Of the 1,013 SCS-I Connecticut participants, 855 (84.4%) returned both questionnaires. Approximately 90% of the 855 cancer survivors provided a qualitative response to the open-ended causal attribution question, leaving us with an analytic population of 775. Just under two-thirds (61.8%) of the 775 cancer survivors were female (61.8%) and over half (56.4%) were 55 years of age or older (). The population was predominantly white (88.8%) and married or in a marriage-like relationship (71.7%). The most common cancer diagnosis was breast (29.9%), followed by prostate (17.7%) then colorectal (14.6%). The mean time between cancer diagnosis and questionnaire completion was 18.8 months (standard deviation=4.1). Just over three-quarters of the participants (n=606, 78.2%) provided a specific causal attribution for why they thought they got their cancer. The remaining 169 participants (21.8%) only provided the reason “don’t know.” In addition, of the 606 who identified a specific reason, 68 participants also listed “don’t know.”
Sociodemographic characteristics of the Connecticut SCS-I participants (n=775)
Among the 606 survivors, who identified specific causal attributions, the three most common broad category causal attributions were lifestyle (n=234, 38.6%), biological (n=214, 35.3%), and environmental (n=145, 23.9%) factors (). The leading lifestyle attributions identified by participants were hormone use (i.e. menopausal hormone therapy, oral contraceptives) (n=72), diet (n=53), and general lifestyle factors (n=41). Among participants who identified biological factors, the vast majority (n=189) listed heredity/genetics as a cause of their cancer. The most common reasons cited within the environmental category were general environment (n=50), toxins (n=41), and occupational hazards (n=29).
We examined variation in attributions across cancer type looking at the five most common cancers (breast, prostate, colorectal, lung, and NHL) and other cancers combined (the five less prevalent cancer types: bladder, uterine, sking, melanoma, ovarian, kidney) (). Both breast cancer survivors and survivors of the less prevalent cancers attributed their illness most often to lifestyle, biological, and environmental factors. Prostate and colorectal cancer survivors were most likely to list biological reasons, while lung and NHL cancer survivors most often ascribed smoking and environmental factors, respectively, as the cause of their cancer.
Specific causal attributions percentages by cancer type (n=606)
We identified 187 individuals who listed only modifiable causal attributions and 268 who listed causal attributions only out of their control. Among these 455 cancer survivors, only age and cancer type were associated with identifying modifiable causal attributions in univariate analyses (). With multivariate modeling, only cancer type remained statistically significant (p=<0.001). Compared to breast cancer survivors, lung (OR=4.49, 95% CI=2.23–9.04) and melanoma (OR=3.11, 95% CI= 1.14–8.47) cancer survivors were 3 to 4 times more likely to identify modifiable causes. Kidney (OR=0.10, 95% CI=0.01–0.82), prostate (OR=0.31, 95% CI=0.16–0.60), NHL (OR=0.40, 95% CI=0.18–0.88), and colorectal (OR=0.45, 95% CI=0.23–0.90) cancer survivors were less likely than breast cancer survivors to identify causal attributions within their control.
Univariate associations between sociodemographic, clinical, and psychosocial characteristics and having attribution reason classified as within one’s control (n=455)
Just under half of the 775 participants (n=368, 47.5%) were categorized as contemplators based on a positive response to “Have you ever thought ‘Why me?’. In univariate analyses, age and all of the psychosocial measures were associated with being a contemplator (). In the multivariate model, age and total CPILS-M scores remained statistically significant. Cancer survivors who had thought “why me” were less likely to be over age 55 (OR=0.57, 95% CI=0.42–0.79, p-value =<0.001) and had higher scores on the CPILS-M (OR=1.05, 95% CI=1.03–1.06, p-value =<0.001). Contemplators in our population were more likely to experience problems across all four factors of the CPILS-M (physical distress, emotional distress, employment and financial problems, and fear of recurrence) than non-contemplators (data not shown).
Univariate associations between sociodemographic, clinical, and psychosocial characteristics and contemplating “Why me?” (n=769)