Psychosocial factors, health behaviors and risk of cancer incidence: Testing interaction and effect modification in an individual participant data meta-analysis

Maartje Basten*, Kuan-Yu Pan, Lonneke A van Tuijl, Alexander de Graeff, Joost Dekker, Adriaan W Hoogendoorn, Femke Lamers, Adelita V Ranchor, Roel Vermeulen, Lützen Portengen, Adri C Voogd, Jessica Abell, Philip Awadalla, Aartjan T F Beekman, Ottar Bjerkeset, Andy Boyd, Yunsong Cui, Philipp Frank, Henrike Galenkamp, Bert GarssenSean Hellingman, Martijn Huisman, Anke Huss, Melanie R Keats, Almar A L Kok, Steinar Krokstad, Flora E van Leeuwen, Annemarie I Luik, Nolwenn Noisel, Yves Payette, Brenda W J H Penninx, Ina Rissanen, Annelieke M Roest, Judith G M Rosmalen, Rikje Ruiter, Robert A Schoevers, David Soave, Mandy Spaan, Andrew Steptoe, Karien Stronks, Erik R Sund, Ellen Sweeney, Emma L Twait, Alison Teyhan, W M Monique Verschuren, Kimberly D van der Willik, Mirjam I Geerlings

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Scopus)
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Abstract

Depression, anxiety and other psychosocial factors are hypothesized to be involved in cancer development. We examined whether psychosocial factors interact with or modify the effects of health behaviors, such as smoking and alcohol use, in relation to cancer incidence. Two-stage individual participant data meta-analyses were performed based on 22 cohorts of the PSYchosocial factors and CAncer (PSY-CA) study. We examined nine psychosocial factors (depression diagnosis, depression symptoms, anxiety diagnosis, anxiety symptoms, perceived social support, loss events, general distress, neuroticism, relationship status), seven health behaviors/behavior-related factors (smoking, alcohol use, physical activity, body mass index, sedentary behavior, sleep quality, sleep duration) and seven cancer outcomes (overall cancer, smoking-related, alcohol-related, breast, lung, prostate, colorectal). Effects of the psychosocial factor, health behavior and their product term on cancer incidence were estimated using Cox regression. We pooled cohort-specific estimates using multivariate random-effects meta-analyses. Additive and multiplicative interaction/effect modification was examined. This study involved 437,827 participants, 36,961 incident cancer diagnoses, and 4,749,481 person years of follow-up. Out of 744 combinations of psychosocial factors, health behaviors, and cancer outcomes, we found no evidence of interaction. Effect modification was found for some combinations, but there were no clear patterns for any particular factors or outcomes involved. In this first large study to systematically examine potential interaction and effect modification, we found no evidence for psychosocial factors to interact with or modify health behaviors in relation to cancer incidence. The behavioral risk profile for cancer incidence is similar in people with and without psychosocial stress.

Original languageEnglish
Pages (from-to)1745-1759
Number of pages15
JournalInternational Journal of Cancer
Volume154
Issue number10
Early online date30-Jan-2024
DOIs
Publication statusPublished - 15-May-2024

Keywords

  • cancer incidence
  • health behaviors
  • individual participant data meta-analysis
  • interaction/effect modification
  • psychosocial factors

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