Purpose: Cancer survivors (CS) residing in nonmetro, medically underserved areas (MUA) are less likely to do physical activity (PA) and more likely to report poor health and psychosocial distress than those residing in urban areas with low need. The purpose of this study was to explore the association between psychosocial distress and PA and self-rated health in CS residing in MUA in central Pennsylvania.
Method: CS were recruited to the Partnering to Prevent and Control Cancer (PPCC) study, a cross-sectional study to explore factors related to PA in CS living in central Pennsylvania. PPCC participants completed mailed or Internet-based questionnaires assessing sociodemographics, psychosocial distress (perceived stress, depressive symptoms, and anxiety), Godin weekly leisure-time PA (WLPA), and self-rated health. Independent samples t-tests and analysis of variance were used to explore associations between psychosocial distress and PA and self-rated health.
Results: Nearly 600 (N=572) CS were contacted to participate; 262 were screened for eligibility. Eligible participants (96.9%, n=254) completed a brief demographic questionnaire, and 211 participants opted to complete a more in-depth questionnaire assessing psychosocial distress and PA. Nearly half of participants were prostate (22.5%) or breast (22.1%) CS, followed by gynecologic (15.7%), colorectal (8.8%), and lung (7.2%) CS, and 21.7% of participants reported multiple cancer diagnoses. Participants were mostly women (58.4%), in their mid-60s (M age=64.9±11.8 years), and overweight (M BMI=29.6±6.8 kg/m2). Only 28.3% of CS reported being active, and 16.0% of CS self-rated their health as poor or fair. Nearly 20% of participants reported an elevated number of depressive symptoms, 41.1% reported moderate-to-high perceived stress, and 4.3% reported moderate-to-high anxiety. MUA CS who reported fewer depressive symptoms engaged in more WLPA (M=26.9 vs. 16.1, t=2.023, p=.045) and self-reported better health (M=3.5 vs. 2.7, t=4.8, p<.001) than those who reported elevated depressive symptoms. Similarly, MUA CS who reported low perceived stress (F=15.6, p<.001) and very low anxiety (F=6.1, p=.003) self-reported their health as better than those who reported moderate-to-high perceived stress and anxiety.
Conclusions: CS in PPCC report higher psychosocial distress and engage in less PA than CS in urban, non-MUA areas in the U.S., contributing to cancer health disparities. Strong associations between high psychosocial distress and physical inactivity and poor self-rated health point to the urgent need for psychosocial interventions designed to meet the unique physical and psychological needs of this population in an effort to improve cancer survivorship outcomes, reduce health disparities, and promote health equity in CS residing in MUA in central Pennsylvania.
Citation Format: Scherezade K. Mama, Nishat Bhuiyan, Kathryn H. Schmitz, Eugene J. Lengerich. Associations between psychosocial distress and physical inactivity and poor health in medically underserved cancer survivors in central Pennsylvania [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B013.