participants categorized by mental health, those with better mental health had lower mortality, independent of lifestyle. Participants with better mental health benefited more from adopting healthy lifestyles, and vice versa. Combinations of higher healthy lifestyle score and better mental health were associated with significant decreased mortality, the lowest mortality was seen in participants with highest healthy lifestyle score and concurrently with best mental health. Conclusions For the first time, in this cohort study with a nationally representative sample of US cancer survivors, we comprehensively explored the complex associations of lifestyle, mental health, and mortality. Evidence derived from this study may give much confidence to cancer survivors and healthcare providers that, changing one’s lifestyle and/or staying mentally healthy after cancer diagnosis can improve survival.

Fibromyalgia and risk of all‐cause, specific mortality: A meta‐analysis of observational studies

“…These findings hold clinical significance because previous studies have reported a possible association between fibromyalgia and cancer 13 . However, the awareness of being at increased risk of developing cancer may exacerbate the anxiety of fibromyalgia patients, hampering disease management 30,31 . To some extent, our results also support that there is no inevitable relationship between cancer and fibromyalgia.…”

“…13 However, the awareness of being at increased risk of developing cancer may exacerbate the anxiety of fibromyalgia patients, hampering disease management. 30,31 To some extent, our results also support that there is no inevitable relationship between cancer and fibromyalgia. However, the limitations in our study require further investigation in subsequent articles.…”

Healthy lifestyle and cancer survival: A multinational cohort study

“…A study from the Guangzhou Cancer Registry (GCR) 10 found the benefit of adopting a healthy lifestyle for the extension of life expectancy and the prevention of premature death among cancer survivors in China. A previous study in the United States also showed that cancer survivors with a higher healthy lifestyle score (3–5) had a substantially lower risk of all‐cause and non‐cancer mortality 37 . Besides, a prospective study that enrolled 1425 newly diagnosed stages I–III colorectal cancer survivors found having a lifestyle highly in line with the WCRF/AICR recommendations was associated with a decreased all‐cause mortality risk 38 .…”

“…A previous study in the United States also showed that cancer survivors with a higher healthy lifestyle score (3-5) had a substantially lower risk of all-cause and noncancer mortality. 37 Besides, a prospective study that enrolled 1425 newly diagnosed stages I-III colorectal cancer survivors found having a lifestyle highly in line with the WCRF/AICR recommendations was associated with a decreased all-cause mortality risk. 38 However, there were also limitations in these studies, which restricted the generalizability of their findings.…”

Comparing survival rates for clusters of depressive symptoms found by Network analysis' community detection algorithms: Results from a prospective population‐based study among 9774 cancer survivors from the PROFILES‐registry

“…Consequently, patients with anhedonia may be less inclined to change their lifestyle and take part in healthy behaviours such as physical activities (Leventhal, 2012) or perceive the benefits when doing so. This in turn may impact the changes of survival when confronted with cancer (Liu et al, 2022; Vijayvergia & Denlinger, 2015).…”