Neighborhood greenness and long-term physical and psychosocial quality of life among prostate cancer survivors in the Health Professionals Follow-up Study

Naiyu Chen; Cindy R Hu; Hari S Iyer; Peter James; Barbra A Dickerman; Lorelei A Mucci; Rachel C Nethery

doi:10.1016/j.envres.2024.119847

Neighborhood greenness and long-term physical and psychosocial quality of life among prostate cancer survivors in the Health Professionals Follow-up Study

Environ Res. 2024 Aug 24;262(Pt 1):119847. doi: 10.1016/j.envres.2024.119847. Online ahead of print.

Authors

Naiyu Chen¹, Cindy R Hu², Hari S Iyer³, Peter James⁴, Barbra A Dickerman⁵, Lorelei A Mucci⁵, Rachel C Nethery⁶

Affiliations

¹ Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA. Electronic address: naiyuchen@g.harvard.edu.
² Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
³ Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
⁴ Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA.
⁵ Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
⁶ Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA.

PMID: 39187150
DOI: 10.1016/j.envres.2024.119847

Abstract

Introduction: Neighborhood greenness may benefit long-term prostate cancer survivorship by promoting physical activity and social integration, and reducing stress and exposure to air pollution, noise, and extreme temperatures. We examined associations of neighborhood greenness and long-term physical and psychosocial quality of life in prostate cancer survivors in the Health Professionals Follow-up Study.

Methods: We included 1437 individuals diagnosed with non-metastatic prostate cancer between 2008 and 2016 across the United States. Neighborhood greenness within a 1230m buffer of each individual's mailing address was measured using the Landsat satellite image-based Normalized Difference Vegetation Index (NDVI). We fit generalized linear mixed effect models to assess associations of greenness (in quintiles) with longitudinal patient reported outcome measures on prostate cancer-specific physical and psychosocial quality of life, adjusting for time-varying individual- and neighborhood-level demographic factors and clinical factors.

Results: The greatest symptom burden was in the sexual domain. More than half of survivors reported good memory function and the lack of depressive signs at diagnosis. In fully adjusted models, cumulative average greenness since diagnosis was associated with fewer vitality/hormonal symptoms (highest quintile, Q5, vs lowest quintile, Q1: mean difference: 0.46, 95% confidence interval [CI]: 0.81, -0.12). Other domains of physical quality of life (bowel symptoms, urinary incontinence, urinary irritation, and sexual symptoms) did not differ by greenness overall. Psychosocial quality of life did not differ by greenness overall (Q5 vs Q1, odds ratio [95% CI]: memory function: 1.01 [0.61, 1.73]; lack of depressive signs: 1.10 [0.63, 1.95]; and wellbeing: 1.17 [0.71, 1.91]).

Conclusion: During long-term prostate cancer survivorship, cumulative average 1230m greenness since diagnosis was associated with fewer vitality/hormonal symptoms. Other domains of physical quality of life and psychosocial quality of life did not differ by greenness overall. Limitations included potential non-differential exposure measurement error and NDVI's lack of time-activity pattern.

Keywords: Cancer survivorship; Green space; Neighborhood greenness; Prostate cancer; Quality of life.

Grants and funding

U01 CA167552/CA/NCI NIH HHS/United States