Breast Cancer Research and Treatment

, Volume 137, Issue 1, pp 261–271 | Cite as

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

  • Candyce H. KroenkeEmail author
  • Charles Quesenberry
  • Marilyn L. Kwan
  • Carol Sweeney
  • Adrienne Castillo
  • Bette J. Caan


Larger social networks have been associated with lower breast cancer mortality. The authors evaluated how levels of social support and burden influenced this association. We included 2,264 women from the Life After Cancer Epidemiology study who were diagnosed with early-stage, invasive breast cancer between 1997 and 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. 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 from friends and family, 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 versus noncaregivers. Larger social networks predicted better prognosis after breast cancer, but associations depended on the quality and burden of family relationships.


Social networks Social support Social strain Caregiving Social burden Breast cancer Survival Mortality Women 


Conflict of interest

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


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Copyright information

© Springer Science+Business Media, LLC. 2012

Authors and Affiliations

  • Candyce H. Kroenke
    • 1
    Email author
  • Charles Quesenberry
    • 2
  • Marilyn L. Kwan
    • 2
  • Carol Sweeney
    • 3
  • Adrienne Castillo
    • 2
  • Bette J. Caan
    • 2
  1. 1.Division of ResearchKaiser PermanenteOaklandUSA
  2. 2.Division of ResearchKaiser PermanenteOaklandUSA
  3. 3.Division of EpidemiologyUniversity of UtahSalt Lake CityUSA

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