Journal of Cancer Survivorship

, Volume 7, Issue 1, pp 131–139

Physical activity, psychological distress, and receipt of mental healthcare services among cancer survivors

  • Guixiang Zhao
  • Chaoyang Li
  • Jun Li
  • Lina S. Balluz
Article

Abstract

Purpose

Physical activity confers multiple health benefits in the general population. This study examined the associations of physical activity with serious psychological distress (SPD) and receipt of mental healthcare services among U.S. adult cancer survivors.

Methods

We analyzed data from 4,797 cancer survivors (aged ≥18 years) and 38,571 adults without cancer who participated in the 2009 Behavioral Risk Factor Surveillance System. SPD was assessed using the Kessler-6 questionnaire. Adjusted prevalence and prevalence ratios were estimated by conducting log-linear regression analysis while controlling for potential confounders.

Results

Overall, 6.6 % of cancer survivors (vs. 3.7 % of adults without cancer, P < 0.001) reported having SPD, and 14.0 % of cancer survivors (vs. 10.0 % of adults without cancer, P < 0.001) reported receiving mental healthcare services; the percentages decreased with increasing physical activity levels. After multivariate adjustment, compared to cancer survivors who were physically inactive, cancer survivors who engaged in physical activity >0 to <150 min/week and ≥150 min/week were 62 % and 61 % (P < 0.001 for both) less likely to report SPD, respectively; cancer survivors who engaged in physical activity ≥150 min/week were 33 % (P < 0.05) less likely to report receiving mental healthcare services. Additionally, the inverse association between physical activity and receiving mental healthcare services persisted among women with breast or reproductive cancers and among men and women with gastrointestinal cancers.

Conclusion

The inverse associations between physical activity and SPD or receiving mental healthcare services suggest that physical activity may play a role in improving mental health among cancer survivors.

Implications for cancer survivors

Healthcare clinicians may consider routinely monitoring and assessing the psychological well-being of cancer survivors and educate them about the potential benefits of physical activity in improving their mental health.

Keywords

Cancer survivor Physical activity Serious psychological distress Mental healthcare services BRFSS 

References

  1. 1.
    Miniño AM, Xu JQ, Kochanek KD. Deaths: Preliminary Data for 2008. National Vital Statistics Reports; vol 59 no 2. Hyattsville, MD: National Center for Health Statistics. 2010. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_02.pdf. Accessed 30 July 2012.
  2. 2.
    Centers for Disease Control and Prevention. U.S. Cancer Statistics: An Interactive Atlas. Available at http://apps.nccd.cdc.gov/DCPC_INCA/DCPC_INCA.aspx. Accessed 30 July 2012.
  3. 3.
    National Cancer Institute. Surveillance Epidemiology and End Results. Cancer Statistics: Fast Stats—age-adjusted mortality rate, 1992–2009. Available at http://seer.cancer.gov/faststats/selections.php?series=data. Accessed 30 July 2012.
  4. 4.
    National Cancer Institute. Surveillance Epidemiology and End Results Program. Prevalence database: ″US Estimated Completed Prevalence Counts on 1/1/2009″. Available at http://seer.cancer.gov/statfacts/html/all.html#prevalence. Accessed 30 July 2012.
  5. 5.
    Zhao L, Portier K, Stein K, Baker F, Smith T. Exploratory factor analysis of the cancer problems in living scale: a report from the American Cancer Society′s Studies of Cancer Survivors. J Pain Symptom Manage. 2009;37:676–86.PubMedCrossRefGoogle Scholar
  6. 6.
    Nord C, Mykletun A, Thorsen L, Bjoro T, Fossa SD. Self-reported health and use of health care services in long-term cancer survivors. Int J Cancer. 2005;114:307–16.PubMedCrossRefGoogle Scholar
  7. 7.
    van de Poll-Franse LV, Mols F, Vingerhoets AJ, Voogd AC, Roumen RM, Coebergh JW. Increased health care utilisation among 10-year breast cancer survivors. Support Care Cancer. 2006;14:436–43.PubMedCrossRefGoogle Scholar
  8. 8.
    Ganz PA. Survivorship: adult cancer survivors. Prim Care. 2009;36:721–41.PubMedCrossRefGoogle Scholar
  9. 9.
    Stein KD, Syrjala KL, Andrykowski MA. Physical and psychological long-term and late effects of cancer. Cancer. 2008;112:2577–92.PubMedCrossRefGoogle Scholar
  10. 10.
    Banks E, Byles JE, Gibson RE, et al. Is psychological distress in people living with cancer related to the fact of diagnosis, current treatment or level of disability? Findings from a large Australian study. Med J Aust. 2010;193:S62–7.PubMedGoogle Scholar
  11. 11.
    Boyes AW, Girgis A, Zucca AC, Lecathelinais C. Anxiety and depression among long-term survivors of cancer in Australia: results of a population-based survey. Med J Aust. 2009;190:S94–8.PubMedGoogle Scholar
  12. 12.
    Boyes AW, Girgis A, D'Este C, Zucca AC. Flourishing or floundering? Prevalence and correlates of anxiety and depression among a population-based sample of adult cancer survivors 6 months after diagnosis. J Affect Disord. 2011;135:184–92.PubMedCrossRefGoogle Scholar
  13. 13.
    Couper JW, Love AW, Pollard AC, Bloch S. Anxiety and depression among long-term survivors of cancer in Australia: results of a population-based survey. Med J Aust. 2009;191:294–5.PubMedGoogle Scholar
  14. 14.
    Lynch BM, Steginga SK, Hawkes AL, Pakenham KI, Dunn J. Describing and predicting psychological distress after colorectal cancer. Cancer. 2008;112:1363–70.PubMedCrossRefGoogle Scholar
  15. 15.
    Mehnert A, Koch U. Psychological comorbidity and health-related quality of life and its association with awareness, utilization, and need for psychosocial support in a cancer register-based sample of long-term breast cancer survivors. J Psychosom Res. 2008;64:383–91.PubMedCrossRefGoogle Scholar
  16. 16.
    Neilson KA, Pollard AC, Boonzaier AM, et al. Psychological distress (depression and anxiety) in people with head and neck cancers. Med J Aust. 2010;193:S48–51.PubMedGoogle Scholar
  17. 17.
    Hoffman KE, McCarthy EP, Recklitis CJ, Ng AK. Psychological distress in long-term survivors of adult-onset cancer: results from a national survey. Arch Intern Med. 2009;169:1274–81.PubMedCrossRefGoogle Scholar
  18. 18.
    Hamer M, Chida Y, Molloy GJ. Psychological distress and cancer mortality. J Psychosom Res. 2009;66:255–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Ku PW, Fox KR, Chen LJ. Physical activity and depressive symptoms in Taiwanese older adults: a seven-year follow-up study. Prev Med. 2009;48:250–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Ku PW, Fox KR, Chen LJ, Chou P. Physical activity and depressive symptoms in older adults: 11-year follow-up. Am J Prev Med. 2012;42:355–62.PubMedCrossRefGoogle Scholar
  21. 21.
    McHugh JE, Lawlor BA. Exercise and social support are associated with psychological distress outcomes in a population of community-dwelling older adults. J Health Psychol. 2012;17:833–44.Google Scholar
  22. 22.
    Salguero A, Martinez-Garcia R, Molinero O, Marquez S. Physical activity, quality of life and symptoms of depression in community-dwelling and institutionalized older adults. Arch Gerontol Geriatr. 2011;53:152–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Ten Have M, de Graaf R, Monshouwer K. Physical exercise in adults and mental health status findings from the Netherlands mental health survey and incidence study (NEMESIS). J Psychosom Res. 2011;71:342–8.PubMedCrossRefGoogle Scholar
  24. 24.
    George ES, Jorm L, Kolt GS, Bambrick H, Lujic S. Physical activity and psychological distress in older men: findings from the New South Wales 45 and up study. J Aging Phys Act. 2012;20:300–16.Google Scholar
  25. 25.
    Vallance JK, Murray TC, Johnson ST, Elavsky S. Quality of life and psychosocial health in postmenopausal women achieving public health guidelines for physical activity. Menopause. 2010;17:64–71.PubMedCrossRefGoogle Scholar
  26. 26.
    Vallance JK, Eurich DT, Lavallee CM, Johnson ST. Physical activity and health-related quality of life among older men: an examination of current physical activity recommendations. Prev Med. 2012;54:234–6.PubMedCrossRefGoogle Scholar
  27. 27.
    Balboa-Castillo T, Leon-Munoz LM, Graciani A, Rodriguez-Artalejo F, Guallar-Castillon P. Longitudinal association of physical activity and sedentary behavior during leisure time with health-related quality of life in community-dwelling older adults. Health Qual Life Outcomes. 2011;9:47.PubMedCrossRefGoogle Scholar
  28. 28.
    Bertheussen GF, Romundstad PR, Landmark T, Kaasa S, Dale O, Helbostad JL. Associations between physical activity and physical and mental health—a HUNT 3 study. Med Sci Sports Exerc. 2011;43:1220–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Mokdad AH, Stroup DF, Giles WH. Public health surveillance for behavioral risk factors in a changing environment. Recommendations from the behavioral risk factor surveillance team. MMWR Recomm Rep. 2003;52:1–12.PubMedGoogle Scholar
  30. 30.
    Nelson DE, Holtzman D, Bolen J, Stanwyck CA, Mack KA. Reliability and validity of measures from the Behavioral Risk Factor Surveillance System (BRFSS). Soc Prev Med. 2001;46 Suppl 1:S3–42.Google Scholar
  31. 31.
    Nelson DE, Powell-Griner E, Town M, Kovar MG. A comparison of national estimates from the National Health Interview Survey and the Behavioral Risk Factor Surveillance System. Am J Public Health. 2003;93:1335–41.PubMedCrossRefGoogle Scholar
  32. 32.
    Zhao G, Ford ES, Li C, Strine TW, Dhingra S, Berry JT, Mokdad AH. Serious psychological distress and its associations with body mass index: findings from the 2007 Behavioral Risk Factor Surveillance System. Int J Public Health. 2009;54 Suppl 1:30–6.PubMedCrossRefGoogle Scholar
  33. 33.
    U.S. Depatment of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Hyattsville, MD: US Department of Health and Human Services; 2008. Available at http://www.health.gov/paguidelines/guidelines/default.aspx. Accessed 30 July 2012.
  34. 34.
    Mehnert A, Berg P, Henrich G, Herschbach P. Fear of cancer progression and cancer-related intrusive cognitions in breast cancer survivors. Psychooncology. 2009;18:1273–80.PubMedCrossRefGoogle Scholar
  35. 35.
    Adamsen L, Quist M, Midtgaard J, et al. The effect of a multidimensional exercise intervention on physical capacity, well-being and quality of life in cancer patients undergoing chemotherapy. Support Care Cancer. 2006;14:116–27.PubMedCrossRefGoogle Scholar
  36. 36.
    Adamsen L, Quist M, Andersen C, et al. Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial. BMJ. 2009;339:b3410.PubMedCrossRefGoogle Scholar
  37. 37.
    Basen-Engquist K, Hughes D, Perkins H, Shinn E, Taylor CC. Dimensions of physical activity and their relationship to physical and emotional symptoms in breast cancer survivors. J Cancer Surviv. 2008;2:253–61.PubMedCrossRefGoogle Scholar
  38. 38.
    Courneya KS, Friedenreich CM. Physical exercise and quality of life following cancer diagnosis: a literature review. Ann Behav Med. 1999;21:171–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Courneya KS, Mackey JR, Bell GJ, Jones LW, Field CJ, Fairey AS. Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: cardiopulmonary and quality of life outcomes. J Clin Oncol. 2003;21:1660–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Lynch BM, Cerin E, Owen N, Aitken JF. Associations of leisure-time physical activity with quality of life in a large, population-based sample of colorectal cancer survivors. Cancer Causes Control. 2007;18:735–42.PubMedCrossRefGoogle Scholar
  41. 41.
    Lynch BM, Cerin E, Owen N, Hawkes AL, Aitken JF. Prospective relationships of physical activity with quality of life among colorectal cancer survivors. J Clin Oncol. 2008;26:4480–7.PubMedCrossRefGoogle Scholar
  42. 42.
    Friedenreich CM, Gregory J, Kopciuk KA, Mackey JR, Courneya KS. Prospective cohort study of lifetime physical activity and breast cancer survival. Int J Cancer. 2009;124:1954–62.PubMedCrossRefGoogle Scholar
  43. 43.
    Irwin ML, Smith AW, McTiernan A, et al. Influence of pre- and postdiagnosis physical activity on mortality in breast cancer survivors: the health, eating, activity, and lifestyle study. J Clin Oncol. 2008;26:3958–64.PubMedCrossRefGoogle Scholar
  44. 44.
    Duijts SF, Faber MM, Oldenburg HS, van Beurden M, Aaronson NK. Effectiveness of behavioral techniques and physical exercise on psychosocial functioning and health-related quality of life in breast cancer patients and survivors—a meta-analysis. Psychooncology. 2011;20:115–26.PubMedCrossRefGoogle Scholar
  45. 45.
    Midtgaard J, Rorth M, Stelter R, et al. The impact of a multidimensional exercise program on self-reported anxiety and depression in cancer patients undergoing chemotherapy: a phase II study. Palliat Support Care. 2005;3:197–208.PubMedCrossRefGoogle Scholar
  46. 46.
    Schmitz KH, Courneya KS, Matthews C, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42:1409–26.PubMedCrossRefGoogle Scholar
  47. 47.
    Chambers SK, Lynch BM, Aitken J, Baade P. Relationship over time between psychological distress and physical activity in colorectal cancer survivors. J Clin Oncol. 2009;27:1600–6.PubMedCrossRefGoogle Scholar
  48. 48.
    Tangka FK, Trogdon JG, Richardson LC, Howard D, Sabatino SA, Finkelstein EA. Cancer treatment cost in the United States: has the burden shifted over time? Cancer. 2010;116:3477–84.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York (outside the USA)  2012

Authors and Affiliations

  • Guixiang Zhao
    • 1
  • Chaoyang Li
    • 1
  • Jun Li
    • 2
  • Lina S. Balluz
    • 1
  1. 1.Division of Behavioral Surveillance, Public Health Surveillance and Informatics Program Office, Office of Surveillance, Epidemiology and Laboratory ServicesCenters for Disease Control and PreventionAtlantaUSA
  2. 2.Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaUSA

Personalised recommendations