Strong Social Support Could Lead to Better Outcomes in Breast Cancer


A recent study indicates that having a strong social network could improve survival of patients with breast cancer.

Candyce Kroenke, MPH, ScD

Candyce Kroenke, MPH, ScD

Candyce Kroenke, MPH, ScD

Women with breast cancer who are socially isolated tend to have higher rates of recurrence and mortality, according to a new study published in the journal Cancer.

Researchers at the Kaiser Permanente Division of Research in Oakland, California, found that these women had a 40% higher risk of recurrence, a 60% higher risk of dying from breast cancer, and a 70% higher risk of dying from any cause when compared with socially integrated women. The associations were stronger in those with stage I and II cancer, according to the study.

“Social ties seem to be strong predictors of mortality in generally healthy populations, but this large study also seems to confirm the importance of social ties for breast cancer-specific deaths as well as for recurrence, so it confirmed associations that I had found a decade ago,” Candyce Kroenke, MPH, ScD, lead researcher on the study, said in an interview with Oncology Nursing News.

She and her team studied 9267 women from four smaller cohorts of women from across the United States and Shanghai, China, to see how their social networks might affect their survival.

A social network was defined by the presence of a spouse/partner, religious ties, community ties, friendship ties and numbers of living first-degree relatives. The women participating provided data within two years of diagnosis.

Over a median follow-up of 10.6 years, there were 1448 cancer recurrences and 1521 deaths, of which 990 were from breast cancer. Researchers determined that socially isolated women were more likely to be white, college-educated, and without children. These women also were more likely to be obese and to smoke and drink more than recommended.

In addition, race and certain social settings played roles in recurrence and mortality.

“When we looked by certain sociodemographic groups, we found that the types of ties that were really critical predictors of outcomes differed for different women,” said Kroenke. “In older white women a marital partner was really important for a predictor of breast cancer mortality, but in nonwhite women friends and family were really important for better outcomes.”

Community ties were beneficial to older white women and Asian women as they predicted lower risks of breast cancer-specific mortality and total mortality. Religious participation was not associated with outcomes.

“Generally speaking, what we see is that more ties seem to be better and they do predict better outcomes, but when you put all these ties together, it is not true in all women; what you see is there is sometimes these subgroups of women in which it’s not this large number of ties, but a critical number of key, high-quality really supportive ties that makes a difference,” she said.

Kroenke noted that it’s important for women with breast cancer to remember to ask for help. She advised getting support from the people around you, talking with clinicians and finding out the opportunities of support that are available, whether it be peer support groups, peer navigation or online support groups. Kroenke hopes to continue further studies as a way to identify the opportunities that will improve outcome for women with breast cancer. She also wants to try to understand the mechanism of social ties and how it affects outcomes.


Kroenke CH, Michael YL, Shu XO, et al. Post-diagnosis social networks, and lifestyle and treatment factors in the After Breast Cancer Pooling Project [published online ahead of print December 12, 2016]. Cancer.

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