Purpose
Larger social networks have been associated with lower breast cancer mortality. The authors evaluated how levels of social support and burden influenced this association.
Methods
We included 2,264 women from the Life After Cancer Epidemiology study who were diagnosed with breast cancer between 1997–2000, and provided data on social networks (spouse or intimate partner, religious/social ties, volunteering, time socializing with friends, and number of first-degree female relatives), social support, and caregiving. 401 died during a median follow-up of 10.8 years follow-up with 215 from breast cancer. We used delayed entry Cox proportional hazards regression to evaluate associations.
Results
In multivariate-adjusted analyses, social isolation was unrelated to recurrence or breast cancer-specific mortality. However, socially isolated women had higher all-cause mortality (HR=1.34, 95%CI:1.03–1.73) and mortality from other causes (HR=1.79, 95%CI:1.19–2.68). Levels of social support and burden modified associations. Among those with low, but not high, levels of social support, lack of religious/social participation (HR=1.58, 95%CI: 1.07–2.36, p=0.02, p-interaction=0.01) and lack of volunteering (HR=1.78, 95%CI: 1.15–2.77, p=0.01, p-interaction=0.01) predicted higher all-cause mortality. In cross-classification analyses, only women with both small networks and low levels of support (HR=1.61, 95%CI:1.10–2.38) had a significantly higher risk of mortality than women with large networks and high levels of support; women with small networks and high levels of support had no higher risk of mortality (HR=1.13, 95%CI:0.74–1.72). Social networks were also more important for caregivers vs. noncaregivers.
Conclusions
Larger social networks predicted better prognosis after breast cancer, but associations depended on the quality and burden of family relationships.