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What do cancer survivors believe caused their cancer? A secondary analysis of cross-sectional survey data

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Abstract

Purpose

Given that risk reduction and healthy lifestyles can prevent 4 in 10 cancers, it is important to understand what survivors believe caused their cancer to inform educational initiatives.

Methods

In this secondary analysis, we analyzed cancer survivor responses on the Causes Subscale of the Revised Illness Perception Questionnaire, which lists 18 possible causes of illness and a free text question. We used descriptive statistics to determine cancer survivors’ agreement with the listed causes and conducted separate partial proportional odds models for the top three causes to examine their associations with sociodemographic and clinical characteristics. Content analysis was used to examine free text responses.

Results

Of the 1,001 participants, most identified as Caucasian (n = 764, 77%), female (n = 845, 85%), and were diagnosed with breast cancer (n = 656, 66%). The most commonly believed causes of cancer were: stress or worry (n = 498, 51%), pollution in the environment (n = 471, 48%), and chance or bad luck (n = 412, 42%). The associations of sociodemographic and clinical variables varied across the models. Free text responses indicated that hereditary and genetic causes (n = 223, 22.3%) followed by trauma and stress (n = 218, 21.8%) and bad luck or chance (n = 79, 7.9%) were the most important causes of cancer.

Conclusions

Study results illuminate cancer survivors’ beliefs about varying causes of their cancer diagnosis and identify characteristics of survivors who are more likely to believe certain factors caused their cancer. Results can be used to plan cancer education and risk-reduction campaigns and highlight for whom such initiatives would be most suitable.

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Data availability

The datasets analyzed during the current study are not publicly available due to ethical compliance.

Notes

  1. The five dimensions of an illness representation are: identity, timeline, consequences, controllability, and causes [22].

  2. The validity and reliability of the IPQ-R has been demonstrated in cancer samples [23, 24].

  3. The IPQ-R is comprised of 70 items and seven theoretically derived factors: identity, timeline, consequences, control, illness coherence, emotional representations, and causal.

  4. Symptom attribution is defined as the beliefs that cancer survivors have about a symptom and its relation to their cancer [5]. In a sample of mixed chronic conditions, the Cronbach’s alpha was 0.75 [5].

  5. Specifically, the model specifies that for j = 1 to 5, the logit log(P(Y <  = j|X = x) / P(Y > j| X = x)) is equal to a_j + b_j^T x, where the components of b_j across j are the same when the proportional odds assumption is not violated. Here, Y can take on values of 1, 2, 3, 4, or 5, which correspond to the responses “Strongly Disagree”, “Disagree”, “Neither Agree nor Disagree", “Agree”, and “Strongly Agree”, respectively.

  6. Of note, 408 (41.7%) participants believed that heredity was a cause for their cancer, which was ranked as the fourth most commonly held belief, although closely after third; for this reason, a proportional odds model was run using this outcome variable. Model results are described in a Supplementary Material File found online.

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Acknowledgements

Preliminary results of this secondary analysis were presented in an oral presentation at the 46th Annual Oncology Nursing Society Congress in April 2021. Full and final results are presented in this manuscript.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Queen’s University School of Nursing, 92 Barrie Street, Kingston, ON, K7L 3N6, Canada

    Jacqueline Galica

  2. The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada

    Stephanie Saunders

  3. Department of Mathematics and Statistics, Queen’s University, 48 University Avenue, Kingston, ON, K7L 3N6, Canada

    Ziwei Pan & Hok Kan Ling

  4. Faculty of Applied Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada

    Amina Silva

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  1. Jacqueline Galica
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  4. Amina Silva
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Contributions

JG: conceptualized this project and oversaw the collection of data and data entry. ZP and HKL: conducted the data cleaning and analysis for Objective 1. JG and SS: conducted the content analysis and SS: led the write-up for Objective 2 results. JG: drafted the initial manuscript and AS: added content and revisions to successive drafts. All authors reviewed the final manuscript uploaded for peer-review.

Corresponding author

Correspondence to Jacqueline Galica.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

Ethical approval for the primary study was granted by the Women’s College Hospital Research Ethics Board (#2104-005-B) which operates in compliance with the Tri-Council Policy Statement, International Council for Harmonisation/ Good Clinical Practice Guidelines and Part C, Division 5 of the Food and Drug Regulations of Health Canada, Part 4 of the Natural Health Products Regulations, and the Medical Devices Regulations. The secondary analysis was approved for ethical compliance by the Queen's University Health Sciences and Affiliated Teaching Hospitals Research Ethics Board (#6029619), which operates in accordance with the ethical principles outlined in the Declaration of Helsinki.

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All participants provided written informed consent.

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Participants in the primary study signed consent indicating that published studies would not reveal their identity. No individual identifiers are contained in this manuscript.

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Supplementary Information

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10552_2023_1846_MOESM1_ESM.docx

Supplementary file1 (DOCX 15 KB) Details about the fourth most commonly believed cause of cancer are presented in an online Supplementary Material File

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Galica, J., Saunders, S., Pan, Z. et al. What do cancer survivors believe caused their cancer? A secondary analysis of cross-sectional survey data. Cancer Causes Control (2024). https://doi.org/10.1007/s10552-023-01846-0

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