Breast Cancer Research and Treatment

, Volume 139, Issue 2, pp 515–527 | Cite as

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

  • Candyce H. KroenkeEmail author
  • Marilyn L. Kwan
  • Alfred I. Neugut
  • Isaac J. Ergas
  • Jaime D. Wright
  • Bette J. Caan
  • Dawn Hershman
  • Lawrence H. Kushi


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 networks Social relationships Breast cancer Quality of life FACT-B Women 



This study was supported by the National Institutes of Health, National Cancer Institute Grant #2R01 CA105274.

Conflict of interest

The authors declare that they have no financial conflicts of interest.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Candyce H. Kroenke
    • 1
    Email author
  • Marilyn L. Kwan
    • 2
  • Alfred I. Neugut
    • 3
  • Isaac J. Ergas
    • 1
  • Jaime D. Wright
    • 4
  • Bette J. Caan
    • 2
  • Dawn Hershman
    • 3
  • Lawrence H. Kushi
    • 2
  1. 1.Division of ResearchKaiser PermanenteOaklandUSA
  2. 2.Division of ResearchKaiser PermanenteOaklandUSA
  3. 3.College of Physicians and Surgeons, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  4. 4.Graduate Theological UnionBerkeleyUSA

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