Subjective Cognitive Decline in US Cancer Survivors: Sociodemographic, Behavioral, and Clinical Determinants

Subjective cognitive decline (SCD) may signal early neurocognitive vulnerability. The prevalence of SCD among the general population and cancer survivors has not been well-defined. We sought to quantify SCD burden and identify key determinants of SCD among cancer survivors.

Cancer survivors from the 2022 to 2024 Behavioral Risk Factor Surveillance System (BRFSS) were identified and matched with noncancer controls. SCD was defined using the BRFSS Cognitive Decline module as self-reported worsening memory or confusion over the past 12 months. Survey-weighted logistic regression models were used to estimate SCD prevalence and identify sociodemographic and clinical predictors adjusting for sociodemographic, behavioral, and health-related factors.

Among 50,970 participants, 33.3% (n = 16,990) had cancer, 68% (n = 36,660) was 65 years and older, 58.7% (n = 29,919) was female, and 77.8% (n = 39,655) identified as non-Hispanic White. SCD prevalence was higher among cancer survivors than noncancer adults (8.9% [95% CI, 8.1 to 9.7] v 6.6% [95% CI, 6.1 to 7.1]; P < .001) with the greatest burden among survivors age 45-54 years (15.0% [95% CI, 10.5 to 19.6]; P < .01). Factors strongly associated with SCD in cancer survivors were depression (adjusted odds ratio [aOR], 3.13 [95% CI, 2.45 to 4.01]) and poor general health (aOR, 2.03 [95% CI, 1.58 to 2.61]; all P < .001), as well as past stroke (aOR, 1.89 [95% CI, 1.27 to 2.80]; P = .022) and past smoking habit (aOR, 1.44 [95% CI, 1.13 to 1.84]; P = .041). The association of depression with SCD was highest among non-Hispanic Black survivors (aOR, 6.70 [95% CI, 2.97 to 15.11]).

Cancer survivors, especially in midlife, face a higher risk of SCD. Depression and poor general health were the strongest determinants of SCD, with past stroke event and past smoking habits also associated with SCD development. Strengthening survivorship care through equitable screening for cognitive concerns and psychological distress with targeted referrals as clinically indicated may support early identification of survivors reporting cognitive concerns and inform care for cancer survivors.