Loneliness, Social Constraints May Increase Cancer Symptom Burden

Loneliness may play a key role in an individual’s social constraints following a cancer diagnosis and its treatment, which in turn, may worsen symptom burden, according to a study published in the Journal of Behavioral Medicine.

“Cancer patients have high rates of persistent and disabling symptoms. Evidence suggests that social constraints (e.g., avoidance and criticism) negatively impact symptoms, but pathways linking these variables have yet to be identified,” the researchers wrote.

The researchers aimed to determine if cancer-related loneliness was a key link between social constraints and symptoms, such as pain interference, fatigue, sleep disturbances and cognitive complaints, by collecting surveys from 182 patients with cancer.

In the survey, social constraints were measured with questions — such as, “How often did you feel as though you had to keep your feelings about your cancer to yourself because they made other people uncomfortable?” – of which participants then answered on a scale of 1 (almost never) to 5 (almost always).

When it came to loneliness, the researchers asked questions, like “How often does your cancer diagnosis make you feel isolated from others?” Again, their answers were ranked from 1 to 5. The Patient Reported Outcomes Measurement Information System (PROMIS) was used to assess pain interference, fatigue, sleep disturbance and cognitive complaints. The researchers explained these issues were chosen because they are some of the most common symptoms that patients with cancer face.

In the sample group, 123 patients (67.6 percent) were married or living with a partner; 38 (20.9 percent) were divorced, separated or widowed; and 21 (11.5 percent) were never married. Cancer types included: breast (28 patients), prostate (20 patients), skin (13 patients), uterine (13 patients), kidney (12 patients), colon (11 patients), lung (10 patients), cancer considered “other” (74 patients) and one patient had cancer of unknown primary.

“Consistent with our hypothesis, cancer-related loneliness mediated the relationships between social constraints and each symptom,” the researchers wrote. “Findings suggest that addressing cancer-related loneliness in symptom management interventions may mitigate the negative impact of social constraints and outcomes.”

Social constraints don’t always have to arise from patients who have nobody to talk to. In fact, the authors explained that sometimes patients’ friends or family members may minimize their symptoms or criticize their approach to managing the symptoms. In turn, the patient may then feel that they cannot discuss their disease with their loved ones. “Patients who alter their behavior or feel unable to disclose their cancer-related thoughts and feelings due to unsupportive interactions are experiencing social constraints,” they added.”

The researchers found that social constraints and cancer-related loneliness were strongly correlated. Both were moderately correlated with symptoms — mainly pain interference, fatigue and sleep disturbances.

“In particular, greater social constraints were associated with greater avoidant coping, reduced self-efficacy for symptom management and greater perceived stress, which, in turn, were associated with greater symptoms in this population,” the authors wrote.

Moving forward, the researchers mentioned that their findings not only lay the groundwork for more investigation on the topic, but also for better social support programs that can lead to decreased symptoms.

“Cancer-related loneliness is a practical treatment target that could be readily incorporated into symptom management interventions for cancer patients,” the researchers wrote. “The development of symptom management interventions that consider loneliness and other social contributors to health may significantly improve cancer patients’ quality of life.”