Cancer-Related Worry as a Predictor of 5-yr Physical Activity Level in Childhood Cancer Survivors

Abstract

ABSTRACT Purpose Cancer-related worry (CRW; concerns related to cancer and its late effects) is prevalent among childhood cancer survivors. Elevated CRW has been associated with self-reported suboptimal physical activity. The aim of this investigation was to describe associations between CRW and objectively assessed physical activity in childhood cancer survivors. Methods CRW was assessed at a baseline evaluation using six survey items. Weekly minutes of moderate and vigorous physical activity were captured by actigraphy 5.25 (3.8–8.0) yr later. Factor analysis was used to identify types of worry; multiple regression determined independent associations between CRW and moderate and vigorous physical activity adjusting for sex, race, diagnosis, age at baseline, anxiety level at baseline, self-reported physical activity at baseline, and pain interference at baseline. Results Participants (n = 1223) were an average of 30.9 (SD, 6.9) yr at baseline and 36.1 (SD, 7.1) yr at follow-up. Thirty-seven percent were survivors of leukemia, 26% of non-CNS solid tumors, 19% of lymphoma, 11% of CNS tumors, and 6% of other malignancies. Two types of CRW were identified: “body-focused” and “general fear.” Body-focused CRW (β = −19.6, P = 0.012), endorsing pain interference (β = −27.7, P = 0.002) at baseline, and having a diagnosis of CNS tumor (β = −41.3, P = 0.0003) or non-CNS solid tumor (β = −19.4, P = 0.02) were negatively associated with physical activity at follow-up. Conclusions CRW related to bodily function and appearance is associated with decreased physical activity. Clinicians should consider the potential negative impact of CRW on physical activity levels and provide behavioral counseling.