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 Garssen; Sean 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

doi:10.1002/ijc.34852

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

Int J Cancer. 2024 May 15;154(10):1745-1759. doi: 10.1002/ijc.34852. Epub 2024 Jan 30.

Authors

Maartje Basten^{1

2

3

4}, Kuan-Yu Pan^{3

5

6}, Lonneke A van Tuijl^{7

8}, Alexander de Graeff⁹, Joost Dekker^{3

5}, Adriaan W Hoogendoorn^{3

5}, Femke Lamers^{3

5}, Adelita V Ranchor⁷, Roel Vermeulen¹⁰, Lützen Portengen¹⁰, Adri C Voogd^{11

12}, Jessica Abell¹³, Philip Awadalla^{14

15

16}, Aartjan T F Beekman^{3

5}, Ottar Bjerkeset^{17

18}, Andy Boyd¹⁹, Yunsong Cui²⁰, Philipp Frank¹³, Henrike Galenkamp²¹, Bert Garssen⁷, Sean Hellingman²², Martijn Huisman^{23

24

25}, Anke Huss¹⁰, Melanie R Keats²⁶, Almar A L Kok^{3

5

23

25}, Steinar Krokstad^{27

28}, Flora E van Leeuwen²⁹, Annemarie I Luik³⁰, Nolwenn Noisel³¹, Yves Payette³¹, Brenda W J H Penninx^{3

5}, Ina Rissanen¹, Annelieke M Roest³², Judith G M Rosmalen^{33

34}, Rikje Ruiter^{30

35}, Robert A Schoevers³⁴, David Soave^{14

22}, Mandy Spaan²⁹, Andrew Steptoe¹³, Karien Stronks^{21

36}, Erik R Sund^{17

27

28}, Ellen Sweeney²⁰, Emma L Twait¹, Alison Teyhan¹⁹, W M Monique Verschuren^{1

37}, Kimberly D van der Willik^{29

30}, Mirjam I Geerlings^{1

25

38

39

40}

Affiliations

¹ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
² Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
³ Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands.
⁴ Amsterdam Public Health, Health Behaviors and Chronic Diseases program, Amsterdam, The Netherlands.
⁵ Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
⁶ Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
⁷ Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁸ Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands.
⁹ Department of Medical Oncology, University Medical Center Utrecht, The Netherlands.
¹⁰ Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
¹¹ Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
¹² Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.
¹³ Department of Behavioural Science and Health, University College London, London, UK.
¹⁴ Ontario Institute for Cancer Research, Toronto, Ontario, Canada.
¹⁵ Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada.
¹⁶ Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
¹⁷ Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway.
¹⁸ Faculty of Medicine and Health Sciences, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
¹⁹ Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
²⁰ Atlantic Partnership for Tomorrow's Health, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
²¹ Department of Public and Occupational Health, Amsterdam UMC, and Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands.
²² Department of Mathematics, Wilfrid Laurier University, Waterloo, Canada.
²³ Department of Epidemiology & Data Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
²⁴ Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
²⁵ Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands.
²⁶ School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada.
²⁷ HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Norway.
²⁸ Levanger hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
²⁹ Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
³⁰ Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
³¹ CARTaGENE, CHU Sainte-Justine, Québec, Canada.
³² Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands.
³³ Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
³⁴ Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
³⁵ Department of Internal Medicine, Maasstad, Rotterdam, The Netherlands.
³⁶ Center for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands.
³⁷ Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
³⁸ Department of General Practice, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands.
³⁹ Amsterdam Public Health, Personalized Medicine, Amsterdam, The Netherlands.
⁴⁰ Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep, Amsterdam, The Netherlands.

PMID: 38289012
DOI: 10.1002/ijc.34852

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.

Keywords: cancer incidence; health behaviors; individual participant data meta-analysis; interaction/effect modification; psychosocial factors.

Publication types

Meta-Analysis

MeSH terms

Alcohol Drinking
Anxiety / etiology
Health Behavior
Humans
Male
Neoplasms* / psychology
Smoking

Abstract

Publication types

MeSH terms

Grants and funding