Fear of Cancer Recurrence Associated with Perceived Cognitive Impairment among Women with Cancers: Findings from the Women’s Health Initiative Life and Longevity After Cancer Study

Figures & data

Table 1. Description of sample characteristics (n = 6714).

Age at diagnosis (years)	Median [Q1-Q3]
N = 6714	71 [66-77]
Years from diagnosis to FACT-Cog survey	Median [Q1-Q3]
N = 6714	8.1 [4.4-13.0]
Race	n (%)
American Indian/Alaskan Native	10 (0.1%)
Asian	114 (1.7%)
Native Hawaiian/Pacific Islander	4 (0.1%)
Black	247 (3.7%)
White	6220 (92.6%)
More than 1 race	72 (1.1%)
Unknown/Not reported	47 (0.7%)
Ethnicity	n (%)
Not Hispanic/Latino	6575 (97.9%)
Hispanic/Latino	123 (1.8%)
Unknown/Not reported	16 (0.2%)
Marital status	n (%)
Married or living as married	3118 (46.4%)
Widowed	2170 (32.3%)
Divorced/separated	839 (12.5%)
Never married	288 (4.3%)
Unknown/missing	299 (4.5%)
Education	n (%)
≤ High school	958 (14.3%)
Some college, AD, Vocational school	2214 (33.0%)
College grad	1935 (28.8%)
Post grad	1567 (23.3%)
Unknown/missing	40 (0.6%)
Cancer Types	n (%)
Breast	3922 (58.4%)
Colorectal	692 (10.3%)
Endometrial	595 (8.9%)
Lung	337 (5.0%)
Ovarian	181 (2.7%)
Leukemia	146 (2.2%)
Lymphoma	397 (5.9%)
Melanoma (invasive)	444 (6.6%)
Cancer Stage	n (%)
Local	4765 (71.0%)
Regional	1371 (20.4%)
Distant	494 (7.4%)
Unknown	84 (1.2%)
Cancer Treatment (Self-reported or from medical records abstraction)	n (%)
Chemotherapy (n = 38 missing data)	1980 (29.7%)
Radiation (n = 39 unknown)	3103 (46.5%)
Hormone/Endocrine (n = 108 missing data)	2821 (42.7%)
Other (Stem cell transplantation, tumor vaccine) (n = 137 missing data)	288 (4.4%)
Comorbidities	n (%)
High blood pressure	4486 (66.8%)
Heart disease	1133 (16.9%)
Diabetes	1188 (17.7%)
Obesity (BMI>30) (n = 4 missing data)	1569 (23.4%)
Weight gain >10 Ib (n = 913 unknown)	942 (16.2%)
Anxiety in past 4 weeks (mild/moderate/severe; n = 156 missing)	2691 (41%)
Social Support	Median [Q1-Q3]
N = 6158	80 [60-95]
Fear of cancer recurrence (FCR)	n (%)
Low (<14)	5512 (82.1%)
High (≥14)	1202 (17.9%)
Cognitive impairment	n (%)
Yes (FACT-Cog score <60)	1444 (21.5%)
No (Score 60-80)	5270 (78.5%)

Table 2. Univariable logistic regression comparing odds of perceived cognitive impairment (FACT-Cog score <60).

Age at diagnosis (years)		Cognitive impairment n (%)	OR (95% CI)	P-value
10-year increase		n/a	1.27 (1.18-1.37)	<0.001
Years from diagnosis to FACT-Cog survey
5-year increase		n/a	1.05 (0.99-1.12)	0.08
Marital status
Married or living as married		620/3118 (19.9)	Ref	<0.001
Widowed		526/2170 (24.2)	1.29 (1.13-1.47)
Divorced/separated		174/839 (20.7)	1.05 (0.87-1.27)
Never married		43/288 (14.9)	0.71 (0.51-0.99)
Education
≤ High school		235/958 (24.5)	Ref	<0.001
Some college, AD, Vocational school		523/2214 (23.6)	0.95 (0.80-1.14)
College grad		372/1935 (19.2)	0.73 (0.61-0.88)
Post grad		306/1567 (19.5)	0.75 (0.62-0.91)
Cancer Types
Breast		848/3922 (21.6)	Ref	0.92
Colorectal		155/692 (22.4)	1.05 (0.86-1.27)
Endometrial		124/595 (20.8)	0.95 (0.77-1.18)
Lung		73/337 (21.7)	1.00 (0.77-1.31)
Ovarian		39/181 (21.6)	1.00 (0.69-1.43)
Leukemia		26/146 (17.8)	0.79 (0.51-1.21)
Lymphoma		90/397 (22.7)	1.06 (0.83-1.36)
Melanoma (invasive)		89/444 (20.1)	0.91 (0.71-1.16)
Cancer Stage
Local		1022/4765 (21.5)	Ref	0.93
Regional		299/1371 (21.8)	1.02 (0.88-1.18)
Distant		104/494 (21.1)	0.98 (0.78-1.23)
Cancer Treatment (Self-reported or from medical records abstraction)
Chemotherapy	Yes	417/1980 (21.1)	0.97 (0.85-1.10)	0.61
	No	1015/4696 (21.6)	Ref
Radiation	Yes	664/3103 (21.4)	1.00 (0.89-1.12)	0.99
	No	765/3572 (21.4)	Ref
Hormone/Endocrine	Yes	592/2821 (21.0)	0.98 (0.87-1.10)	0.74
	No	807/3785 (21.3)	Ref
Other (Stem cell transplantation, tumor vaccine)	Yes	54/288 (18.8)	0.85 (0.63-1.15)	0.29
	No	1343/6289 (21.4)	Ref
Comorbidities
High blood pressure	Yes	991/4486 (22.1)	1.11 (0.98-1.26)	0.10
	No	453/2228 (20.3)	Ref
Heart disease	Yes	299/1133 (26.4)	1.39 (1.20-1.61)	<0.001
	No	1145/5581 (20.5)	Ref
Diabetes	Yes	287/1188 (24.2)	1.20 (1.04-1.39)	0.01
	No	1157/5526 (20.9)	Ref
Obesity (BMI>30)	Yes	320/1569 (20.4)	0.92 (0.80-1.05)	0.22
	No	1123/5141 (21.8)	Ref
Weight gain >10 Ib	Yes	232/942 (24.6)	1.30 (1.11-1.54)	0.002
	No	974/4859 (20.1)	Ref
Anxiety in past 4 weeks (mild/moderate/severe)	Yes	936/2691 (34.8)	3.98 (3.51-4.51)	<0.001
	No	457/3867 (11.8)	Ref
Social Support
10-point increase		n/a	0.91 (0.88-0.93)	<0.001
Fear of cancer recurrence
Low (<14)		1044/5512 (18.9)	Ref	<0.001
High (≥14)		400/1202 (33.3)	2.14 (1.86-2.45)
2-point increase (modeled continuously)		n/a	1.24 (1.20-1.29)	<0.001

Table 3. Multivariable logistic regression estimating the association between FCR and odds of perceived cognitive functioning in women with any non-CNS cancers.

	Odds ratio	95% Confidence Interval	P-value
Fear of cancer recurrence (2-point increase)	1.15	1.10-1.20	<0.001
Covariates
Social support (10-point increase)	0.96	0.93-0.99	0.01
Age at diagnosis (10-point increase)	1.66	1.46-1.89	<0.001
Years from diagnosis to FACT-Cog survey (5-year increase)	1.34	1.21-1.47	<0.001
Education			0.06
HS or less	Ref	Ref
Some college/ Assoc. deg.	0.95	0.76-1.19
College degree	0.81	0.64-1.02
Graduate degree	0.77	0.60-0.99
Weight gain >10 lbs	1.27	1.05-1.54	0.02
Mild or worse anxiety	3.54	3.04-4.12	<0.001

*Multivariable model only contains variables included after model selection

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.