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Cited by 377Cancer, Stress, Anesthesia, and Immune ResponseCancer survivorship and careGlobal Cancer Incidence and Screening

Psychological distress in relation to site specific cancer mortality: pooling of unpublished data from 16 prospective cohort studies

Open access
Batty, G David, Russ, Tom C, Stamatakis, Emmanuel, Kivimäki, Mika·2017·BMJ
DOI 10.1136/bmj.j108PMC PMC5266623
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Abstract

OBJECTIVE: To examine the role of psychological distress (anxiety and depression) as a potential predictor of site specific cancer mortality. DESIGN: Pooling of individual participant data from 16 prospective cohort studies initiated 1994-2008. SETTING: Nationally representative samples drawn from the health survey for England (13 studies) and the Scottish health survey (three studies). PARTICIPANTS: 163 363 men and women aged 16 or older at study induction, who were initially free of a cancer diagnosis, provided self reported psychological distress scores (based on the general health questionnaire, GHQ-12) and consented to health record linkage. MAIN OUTCOME MEASURE: Vital status records used to ascertain death from 16 site specific malignancies; the three Scottish studies also had information on cancer registration (incidence). RESULTS: The studies collectively contributed an average of 9.5 years of mortality surveillance during which there were 16 267 deaths (4353 from cancer). After adjustment for age, sex, education, socioeconomic status, body mass index (BMI), and smoking and alcohol intake, and with reverse causality (by left censoring) and missing data (by imputation) taken into account, relative to people in the least distressed group (GHQ-12 score 0-6), death rates in the most distressed group (score 7-12) were consistently raised for cancer of all sites combined (multivariable adjusted hazard ratio 1.32, 95% confidence interval 1.18 to 1.48) and cancers not related to smoking (1.45, 1.23 to 1.71), as well as carcinoma of the colorectum (1.84, 1.21 to 2.78), prostate (2.42, 1.29 to 4.54), pancreas (2.76, 1.47 to 5.19), oesophagus (2.59, 1.34 to 5.00), and for leukaemia (3.86, 1.42 to 10.5). Stepwise associations across the full range of distress scores were observed for colorectal and prostate cancer. CONCLUSION: This study contributes to the growing evidence that psychological distress might have some predictive capacity for selected cancer presentations, in addition to other somatic diseases.

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Crossref · 10.1136/bmj.j108

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  • These factors can have negative consequences for the disease course, including increased frequency and duration of hospital stays, lower adherence to treatment recommendations, difficulties coping, reduced quality of life, and increased mortality.

    “These factors can have negative consequences for the disease course, including an increase in the frequency and duration of hospital stays, lower adherence to treatment recommendations, difficulties in coping with the disease, reduced quality of life and an increase in mortality [9–14].”

    From The BrEasT cancer afTER-CARE (BETTER-CARE) programme to improve breast cancer follow-up: design and feasibility study results of a cluster-randomised complex intervention trial (2024) · cites this paper as [12]

    The Discussion’s Principal findings section reports an association between higher psychological distress and increased mortality from selected cancers. Its Mechanisms of effect section suggests that depression might hamper treatment adherence, but says treatment behaviours were not measured. The paper does not support the claimed increases in hospital stays, difficulties coping, or reduced quality of life (page numbers unavailable in our copy). (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Distress in cancer patients has been associated with non-adherence to anti-cancer medications; increased number of clinic and emergency room visits, longer hospital stays; worse quality of life and inferior survival.

    “Distress in cancer patients has been associated with non-adherence to anti-cancer medications; increased number of clinic and emergency room visits, longer hospital stays [55, 56]; worse quality of life and inferior survival [57–59].”

    From Being present: A single-arm feasibility study of audio-based mindfulness meditation for colorectal cancer patients and caregivers (2018) · cites this paper as [57]

    The Results report an association between higher distress and higher cancer mortality, which supports a link to poorer outcomes. But the study excluded people with a self-reported malignancy at entry, and the Discussion (Mechanisms of effect) says cancer mortality combines cancer onset with survival after diagnosis; it does not establish inferior survival specifically among cancer patients. Our copy does not address quality of life. The medication-adherence and healthcare-use clauses are attached to other citations in the citing sentence. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • In a large pooled analysis, Batty et al found a direct correlation between level of distress and risk of colorectal cancer mortality.

    “In a large pooled analysis, Batty et al found a direct correlation between level of distress and risk of colorectal cancer mortality [57].”

    From Being present: A single-arm feasibility study of audio-based mindfulness meditation for colorectal cancer patients and caregivers (2018) · cites this paper as [57]

  • Psychosocial stress worsens most inflammatory diseases, including allergic diseases, autoimmune diseases, and cancers.

    “Indeed, psychosocial stress worsens most inflammatory diseases, including allergic diseases, autoimmune diseases, and cancers (Batty et al., 2017; Liu et al., 2002; Mohr et al., 2004; Roussou et al., 2013).”

    From Origin and function of stress-induced IL-6 in murine models (2020) · cites this paper as Batty et al., 2017

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Research works printed but not linked: 1

  1. [30]UK Chief Medical Officers. UK Chief Medical Officers’ Alcohol Guidelines Review: Summary of Proposed New Guidelines.Department of Health, 2015.

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Authors
Batty, G. D., Russ, T. C., Stamatakis, E., & Kivimäki, M.
Affiliations
  • University College London (GB)
  • University of Edinburgh (GB)
  • The University of Sydney (AU)
Corresponding author
Batty, G David
ORCID
Venue
BMJ
Publisher
BMJ
Published
2017-01-25
Volume
356
Pages
j108
ISSN
  • 1756-1833 (ISSN-L)
  • 0959-8138
DOI
10.1136/bmj.j108
PMC
PMC5266623
OpenAlex
W2580783696
Cited by
377
References
75
Citations by year
2026: 21 · 2025: 44 · 2024: 42 · 2023: 45 · 2022: 56 · 2021: 43 · 2020: 50 · 2019: 31 · 2018: 33 · 2017: 11
FWCI
5.20
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • HighWire Press Open Archive (submittedVersion)
  • Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
Funders
  • Academy of Medical Sciences (AMS-SGCL12-Russ)
  • NordForsk (K013351)
  • Medical Research Council (MR/K013351/1, K013351, MR/K026992/1)
  • Economic and Social Research Council (ES/J023299/1)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Cancer, Stress, Anesthesia, and Immune Response
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
Keywords
psychological distress, anxiety, depression, cancer mortality, site-specific cancer, colorectal cancer, prostate cancer, pancreatic cancer, esophageal cancer, leukemia, GHQ-12, mortality prediction, reverse causality
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Anxiety, Depression, England, Female, Health Surveys, Humans, Male, Middle Aged, Neoplasms, Prognosis, Scotland, Stress, Psychological, Survival Analysis, Young Adult, Self Report

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