Impact of depression and anxiety on cancer patients' perceptions of lifestyle behaviors.

Abstract

141 Background: Health behaviors including tobacco use, alcohol consumption, and physical activity (PA) can impact outcomes in cancer survivors. While the peri-diagnostic period can be a "teachable moment" for behavior change, patients may face barriers including mental health comorbidities. We have previously identified that patient perceptions of behaviors can influence behavior change. Here, we evaluated the impact of anxiety and depression on patient perceptions of these behaviors. Methods: Cancer patients from all disease sites were surveyed (2016-17) on their smoking, alcohol habits, and PA, and perceptions of the impact of these behaviors on fatigue, survival, and quality of life (QofL). Survey data were linked with same day Edmonton Symptom Assessment Symptom (ESAS) anxiety and depression scores. Logistic regression models evaluated the impact of anxiety and depression on patient perceptions. Results: Of 496, 53% were male; median age, 60 years. At diagnosis, 20% were current smokers, 47% were current drinkers, and 67% were not meeting PA guidelines. 30% screened positive for anxiety (ESAS anxiety > 3) and 34% screened positive for depression (ESAS depression > 2); mean [standard deviation] scores were 1.9 [2.3] for anxiety and 1.5 [2.2] for depression. Most current smokers (> 80%) perceived smoking to negatively impact fatigue, survival and QofL. Smokers screening positive for anxiety were more likely to perceive smoking as harmful on survival (OR=9.09, 95% CI (1.15-100), P=0.04); greater ESAS anxiety scores were associated with perceiving smoking to worsen survival (OR=1.51 per point, 95% CI (1.04-2.17), P=0.03). While those less physically active at diagnosis (> 65%) felt that PA improves fatigue, survival and QofL and half of current drinkers (45%-50%) felt that alcohol worsens outcomes, anxiety and depression were not found associated with perceptions (P > 0.10). Conclusions: Among current smokers, greater anxiety scores and those screening positive for anxiety were more likely to perceive continued smoking as harmful to survival. Mental health comorbidities were not found to have an impact on patient perceptions of the effect of alcohol consumption and PA on fatigue, survival, and QofL.