Skip to main content

Advertisement

SpringerLink
Log in

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

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Berkman L, Glass TA (2000) Social integration, social networks, social support, and health. In: Berkman L, Kawachi I (eds) Social epidemiology. Oxford University Press, New York

    Google Scholar 

  2. Beasley JM, Newcomb PA, Trentham-Dietz A, Hampton JM, Ceballos RM, Titus-Ernstoff L, Egan KM, Holmes MD (2010) Social networks and survival after breast cancer diagnosis. J Cancer Surviv 4(4):372–380

    Article  PubMed  Google Scholar 

  3. Chou AF, Stewart SL, Wild RC, Bloom JR (2010) Social support and survival in young women with breast carcinoma. Psychooncology 21:125–133

    PubMed  Google Scholar 

  4. Kroenke CH, Kubzansky LD, Schernhammer ES, Holmes MD, Kawachi I (2006) Social networks, social support, and survival after breast cancer diagnosis. J Clin Oncol 24(7):1105–1111

    Article  PubMed  Google Scholar 

  5. Reynolds P, Boyd PT, Blacklow RS, Jackson JS, Greenberg RS, Austin DF, Chen VW, Edwards BK (1994) The relationship between social ties and survival among black and white breast cancer patients. National Cancer Institute Black/White Cancer Survival Study Group. Cancer Epidemiol Biomarkers Prev 3(3):253–259

    PubMed  CAS  Google Scholar 

  6. Waxler-Morrison N, Hislop TG, Mears B, Kan L (1991) Effects of social relationships on survival for women with breast cancer: a prospective study. Soc Sci Med 33(2):177–183

    Article  PubMed  CAS  Google Scholar 

  7. Kroenke CH, Michael Y, Tindle H, Gage E, Chlebowski R, Garcia L, Messina C, Manson JE, Caan BJ (2012) Social networks, social support and burden in relationships, and mortality after breast cancer diagnosis. Breast Cancer Res Treat 133(1):375–385

    Article  PubMed  Google Scholar 

  8. Spiegel D, Butler LD, Giese-Davis J, Koopman C, Miller E, DiMiceli S, Classen CC, Fobair P, Carlson RW, Kraemer HC (2007) Effects of supportive-expressive group therapy on survival of patients with metastatic breast cancer: a randomized prospective trial. Cancer 110(5):1130–1138

    Article  PubMed  Google Scholar 

  9. Goodwin PJ, Leszcz M, Ennis M, Koopmans J, Vincent L, Guther H, Drysdale E, Hundleby M, Chochinov HM, Navarro M et al (2001) The effect of group psychosocial support on survival in metastatic breast cancer. N Engl J Med 345(24):1719–1726

    Article  PubMed  CAS  Google Scholar 

  10. Gellert GA, Maxwell RM, Siegel BS (1993) Survival of breast cancer patients receiving adjunctive psychosocial support therapy: a 10-year follow-up study. J Clin Oncol 11(1):66–69

    PubMed  CAS  Google Scholar 

  11. Cousson-Gelie F, Bruchon-Schweitzer M, Atzeni T, Houede N (2011) Evaluation of a psychosocial intervention on social support, perceived control, coping strategies, emotional distress, and quality of life of breast cancer patients. Psychol Rep 108(3):923–942

    Article  PubMed  Google Scholar 

  12. Helgeson VS, Cohen S, Schulz R, Yasko J (2000) Group support interventions for women with breast cancer: who benefits from what? Health Psychol 19(2):107–114

    Article  PubMed  CAS  Google Scholar 

  13. Caan B, Sternfeld B, Gunderson E, Coates A, Quesenberry C, Slattery ML (2005) Life After Cancer Epidemiology (LACE) Study: a cohort of early stage breast cancer survivors (United States). Cancer Causes Control 16(5):545–556

    Article  PubMed  Google Scholar 

  14. Staten LK, Taren DL, Howell WH, Tobar M, Poehlman ET, Hill A, Reid PM, Ritenbaugh C (2001) Validation of the Arizona Activity Frequency Questionnaire using doubly labeled water. Med Sci Sports Exerc 33(11):1959–1967

    Article  PubMed  CAS  Google Scholar 

  15. Berkman LF, Syme SL (1979) Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents. Am J Epidemiol 109(2):186–204

    PubMed  CAS  Google Scholar 

  16. Cohen S, Doyle WJ, Skoner DP, Rabin BS, Gwaltney JM Jr (1997) Social ties and susceptibility to the common cold. JAMA 277(24):1940–1944

    Article  PubMed  CAS  Google Scholar 

  17. Brady MJ, Cella DF, Mo F, Bonomi AE, Tulsky DS, Lloyd SR, Deasy S, Cobleigh M, Shiomoto G (1997) Reliability and validity of the functional assessment of cancer therapy-breast quality-of-life instrument. J Clin Oncol 15(3):974–986

    PubMed  CAS  Google Scholar 

  18. Demissie S, LaValley MP, Horton NJ, Glynn RJ, Cupples LA (2003) Bias due to missing exposure data using complete-case analysis in the proportional hazards regression model. Stat Med 22(4):545–557

    Article  PubMed  Google Scholar 

  19. Cox D (1972) Regression models and life-tables. J Royal Stat Soc B 34:187–220

    Google Scholar 

  20. Cupples LA, D’Agostino RB, Anderson K, Kannel WB (1988) Comparison of baseline and repeated measure covariate techniques in the Framingham Heart Study. Stat Med 7(1–2):205–222

    Article  PubMed  CAS  Google Scholar 

  21. Kubzansky LD, Mendes WB, Appleton AA, Block J, Adler GK (2012) A heartfelt response: oxytocin effects on response to social stress in men and women. Biol Psychol 90(1):1–9

    Article  PubMed  Google Scholar 

  22. Heinrichs M, Baumgartner T, Kirschbaum C, Ehlert U (2003) Social support and oxytocin interact to suppress cortisol and subjective responses to psychosocial stress. Biol Psychiatry 54(12):1389–1398

    Article  PubMed  CAS  Google Scholar 

  23. Glei DA, Goldman N, Ryff CD, Lin YH, Weinstein M (2012) Social relationships and inflammatory markers: an analysis of Taiwan and the U.S. Soc Sci Med 74(12):1891–1899

    Article  PubMed  Google Scholar 

  24. Ford ES, Loucks EB, Berkman LF (2006) Social integration and concentrations of C-reactive protein among US adults. Ann Epidemiol 16(2):78–84

    Article  PubMed  Google Scholar 

  25. Loucks EB, Berkman LF, Gruenewald TL, Seeman TE (2006) Relation of social integration to inflammatory marker concentrations in men and women 70 to 79 years. Am J Cardiol 97(7):1010–1016

    Article  PubMed  CAS  Google Scholar 

  26. Loucks EB, Sullivan LM, D’Agostino RB Sr, Larson MG, Berkman LF, Benjamin EJ (2006) Social networks and inflammatory markers in the Framingham Heart Study. J Biosoc Sci 38(6):835–842

    Article  PubMed  Google Scholar 

  27. Peuler JD, Scotti MA, Phelps LE, McNeal N, Grippo AJ (2012) Chronic social isolation in the prairie vole induces endothelial dysfunction: implications for depression and cardiovascular disease. Physiol Behav 106(4):476–484

    Article  PubMed  CAS  Google Scholar 

  28. Cohen S, Wills TA (1985) Stress, social support, and the buffering hypothesis. Psychol Bull 98(2):310–357

    Article  PubMed  CAS  Google Scholar 

  29. Shaw BA, Krause N, Liang J, Bennett J (2007) Tracking changes in social relations throughout late life. J Gerontol B Psychol Sci Soc Sci 62(2):S90–S99

    Article  PubMed  Google Scholar 

  30. Fiori KL, Antonucci TC, Cortina KS (2006) Social network typologies and mental health among older adults. J Gerontol B Psychol Sci Soc Sci 61(1):P25–P32

    Article  PubMed  Google Scholar 

  31. Lyyra TM, Lyyra AL, Lumme-Sandt K, Tiikkainen P, Heikkinen RL (2010) Social relations in older adults: Secular trends and longitudinal changes over a 16-year follow-up. Arch Gerontol Geriatr 51(3):e133–e138

    Article  PubMed  Google Scholar 

  32. Holt-Lunstad J, Birmingham W, Jones BQ (2008) Is there something unique about marriage? The relative impact of marital status, relationship quality, and network social support on ambulatory blood pressure and mental health. Ann Behav Med 35(2):239–244

    Article  PubMed  Google Scholar 

  33. Yates BC, Bensley LS, Lalonde B, Lewis FM, Woods NF (1995) The impact of marital status and quality on family functioning in maternal chronic illness. Health Care Women Int 16(5):437–449

    Article  PubMed  CAS  Google Scholar 

  34. Fothergill KE, Ensminger ME, Robertson J, Green KM, Thorpe RJ, Juon HS (2011) Effects of social integration on health: a prospective study of community engagement among African American women. Soc Sci Med 72(2):291–298

    Article  PubMed  Google Scholar 

  35. Oman D, Kurata JH, Strawbridge WJ, Cohen RD (2002) Religious attendance and cause of death over 31 years. Int J Psychiatry Med 32(1):69–89

    Article  PubMed  Google Scholar 

  36. Strawbridge WJ, Shema SJ, Cohen RD, Kaplan GA (2001) Religious attendance increases survival by improving and maintaining good health behaviors, mental health, and social relationships. Ann Behav Med 23(1):68–74

    Article  PubMed  CAS  Google Scholar 

  37. Strawbridge WJ, Cohen RD, Shema SJ, Kaplan GA (1997) Frequent attendance at religious services and mortality over 28 years. Am J Public Health 87(6):957–961

    Article  PubMed  CAS  Google Scholar 

  38. Hirschman KB, Bourjolly JN (2005) How do tangible supports impact the breast cancer experience? Soc Work Health Care 41(1):17–32

    Article  PubMed  Google Scholar 

  39. Woloshin S, Schwartz LM, Tosteson AN, Chang CH, Wright B, Plohman J, Fisher ES (1997) Perceived adequacy of tangible social support and health outcomes in patients with coronary artery disease. J Gen Intern Med 12(10):613–618

    Article  PubMed  CAS  Google Scholar 

  40. Arno PS (2002) The economic value of informal caregiving, U.S., 2000. American Association for Geriatric Psychiatry, Orlando, FL

    Google Scholar 

  41. Arno PS, Levine C, Memmott MM (1999) The economic value of informal caregiving. Health Aff (Millwood) 18(2):182–188

    Article  CAS  Google Scholar 

  42. Cannuscio CC, Jones C, Kawachi I, Colditz GA, Berkman L, Rimm E (2002) Reverberations of family illness: a longitudinal assessment of informal caregiving and mental health status in the Nurses’ Health Study. Am J Public Health 92(8):1305–1311

    Article  PubMed  Google Scholar 

  43. Lee S, Kawachi I, Grodstein F (2004) Does caregiving stress affect cognitive function in older women? J Nerv Ment Dis 192(1):51–57

    Article  PubMed  Google Scholar 

  44. Lee S, Colditz G, Berkman L, Kawachi I (2003) Caregiving to children and grandchildren and risk of coronary heart disease in women. Am J Public Health 93(11):1939–1944

    Article  PubMed  Google Scholar 

  45. Lee S, Colditz GA, Berkman LF, Kawachi I (2003) Caregiving and risk of coronary heart disease in U.S. women: a prospective study. Am J Prev Med 24(2):113–119

    Article  PubMed  Google Scholar 

  46. Schulz R, Beach SR (1999) Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. JAMA 282(23):2215–2219

    Article  PubMed  CAS  Google Scholar 

  47. Lovell B, Moss M, Wetherell MA (2011) With a little help from my friends: psychological, endocrine and health corollaries of social support in parental caregivers of children with autism or ADHD. Res Dev Disabil 33(2):682–687

    Article  PubMed  Google Scholar 

  48. Wilks SE, Croom B (2008) Perceived stress and resilience in Alzheimer’s disease caregivers: testing moderation and mediation models of social support. Aging Ment Health 12(3):357–365

    Article  PubMed  Google Scholar 

  49. Turner HA, Catania JA (1997) Informal caregiving to persons with AIDS in the United States: caregiver burden among central cities residents eighteen to forty-nine years old. Am J Community Psychol 25(1):35–59

    Article  PubMed  CAS  Google Scholar 

  50. Lechner VM (1993) Support systems and stress reduction among workers caring for dependent parents. Soc Work 38(4):461–469

    PubMed  CAS  Google Scholar 

  51. Huisman M (2009) Imputation of missing network data: some simple procedures. J Soc Struct 10(1):1–29

    Google Scholar 

  52. Schafer JL, Graham JW (2002) Missing data: our view of the state of the art. Psychol Methods 7:147–177

    Article  PubMed  Google Scholar 

  53. Little RAJ, Rubin DB (1987) Statistical analysis with missing data. Wiley, New York

    Google Scholar 

Download references

Conflict of interest

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

Author information

Authors and Affiliations

  1. Division of Research, Kaiser Permanente, 2101 Webster, 20th Floor, Oakland, CA, 94612, USA

    Candyce H. Kroenke

  2. Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA, 94612, USA

    Charles Quesenberry, Marilyn L. Kwan, Adrienne Castillo & Bette J. Caan

  3. Division of Epidemiology, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84132, USA

    Carol Sweeney

Authors
  1. Candyce H. Kroenke
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Charles Quesenberry
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marilyn L. Kwan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carol Sweeney
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Adrienne Castillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bette J. Caan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Candyce H. Kroenke.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kroenke, C.H., Quesenberry, C., Kwan, M.L. et al. Social networks, social support, and burden in relationships, and mortality after breast cancer diagnosis in the Life After Breast Cancer Epidemiology (LACE) Study. Breast Cancer Res Treat 137, 261–271 (2013). https://doi.org/10.1007/s10549-012-2253-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-012-2253-8

Keywords

Search

Navigation