OAKLAND, Calif., Nov. 9, 2012 —The quality of a woman's social networks—the personal relationships that surround an individual—appears to be just as important as the size of her networks in predicting breast cancer survival, Kaiser Permanente scientists report in the current issue of Breast Cancer Research and Treatment.
Previous research has shown that women with larger social networks—including spouses or partners, female relatives, friends, religious and social ties, and ties to the community through volunteering—have better breast cancer survival. This study is among the first to show that the quality of those relationships also is important to survival.
The study included 2,264 women who were diagnosed with early-stage, invasive breast cancer between 1997 and 2000, and who were part of the Life After Cancer Epidemiology (LACE) study. After providing information on their personal relationships, they were characterized as socially isolated (few ties), moderately integrated, or socially integrated (many ties).
"We found that women with small social networks had a significantly higher risk of mortality than those with large networks," said Candyce H. Kroenke, ScD, MPH, a research scientist with the Kaiser Permanente Northern California Division of Research and lead author of the study.
The study found that socially isolated women were 34 percent more likely to die from breast cancer or other causes than socially integrated women. Specifically, larger social networks were "unrelated to recurrence or breast cancer mortality, (they) were associated with lower mortality from all causes," the authors wrote.
Researchers measured levels of social support from friends and family using a survey that asked women to rate the quality of their relationships on a five-point scale within the past week. For example, the questions included, "My family has accepted my illness," "family communication about my illness is poor," and "I feel distant from my friends." Based on their survey results, the women were additionally characterized as having high or low levels of social support.
The study found that levels of support within relationships were important risk factors for breast cancer mortality. "Women with small networks and high levels of support were not at greater risk than those with large networks, but those with small networks and low levels of support were," Kroenke said. In fact, women with small networks and low levels of support were 61 percent more likely to die from breast cancer and other causes than those with small networks and high levels of support.
"We also found that when family relationships were less supportive, community and religious ties were critical to survival. This suggests that both the quality of relationships, rather than just the size of the network, matters to survival, and that community relationships matter when relationships with friends and family are less supportive."
The women were recruited primarily from the Kaiser Permanente Northern California Cancer Registry (83 percent) and the Utah Cancer Registry (12 percent), and enrolled in the study between 11 and 39 months post-diagnosis. After an average of 11 years post-diagnosis, 410 women had died from all causes and 215 from breast cancer.
The study suggests that interventions designed to help women with breast cancer improve the quality of their relationships could have an impact on breast cancer outcomes, Kroenke noted. "Women in the LACE study also gained health advantages from developing community and religious ties."
This study was funded by National Cancer Institute Grant #R01CA129059, Molecular Profiles and Lifestyle Factors in Breast Cancer Prognosis (LACE3).
Co-authors of the study were Charles Quesenberry, PhD, Marilyn L. Kwan, PhD, Adrienne Castilllo, MS, RD, and Bette J. Caan, DrPH, of the Kaiser Permanente Division of Research; and Carol Sweeney, PhD, of the University of Utah Division of Epidemiology.
About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large. It seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR's 600-plus staff is working on more than 250 epidemiological and health services research projects. For more information, visit www.dor.kaiser.org.
About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 9 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/newscenter.
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