Department of Nutrition, School of Public Health, Sun Yat-Sen University, 74 Zhong Shan Road 2, Guangzhou, 510080, Guangdong, China.
Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China.
J Transl Med. 2022 Aug 19;20(1):376. doi: 10.1186/s12967-022-03584-4.
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.
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.
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.
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.
采用健康的生活方式和保持心理健康是癌症幸存者可以在自我管理中实施的两种具有成本效益的可改变策略。我们旨在评估联合生活方式和心理健康与癌症幸存者死亡率的独立、中介、交互和联合关联。
我们进行了一项队列研究，纳入了来自全国健康与营养调查（2005-2018 年）的 3145 名癌症幸存者。根据诊断后体重指数、身体活动、饮食、吸烟和饮酒情况构建了健康生活方式评分。诊断后心理健康状况采用患者健康问卷（PHQ-9）进行评估。使用 Cox 比例风险回归模型计算全因、癌症和非癌症死亡率的风险比（HRs）和 95%置信区间（CIs）。
在 20900 人年的随访（中位数，6.3 年）后，生活方式评分较高的癌症幸存者死亡率降低，独立于心理健康状况。与生活方式评分较低（0-1）的参与者相比，生活方式评分较高（3-5）的参与者全因和非癌症死亡率的 HR（95%CI）分别为 0.68（0.52-0.89）和 0.69（0.56-0.85）。6.2%-10.3%的关联通过心理健康进行中介。在根据心理健康状况分类的参与者中观察到了类似的趋势，心理健康状况较好的参与者死亡率较低，独立于生活方式。心理健康状况较好的参与者从采用健康的生活方式中获益更多，反之亦然。较高的健康生活方式评分和较好的心理健康相结合与死亡率显著降低相关，死亡率最低见于生活方式评分最高且同时心理健康状况最佳的参与者。
这是首次在具有美国癌症幸存者代表性样本的队列研究中，全面探讨了生活方式、心理健康和死亡率之间的复杂关联。本研究得出的证据可能使癌症幸存者和医疗保健提供者充满信心，即改变一个人的生活方式和/或在癌症诊断后保持心理健康可以提高生存率。
