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Social networks, social support and burden in relationships, and mortality after breast cancer diagnosis

  • Epidemiology
  • Published:
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Abstract

Though larger social networks are associated with reduced breast cancer mortality, there is a need to clarify how both social support and social burden influence this association. We included 4,530 women from the Women’s Health Initiative who were diagnosed with breast cancer between 1993 and 2009, and provided data on social networks (spouse or intimate partner, religious ties, club ties, and number of first-degree relatives) before diagnosis. Of those, 354 died during follow-up, with 190 from breast cancer. We used Cox proportional hazards regression to evaluate associations of social network members with risk of post-diagnosis mortality, further evaluating associations by social support and social burden (caregiving, social strain). In multivariate-adjusted analyses, among women with high but not low social support, being married was related to lower all-cause mortality. By contrast, among women with high but not low social burden, those with a higher number of first-degree relatives, including siblings, parents, and children, had higher all-cause and breast cancer mortality (among caregivers: 0–3 relatives (ref), 4–5 relatives, HR = 1.47 (95% CI: 0.62–3.52), 6–9 relatives, HR = 2.08 (95% CI: 0.89–4.86), 10+ relatives, HR = 3.55 (95% CI: 1.35–9.33), P-continuous = 0.02, P-interaction = 0.008). The association by social strain was similar though it was not modified by level of social support. Other social network members were unrelated to mortality. Social relationships may have both adverse and beneficial influences on breast cancer survival. Clarifying these depends on understanding the context of women’s relationships.

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Conflict of interest

The authors declare that they have no financial conflicts of interest.

Author information

Authors and Affiliations

  1. Kaiser Permanente, Division of Research, 2101 Webster, 20th Floor, Oakland, CA, 94612, USA

    Candyce H. Kroenke

  2. Department of Epidemiology and Biostatistics, Drexel University School of Public Health, 1505 Race Street, 6th Floor, MS 1033, Philadelphia, PA, 19102, USA

    Yvonne Michael

  3. Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Hilary Tindle

  4. School of Public Health, University at Buffalo, State University of New York, Buffalo, NY, USA

    Elizabeth Gage

  5. David Geffen School of Medicine, University of California, Los Angeles, CA, USA

    Rowan Chlebowski

  6. School of Medicine, University of California, Davis, CA, USA

    Lorena Garcia

  7. Department of Preventive Medicine, Stony Brook University, Stony Brook, NY, USA

    Catherine Messina

  8. Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    JoAnn E. Manson

  9. Kaiser Permanente, Division of Research, 2000 Broadway, Oakland, CA, 94612, USA

    Bette J. Caan

Authors
  1. Candyce H. Kroenke
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  2. Yvonne Michael
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  3. Hilary Tindle
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  4. Elizabeth Gage
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  6. Lorena Garcia
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  7. Catherine Messina
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Correspondence to Candyce H. Kroenke.

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Kroenke, C.H., Michael, Y., Tindle, H. et al. Social networks, social support and burden in relationships, and mortality after breast cancer diagnosis. Breast Cancer Res Treat 133, 375–385 (2012). https://doi.org/10.1007/s10549-012-1962-3

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  • DOI: https://doi.org/10.1007/s10549-012-1962-3

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