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Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs
evidence that the perception of the availability of social support protects individuals under stress from psychological distress, anxiety, and depression (Wills and Fegan, 2001; Cohen, 2004), in part by buffering them from the effects of stress (House et al., 1988; IOM, 2001). Consistent with this evidence, greater social integration has been associated with reduced mortality in multiple prospective community-based studies (Wills and Fegan, 2001). Conversely, well-designed studies have shown social isolation to be a potent risk factor for mortality across all causes of death (including cancer), as well as death due to specific conditions such as heart disease and stroke (Berkman and Glass, 2000). Indeed, the relative risk of death associated with social isolation is comparable to that associated with high cholesterol, mild hypertension, and smoking (House et al., 1988; IOM, 2001). The mechanisms by which these effects occur are not fully known, but there is evidence that social relationships that are stressful, weak, or absent can lead to decreased ability to cope with illness, negative emotions such as depression or anxiety, and immune and endocrine system dysfunction (see the discussion below) (Uchino et al., 1996; Kielcolt-Glaser et al., 2002).
Effects of social support on health outcomes have been found specifically among individuals with cancer (Patenaude and Kupst, 2005; Weihs et al., 2005). A recent study following 2,800 women with breast cancer for a median of 6 years, for example, found that women who were socially isolated before their diagnosis had a 66 percent higher risk of dying from all causes during the observation period compared with women who were socially integrated. They were also twice as likely to die from breast cancer during this period2 (Kroenke et al., 2006).
Weakened Coping Abilities and Increased Mental Illness
Psychological adjustment to an illness involves “adaptation to disease without continued elevations of psychological distress (e.g., anxiety, depression) and loss of role function (i.e., social, sexual, vocational)” (Helgeson and Cohen, 1996:136). Positive emotional support is linked to good psychological adjustment to chronic illnesses generally and cancer specifically, and to fewer symptoms of depression and anxiety (Helgeson and Cohen, 1996; Wills and Fegan, 2001; Maly et al., 2005). Conversely, unsupportive social interactions are associated with greater psychological distress (Norton et al., 2005), decreased social role functioning (Figueiredo et al., 2004), and higher rates of post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms (PTSS) in children with cancer (Bruce, 2006).
The analysis of data adjusted for stage of cancer at diagnosis, age, and other variables that might also affect survival.