How Do Tangible Supports Impact the Breast Cancer Experience?

Kwan

Neugut

et al. 2013

184

144

Purpose We examined mechanisms through which social relationships influence quality of life (QOL) in breast cancer survivors. Methods This study included 3,139 women from the Pathways Study who were diagnosed with breast cancer from 2006-2011 and provided data on social networks (presence of spouse or intimate partner, religious/social ties, volunteering, and numbers of close friends and relatives), social support (tangible, emotional/informational, affection, positive social interaction), and quality of life (QOL), measured by the FACT-B, approximately two months post-diagnosis. We used logistic models to evaluate associations between social network size, social support, and lower vs. higher than median QOL scores. We further stratified by stage at diagnosis and treatment. Results In multivariate-adjusted analyses, women who were characterized as socially isolated had significantly lower FACT-B (OR=2.18, 95%CI:1.72-2.77), physical well-being (WB) (OR=1.61, 95%CI:1.27-2.03), functional WB (OR=2.08, 95%CI:1.65-2.63), social WB (OR=3.46, 95%CI:2.73-4.39), and emotional WB (OR=1.67, 95%CI:1.33-2.11) scores and higher breast cancer symptoms (OR=1.48, 95%CI:1.18-1.87), compared with socially integrated women. Each social network member independently predicted higher QOL. Simultaneous adjustment for social networks and social support partially attenuated associations between social networks and QOL. The strongest mediator and type of social support that was most predictive of QOL outcomes was “positive social interaction”. However, each type of support was important depending on outcome, stage, and treatment status. Conclusions Larger social networks and greater social support were related to higher QOL after a diagnosis of breast cancer. Effective social support interventions need to evolve beyond social-emotional interventions and need to account for disease severity and treatment status.

Section: Discussionmentioning

confidence: 99%

Social networks, social support mechanisms, and quality of life after breast cancer diagnosis

Kwan

Neugut

et al. 2013

184

144

“…Though large social networks may increase the odds that women have friends and family to rely on for instrumental (e.g., rides to the hospital, trips to the pharmacy, assistance with exercise, or provision of healthy meals[38, 39]) and social-emotional support, they can also increase the likelihood of caregiving obligations[40, 41] to network members and associated adverse health outcomes[42–46]. Though larger relative networks were related to higher mortality among caregivers in the WHI[7], a greater number of network members in the LACE cohort appeared to buffer the stress of caregiving responsibilities, either by providing emotional support or taking on responsibilities that relieved the caregivers of some of their burden[47–50].…”

Section: Discussionmentioning

confidence: 99%

Social networks, social support, and burden in relationships, and mortality after breast cancer diagnosis in the Life After Breast Cancer Epidemiology (LACE) Study

Quesenberry

Kwan

et al. 2012

133

100

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.

“…Though large social networks may increase the odds that women will have friends and family to rely on for instrumental (e.g., rides to the hospital, trips to the pharmacy, assistance with exercise, or provision of healthy meals [9, 10]) and social-emotional support, they can also increase the likelihood of caregiving obligations to network members since women comprise up to three-quarters of informal caregivers [11, 12]. While potentially rewarding or beneficial [13], caregiving can be physically and emotionally demanding, and has been linked to lowered immune function [14], poorer mental health [15], lower cognitive function [16], higher coronary heart disease risk [17, 18], and higher mortality [19].…”

Section: Introductionmentioning

confidence: 99%

Social networks, social support and burden in relationships, and mortality after breast cancer diagnosis

Michael

Tindle

et al. 2012

Though larger social networks are associated with reduced breast cancer mortality, there is a need to clarify how both social support and social burden influence this association. We included 4,530 women from the Women's Health Initiative who were diagnosed with breast cancer between 1993 and 2009, and provided data on social networks (spouse or intimate partner, religious ties, club ties, and number of first-degree relatives) before diagnosis. Of those, 354 died during follow-up, with 190 from breast cancer. We used Cox proportional hazards regression to evaluate associations of social network members with risk of post-diagnosis mortality, further evaluating associations by social support and social burden (caregiving, social strain). In multivariate-adjusted analyses, among women with high but not low social support, being married was related to lower all-cause mortality. By contrast, among women with high but not low social burden, those with a higher number of first-degree relatives, including siblings, parents, and children, had higher all-cause and breast cancer mortality (among caregivers: 0–3 relatives (ref), 4–5 relatives, HR = 1.47 (95% CI: 0.62–3.52), 6–9 relatives, HR = 2.08 (95% CI: 0.89–4.86), 10+ relatives, HR = 3.55 (95% CI: 1.35–9.33), P-continuous = 0.02, P-interaction = 0.008). The association by social strain was similar though it was not modified by level of social support. Other social network members were unrelated to mortality. Social relationships may have both adverse and beneficial influences on breast cancer survival. Clarifying these depends on understanding the context of women's relationships.