Breast Cancer Research and Treatment

, Volume 139, Issue 2, pp 515–527

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


    • Division of ResearchKaiser Permanente
  • Marilyn L. Kwan
    • Division of ResearchKaiser Permanente
  • Alfred I. Neugut
    • College of Physicians and Surgeons, Mailman School of Public HealthColumbia University
  • Isaac J. Ergas
    • Division of ResearchKaiser Permanente
  • Jaime D. Wright
    • Graduate Theological Union
  • Bette J. Caan
    • Division of ResearchKaiser Permanente
  • Dawn Hershman
    • College of Physicians and Surgeons, Mailman School of Public HealthColumbia University
  • Lawrence H. Kushi
    • Division of ResearchKaiser Permanente

DOI: 10.1007/s10549-013-2477-2

Cite this article as:
Kroenke, C.H., Kwan, M.L., Neugut, A.I. et al. Breast Cancer Res Treat (2013) 139: 515. doi:10.1007/s10549-013-2477-2


We examined mechanisms through which social relationships influence quality of life (QOL) in breast cancer survivors. This study included 3,139 women from the Pathways Study who were diagnosed with breast cancer from 2006 to 2011 and provided data on social networks (the presence of a spouse or intimate partner, religious/social ties, volunteering, and numbers of close friends and relatives), social support (tangible support, emotional/informational support, affection, positive social interaction), and QOL, measured by the FACT-B, approximately 2 months post diagnosis. We used logistic models to evaluate associations between social network size, social support, and lower versus higher than median QOL scores. We further stratified by stage at diagnosis and treatment. 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. 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.


Social networksSocial relationshipsBreast cancerQuality of lifeFACT-BWomen

Copyright information

© Springer Science+Business Media New York 2013