Psychological distress and health behaviours in people living with and beyond cancer: a cross-sectional study

Abstract Purpose This study aimed to examine whether psychological distress was cross-sectionally associated with meeting World Cancer Research Fund (WCRF) recommendations in people living with and beyond cancer. Methods Participants were adults living with and beyond breast, prostate and colorectal cancer, participating in the baseline wave of the Advancing Survivorship after Cancer Outcomes Trial (ASCOT). Anxiety/depression was assessed using the EQ-5D-5L and dichotomised into any/no problems. WCRF recommendations were assessed via pedometers, 24-hour dietary recalls, self-reported alcohol intake (AUDIT-C), and self-reported smoking status. A composite health behaviour risk index (CHBRI) was calculated by summing the number of WCRF recommendations met (range: 0-9). Results Among 1348 participants (mean age = 64 years (SD = 11.4)), 41.5% reported anxiety/depression problems. The mean CHBRI score was 4.4 (SD = 1.4). Anxiety/depression problems were associated with a lower CHBRI score, after multivariable adjustment (beta = -0.27; 95% confidence interval (CI): -0.46, -0.07). Anxiety/depression problems were also associated with lower odds of meeting WCRF recommendations for average daily steps (odds ratio (OR) = 0.73; 95% CI: 0.55, 0.97) and average weekly aerobic steps (OR = 0.78; 95% CI: 0.67, 0.92), but not for any other health behaviour. Conclusions Psychological distress is associated with lower adherence to WCRF recommendations in people living with and beyond cancer, and specifically with not meeting physical activity recommendations. Implications for cancer survivors Physical activity may be a mechanism linking psychological distress and poorer outcomes among people living with and beyond cancer, and this should be explored in longitudinal studies.