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Social support can improve outcomes for post-menopausal women with CRC

Thu, 01/23/2020 - 14:38
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Post-menopausal women with colorectal cancer (CRC) were more likely to die from their disease or from any cause if they had low social support before diagnosis, according to research from Kaiser Permanente. The study, ‘Prediagnosis social support, social integration, living status, and colorectal cancer mortality in postmenopausal women from the women's health initiative’ of 1,429 women in the long-term health study Women's Health Initiative, which included patients from Kaiser Permanente and other health systems, was published in the journal Cancer.

The study evaluated associations between perceived social support, social integration, living alone, and CRC outcomes in postmenopausal women and included 1,431 women from the Women's Health Initiative who were diagnosed from 1993 to 2017 with stage I through IV CRC and who responded to the Medical Outcomes Study Social Support survey before their CRC diagnosis. The researchers used proportional hazards regression to evaluate associations of social support (tertiles) and types of support, assessed up to six years before diagnosis, with overall and CRC‐specific mortality.

Outcomes

In multivariable analyses, the study found that women who reported low social support had 52% higher overall mortality than those who reported high levels of support, and 42% higher mortality from colorectal cancer specifically. Emotional, informational, and tangible support and positive interaction were all significantly associated with outcomes, whereas affection was not. In main‐effects analyses, the level of social integration was related to overall mortality (p=0.02), but not CRC mortality (p=0.25) and living alone was not associated with mortality outcomes. However, both the level of social integration and living alone were related to outcomes in patients with rectal cancer.

The results confirm previous research suggesting a role for social support for patients with serious illness, said lead author, Dr Candyce Kroenke, a research scientist with the Kaiser Permanente Division of Research.

"These findings support the idea that women who have supportive friends and family around them when they are diagnosed do better," said Kroenke.

The researchers delved into the specifics of the women's personal connections, their links with the community, and their living status to better understand the association. They found higher rates of mortality when women lacked:

  • Emotional support: caring and concern
  • Informational support: help provided through information
  • Tangible support: help with tasks, chores, or tangible needs
  • Positive interaction: someone for the patient to have fun with and take their mind off their illness

They also assessed associations of social integration and living alone with outcomes also in a subset of 1,141 women who had information available on social ties (marital/partner status, community and religious participation) and living situation. The researchers found that having a partner or engaging with their community or in a religious organization was associated with lower risk of death from rectal cancer, but not colon cancer.

Similarly, the analysis found that living alone was associated with higher mortality in patients with rectal cancer. Kroenke said these different findings for rectal and colon cancer need to be replicated.

For patients, the study's message is to lean on others when dealing with a serious diagnosis.

"You can and should ask for support instead of going it alone," she added.

For medical practitioners, the findings are a reminder that social support is an important determinant of outcomes.

"Clinicians can identify patients who are at risk of low social support and provide them with additional resources," she said.

Resources might include a therapist to help with the emotional burden of cancer treatment or social services to provide logistical help such as rides to the doctor.

Kaiser Permanente patients in Northern California diagnosed with cancer undergo a 22-point evaluation of their practical, family, emotional, and spiritual support. After treatment cancer patients receive personalised survivorship care including social and emotional support.

"In viewing our patients as holistic beings with a variety of needs, we provide more comprehensive care that leads to better outcomes," said Dr Brian Missett, associate executive director of The Permanente Medical Group.