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Relationship between social support, physical symptoms, and depression in women with breast cancer and pain

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Abstract

Purpose

Fatigue and pain are common among women with breast cancer, and often related to depressive symptoms. Social support may influence levels of fatigue, pain interference, and depressive symptoms. We tested a theory-based, structural model examining the relationship between social support (i.e., emotional and instrumental) and depressive symptoms via fatigue and pain interference in women with breast cancer.

Methods

Women (N = 327) with stages I–III breast cancer were enrolled in a randomized trial investigating a behavioral pain intervention. Measures of social support, fatigue, pain interference, and depressive symptoms were completed at enrollment. Data were analyzed using structural equation modeling to test direct and indirect pathways relating social support, fatigue, pain interference, and depressive symptoms.

Results

Our model evidenced good fit. Significant direct effects emerged linking higher levels of emotional support with lower levels of fatigue (β = −.30), pain interference (β = −.32), and depressive symptoms (β = −.31). More instrumental support was significantly associated with more depressive symptoms (β = .11), but not fatigue or pain interference. Higher levels of fatigue (β = .30) and pain interference (β = .34) were significantly related to higher levels of depressive symptoms. More emotional support related to less depressive symptoms via lower levels of fatigue (β = −.09) and pain interference (β = −.11).

Conclusion

Women reporting higher levels of emotional support endorsed fewer depressive symptoms, and that relationship was driven by lower levels of fatigue and pain interference. Our results highlight novel pathways that healthcare professionals can leverage to optimize social support topics in psychosocial interventions targeting breast cancer symptoms. This model should be replicated using longitudinal data.

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Funding

This study was funded through an NIH/NCI 1R01CA202779-01 awarded to senior author, Tamara J. Somers, PhD. The work of Joseph G. Winger, PhD, was supported, in part, by a Kornfeld Scholars Program Award from the National Palliative Care Research Center.

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Authors and Affiliations

  1. Pain Prevention and Treatment Research Program, Duke University Medical Center, 2200 W. Main Street, Suite 340, Durham, NC, 27705, USA

    Hannah M. Fisher, Joseph G. Winger, Shannon N. Miller, Arianna N. Wright, Jennifer C. Plumb Vilardaga, Catherine Majestic, Sarah A. Kelleher & Tamara J. Somers

Authors
  1. Hannah M. Fisher
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  2. Joseph G. Winger
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  3. Shannon N. Miller
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  5. Jennifer C. Plumb Vilardaga
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  6. Catherine Majestic
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  7. Sarah A. Kelleher
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  8. Tamara J. Somers
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Contributions

All authors contributed to the study conception and design. Material preparation, recruitment, delivery of study intervention, and data collection were performed by Joseph G. Winger, PhD, Shannon N. Miller, BPH, Arianna N. Wright, BS, Jennifer C. Plumb Vilardaga, PhD, Catherine Majestic, PhD, Sarah A. Kelleher, PhD, and Tamara J. Somers, PhD. Data analyses were performed by Hannah M. Fisher, PhD. The first draft of the manuscript was written by Hannah M. Fisher, PhD, and all authors commented on subsequent versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hannah M. Fisher.

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The procedures complied with ethical guidelines and received Duke University Institutional Review Board approval (Pro00070823).

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Informed consent was obtained from all individual participants included in this study.

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The authors declare no competing interests.

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Fisher, H.M., Winger, J.G., Miller, S.N. et al. Relationship between social support, physical symptoms, and depression in women with breast cancer and pain. Support Care Cancer 29, 5513–5521 (2021). https://doi.org/10.1007/s00520-021-06136-6

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  • DOI: https://doi.org/10.1007/s00520-021-06136-6

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