High Quality Personal Relationships Improve
Survival for Breast Cancer Patients
Study is among first to show that the quality of
relationships is important to survival - family, community, religious
12, 2012 The quality of a woman's social
networks - the personal relationships that surround her -
appears to be just as important as the size of her networks in
predicting breast cancer survival. Kaiser Permanente scientists found
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.
They also say when family relationships were less
supportive, community and religious ties were critical to survival. The
report appears in the current issue of Breast Cancer Research and
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.
"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.
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).
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
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
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."
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.
This study was funded by National Cancer Institute
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. For more information, visit
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