Smoking versus quitting and fear of cancer recurrence 9 years after diagnosis in the American Cancer Society's Longitudinal Study of Cancer Survivors-I (SCS-I)

Cancer. 2019 Dec 1;125(23):4260-4268. doi: 10.1002/cncr.32431. Epub 2019 Aug 7.


Background: Fear of cancer recurrence (FCR) adversely affects quality of life. Cigarette smoking increases the risk of recurrence and may exacerbate FCR among survivors who smoke. FCR also may motivate quitting, but research on whether quitting reduces long-term survivors' FCR is lacking. Among long-term survivors of various cancers, the authors investigated relationships between quitting (vs smoking) and FCR, controlling for sociodemographic, cancer-related, and health-related variables.

Methods: Data from the American Cancer Society's Longitudinal Study of Cancer Survivors-I were used in generalized estimating equations to compare FCR at 3 waves (T1-T3) after diagnosis between 2 groups; survivors who reported current smoking (n = 196) approximately 9 years after diagnosis (at T3) or who, based on T3 recall of quitting age, had quit smoking after diagnosis (n = 97). T3 cross-sectional analyses among current smokers examined associations of FCR with smoking level and intentions of quitting.

Results: A significant smoking status × time interaction (P = .003) indicated that only quitters experienced decreases in FCR from T1 to T3 (P = .007). At T3, FCR was significantly lower among quitters than among current smokers (P = .05), and current smokers reported that FCR caused more functioning impairments (eg, disruption of relationships, everyday activities, mood) than quitters (P = .001). Cross-sectional analyses (T3) among smokers found that heavier smoking predicted less attempts to cope with FCR (P = .04) and that reassurance behaviors (eg, self-examination for cancer) predicted stronger quitting intentions (P = .02).

Conclusions: Quitting smoking lowers FCR, and FCR may disrupt functioning among continuing smokers. Interventions for FCR should be multimodal and should treat both psychological distress and health-related behaviors such as smoking.

Keywords: cancer survivors; fear of recurrence; longitudinal; motivation; smoking cessation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • American Cancer Society
  • Cancer Survivors / psychology*
  • Cancer Survivors / statistics & numerical data
  • Fear
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Neoplasms / epidemiology*
  • Recurrence
  • Smoking / psychology
  • Smoking Cessation / psychology*
  • Time Factors
  • United States