Kaiser Permanente study among the first to examine how social relationships influence quality of life in breast cancer patients
Breast cancer patients who say they have people with whom they have a good time, or have “positive social interactions” with, are better able to deal with pain and other physical symptoms, according to a new Kaiser Permanente study published today in Breast Cancer Research and Treatment.
“This study provides research-based evidence that social support helps with physical symptoms,” said lead author Candyce H. Kroenke, ScD, MPH, staff scientist with the Kaiser Permanente Division of Research. “Social support mechanisms matter in terms of physical outcomes.”The study, which is among the first to examine exactly how social relationships influence quality of life in breast cancer patients, also found that tangible support (such as help with household tasks and errands) was most useful to those with late-stage cancer.
“While hundreds of studies have examined the role of factors influencing cancer risk and prevention, this study is one of a small but growing number that focus quality of life after a breast cancer diagnosis,” Kroenke said.
Part of the Pathways study of breast cancer survivorship at the Kaiser Permanente Division of Research, the study included 3,139 female members of Kaiser Permanente in Northern California who were newly diagnosed with breast cancer between 2006 and 2011. Within about two months of their breast cancer diagnosis, study participants answered several detailed questionnaires on their social networks (including friends and relatives, spouse/intimate relationships, and religious, social and community ties); the kinds of support they received (tangible, emotional/informational, affection and positive social interaction); and their emotional and physical quality of life, and physical symptoms from breast cancer.
Women with the highest levels of social integration — the largest social networks, or the personal relationships that surround an individual — were most likely to report the best overall quality of life during breast cancer treatment, and higher levels of social support were also related to better emotional quality of life. Moreover, of the different types of social support, positive social interaction, defined as the availability of other persons to do fun things was the most important predictor of physical quality of life. Those who indicated having little or no positive interaction were three times more likely to report a low quality of life and greater physical symptoms.
“Positive social interaction was significantly related to every quality-of-life measure,” Kroenke and co-authors wrote. “Given that this dimension was determined by the availability of someone with whom to have fun, relax and get one’s mind off things for awhile, it is possible that positive social interaction may enable women to forget for awhile the distress of being a cancer patient, and the physiologic effects last beyond the actual interaction.”
The impact of tangible support for breast cancer patients — such as doing chores, bringing them to the doctor, or providing food — was also strong among late-stage patients: those with low levels of tangible support were 2.74 times more likely to report that their quality of life was worse than average.
According to the American Cancer Society, about 230,000 women are diagnosed with invasive breast cancer each year in the United States, and as of 2012 there were about 2.9 million breast cancer survivors. The fact that more women are being cured of breast cancer increases the importance of quality of life after diagnosis, Kroenke explained.
The Pathways study and an additional study based at the Division of Research called LACE (Life After Cancer Epidemiology) are collecting and analyzing data about women’s genetic background, tumor characteristics and lifestyle choices immediately after diagnosis. Findings from these studies are providing information to help guide women as they make decisions following a breast cancer diagnosis. Among these findings are that high-fat dairy consumption increases mortality risk; soy decreases the risk of breast cancer recurrence; quality of life after diagnosis influences outcomes; and physical activity is beneficial.
Kaiser Permanente can conduct transformational health research like this study in part because it has the largest private electronic health system in the world. The organization’s integrated model and electronic health record system, Kaiser Permanente HealthConnect®, securely connects 9 million people, 611 medical offices, and 37 hospitals, linking patients with their health care teams, their personal health information and the latest medical knowledge. It also connects Kaiser Permanente’s research scientists, clinicians and operational leaders to one of the most extensive collections of longitudinal medical data available, facilitating studies and important medical discoveries that shape the future of health and care delivery for patients and the medical community.
In addition to Kroenke, co-authors of the study were Marilyn L. Kwan, PhD, Isaac J. Ergas, MPH, Bette J. Caan, DrPH, and Larry H. Kushi, ScD, Kaiser Permanente Division of Research, Oakland, Calif.; Alfred I. Neugat, MD, MPH, PhD, and Dawn Hershman, MD, College of Physicians and Surgeons, Mailman School of Public Health, Columbia University, N.Y.; and Jaime D. Wright, PhD candidate, Graduate Theological Union, Berkeley, Calif.
The National Institutes of Health, National Cancer Institute Grant No. 2R01 CA105274 supported this study.