This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kroenke, C. H. Articles by Kawachi, I. Search for Related Content PubMed PubMed Citation Articles by Kroenke, C. H. Articles by Kawachi, I. Social Bookmarking                            What's this?

Social Networks, Social Support, and Survival After Breast Cancer Diagnosis

From the University of California, San Francisco and Berkeley, CA; Department of Society, Human Development and Health, Harvard School of Public Health, Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA

Address reprint requests to Candyce H. Kroenke, Robert Wood Johnson Health and Society Scholars, University of California, San Francisco, Center for Health and Community, 3333 California St, Suite 465, San Francisco, CA 94118; ckroenke{at}berkeley.edu

PURPOSE: We prospectively examined social ties and survival after breast cancer diagnosis.

PATIENTS AND METHODS: Participants included 2,835 women from the Nurses' Health Study who were diagnosed with stages 1 to 4 breast cancer between 1992 and 2002. Of these women, 224 deaths (107 of these related to breast cancer) accrued to the year 2004. Social networks were assessed in 1992, 1996, and 2000 with the Berkman-Syme Social Networks Index. Social support was assessed in 1992 and 2000 as the presence and availability of a confidant. Cox proportional hazards models were used in prospective analyses of social networks and support, both before and following diagnosis, and subsequent survival.

RESULTS: In multivariate-adjusted analyses, women who were socially isolated before diagnosis had a subsequent 66% increased risk of all-cause mortality (HR = 1.66; 95% CI, 1.04 to 2.65) and a two-fold increased risk of breast cancer mortality (HR = 2.14; 95% CI, 1.11 to 4.12) compared with women who were socially integrated. Women without close relatives (HR = 2.65; 95% CI, 1.03 to 6.82), friends (HR = 4.06; 95% CI, 1.40 to 11.75), or living children (HR = 5.62; 95% CI, 1.20 to 26.46) had elevated risks of breast cancer mortality and of all-cause mortality compared with those with the most social ties. Neither participation in religious or community activities nor having a confidant was related to outcomes. Effect estimates were similar in analyses of postdiagnosis networks.

CONCLUSION: Socially isolated women had an elevated risk of mortality after a diagnosis of breast cancer, likely because of a lack of access to care, specifically beneficial caregiving from friends, relatives, and adult children.

Supported by grant CA87969, supplied by the National Cancer Institute, National Institutes of Health, Bethesda, MD.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				S. Ashida, A. E. L. Palmquist, K. Basen-Engquist, S. E. Singletary, and L. M. Koehly Changes in Female Support Network Systems and Adaptation After Breast Cancer Diagnosis: Differences Between Older and Younger Patients Gerontologist, August 1, 2009; 49(4): 549 - 559. [Abstract] [Full Text] [PDF]

				S. W. Cole, S. P. Mendoza, and J. P. Capitanio Social Stress Desensitizes Lymphocytes to Regulation by Endogenous Glucocorticoids: Insights from In Vivo Cell Trafficking Dynamics in Rhesus Macaques Psychosom Med, July 1, 2009; 71(6): 591 - 597. [Abstract] [Full Text] [PDF]

				J. Spinale, S. D. Cohen, P. Khetpal, R. A. Peterson, B. Clougherty, C. M. Puchalski, S. S. Patel, and P. L. Kimmel Spirituality, Social Support, and Survival in Hemodialysis Patients Clin. J. Am. Soc. Nephrol., November 1, 2008; 3(6): 1620 - 1627. [Abstract] [Full Text] [PDF]

				K.-A. Phillips, R. H. Osborne, G. G. Giles, G. S. Dite, C. Apicella, J. L. Hopper, and R. L. Milne Psychosocial Factors and Survival of Young Women With Breast Cancer: A Population-Based Prospective Cohort Study J. Clin. Oncol., October 1, 2008; 26(28): 4666 - 4671. [Abstract] [Full Text] [PDF]

				K. L. Weihs, T. M. Enright, and S. J. Simmens Close Relationships and Emotional Processing Predict Decreased Mortality in Women with Breast Cancer: Preliminary Evidence Psychosom Med, January 1, 2008; 70(1): 117 - 124. [Abstract] [Full Text] [PDF]

				F. Cousson-Gelie, M. Bruchon-Schweitzer, J. M. Dilhuydy, and M.-A. Jutand Do Anxiety, Body Image, Social Support and Coping Strategies Predict Survival in Breast Cancer? A Ten-Year Follow-Up Study Psychosomatics, June 1, 2007; 48(3): 211 - 216. [Abstract] [Full Text] [PDF]

				M. Extermann and A. Hurria Comprehensive Geriatric Assessment for Older Patients With Cancer J. Clin. Oncol., May 10, 2007; 25(14): 1824 - 1831. [Abstract] [Full Text] [PDF]

				D. S. Dizon, J. S. Gass, C. Bandera, S. Weitzen, and M. Clark Does One Person Provide It All? Primary Support and Advanced Care Planning for Women With Cancer J. Clin. Oncol., April 10, 2007; 25(11): 1412 - 1416. [Abstract] [Full Text] [PDF]