Current Breast Cancer Reports

, Volume 10, Issue 1, pp 1–6 | Cite as

Threats to Belonging among Breast Cancer Survivors: Consequences for Mental and Physical Health

  • Lisa M. Jaremka
  • Megan A. Nadzan
Psycho-Oncology and Supportive Care (E Shinn and C Fagundes, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Psycho-Oncology and Supportive Care


Purpose of review

This review summarizes research linking loneliness and low perceived social support, two threats to belonging, to mental and physical health among breast cancer survivors. We also highlight similarities with research using non-cancer populations.

Recent findings

Loneliness and low perceived social support are common complaints among breast cancer survivors. Both loneliness and low perceived social support are linked to higher pain, depression, and fatigue, along with worse cognitive function among breast cancer survivors during survivorship. In addition, survivors perceiving lower social support have lower breast cancer-specific and all-cause survival rates relative to those perceiving more support.


Loneliness and a lack of perceived social support threaten the need to belong and thus increase risk for mental and physical health problems among breast cancer survivors. These findings mirror research examining belonging threats and health among people without a history of cancer.


Breast cancer survivors Social support Mental and physical health problems Review 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


  1. 1.
    Centers for Disease Control. CDC—breast cancer statistics. 2013.
  2. 2.
    National Cancer Institute Mortality Cancer trends progress report. Accessed 1 Dec 2017.
  3. 3.
    National Cancer Institute Survival Cancer trends progress report. Accessed 1 Dec 2017.
  4. 4.
    Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A. Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ. 2005;330(7493):702–0. Scholar
  5. 5.
    Harrington CB, Hansen JA, Moskowitz M, Todd BL, Feuerstein M. It’s not over when it’s over: long-term symptoms in cancer survivors—a systematic review. Int J Psychiatry Med. 2010;40(2):163–81. Scholar
  6. 6.
    Nguyen CM, Yamada TH, Beglinger LJ, Cavanaugh JE, Denburg NL, Schultz SK. Cognitive features 10 or more years after successful breast cancer survival: comparisons across types of cancer interventions. Psychooncology. 2013;22(4):862–8. Scholar
  7. 7.
    Patnaik JL, Byers T, DiGuiseppi C, Dabelea D, Denberg TD. Cardiovascular disease competes with breast cancer as the leading cause of death for older females diagnosed with breast cancer: a retrospective cohort study. Breast Cancer Res. 2011;13(3):R64. Scholar
  8. 8.
    Chapman J-AW, Meng D, Shepherd L, Parulekar W, Ingle JN, Muss HB, et al. Competing causes of death from a randomized trial of extended adjuvant endocrine therapy for breast cancer. J Natl Cancer Inst. 2008;100(4):252–60. Scholar
  9. 9.
    Hodgson KD, Hutchinson AD, Wilson CJ, Nettelbeck T. A meta-analysis of the effects of chemotherapy on cognition in patients with cancer. Cancer Treat Rev. 2013;39(3):297–304. Scholar
  10. 10.
    Jansen CE, Miaskowski C, Dodd M, Dowling G, Kramer J. A meta-analysis of studies of the effects of cancer chemotherapy on various domains of cognitive function. Cancer. 2005;104(10):2222–33. Scholar
  11. 11.
    DeSantis CE, Lin CC, Mariotto AB, Siegel RL, Stein KD, Kramer JL, et al. Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin. 2014;64(4):252–71. Scholar
  12. 12.
    Bradshaw PT, Stevens J, Khankari N, Teitelbaum SL, Neugut AI, Gammon MD. Cardiovascular disease mortality among breast cancer survivors. Epidemiol Camb Mass. 2016;27:6–13.CrossRefGoogle Scholar
  13. 13.
    Thurston RC, Kubzansky LD. Women, loneliness, and incident coronary heart disease. Psychosom Med. 2009;71(8):836–42. Scholar
  14. 14.
    Baumeister RF, Leary MR. The need to belong: desire for interpersonal attachments as a fundamental human motivation. Psychol Bull. 1995;117(3):497–529. Scholar
  15. 15.
    Leary MR. Interpersonal rejection. New York: Oxford University Press; 2001.Google Scholar
  16. 16.
    Tooby J, Cosmides L. Friendship and the banker’s paradox: other pathways to the evolution of adaptations for altruism. In: Runciman WG, Smith JM, RIM D, editors. Evol. Soc. Behav. Patterns Primates Man. New York: Oxford University Press; 1996. p. 119–43.Google Scholar
  17. 17.
    Wells M, Kelly D. The loneliness of cancer. Eur J Oncol Nurs. 2008;12(5):410–1. Scholar
  18. 18.
    Rosedale M. Survivor loneliness of women following breast cancer. Oncol Nurs Forum. 2009;36(2):175–83. Scholar
  19. 19.
    Deckx L, van den Akker M, Buntinx F. Risk factors for loneliness in patients with cancer: a systematic literature review and meta-analysis. Eur J Oncol Nurs. 2014;18(5):466–77. Scholar
  20. 20.
    Kroenke CH, Kwan ML, Neugut AI, Ergas IJ, Wright JD, Caan BJ, et al. Social networks, social support mechanisms, and quality of life after breast cancer diagnosis. Breast Cancer Res Treat. 2013;139(2):515–27. Scholar
  21. 21.
    Perry GR. Loneliness and coping among tertiary-level adult cancer patients in the home. Cancer Nurs. 1990;13(5):293–302.CrossRefPubMedGoogle Scholar
  22. 22.
    Yildirim Y, Kocabiyik S. The relationship between social support and loneliness in Turkish patients with cancer. J Clin Nurs. 2010;19(5-6):832–9. Scholar
  23. 23.
    Deckx L, van den Akker M, van Driel M, Bulens P, van Abbema D, Tjan-Heijnen V, et al. Loneliness in patients with cancer: the first year after cancer diagnosis. Psychooncology. 2015;24(11):1521–8. Scholar
  24. 24.
    Bloom JR, Kessler L. Emotional support following cancer: a test of the stigma and social activity hypotheses. J Health Soc Behav. 1994;35(2):118–33. Scholar
  25. 25.
    Courtens AM, Stevens FC, Crebolder HF, Philipsen H. Longitudinal study on quality of life and social support in cancer patients. Cancer Nurs. 1996;19(3):162–9. Scholar
  26. 26.
    Den Oudsten BL, Van Heck GL, Van der Steeg AFW, Roukema JA, De Vries J. Personality predicts perceived availability of social support and satisfaction with social support in women with early stage breast cancer. Support Care Cancer. 2010;18(4):499–508. Scholar
  27. 27.
    Thompson T, Rodebaugh TL, Pérez M, Schootman M, Jeffe DB. Perceived social support change in patients with early stage breast cancer and controls. Health Psychol. 2013;32(8):886–95. Scholar
  28. 28.
    Jaremka LM, Fagundes CP, Glaser R, Bennett JM, Malarkey WB, Kiecolt-Glaser JK. Loneliness predicts pain, depression, and fatigue: understanding the role of immune dysregulation. Psychoneuroendocrinology. 2013;38(8):1310–7. Scholar
  29. 29.
    Jaremka LM, Andridge RR, Fagundes CP, Alfano CM, Povoski SP, Lipari AM, et al. Pain, depression, and fatigue: loneliness as a longitudinal risk factor. Health Psychol. 2014;33(9):948–57. Scholar
  30. 30.
    Laird BJA, Scott AC, Colvin LA, McKeon A-L, Murray GD, Fearon KCH, et al. Pain, depression, and fatigue as a symptom cluster in advanced cancer. J Pain Symptom Manag. 2011;42(1):1–11. Scholar
  31. 31.
    Jaremka LM, Peng J, Bornstein R, Alfano CM, Andridge RR, Povoski SP, et al. Cognitive problems among breast cancer survivors: loneliness enhances risk. Psychooncology. 2014;23(12):1356–64. Scholar
  32. 32.
    Gagliardi C, Vespa A, Papa R, Mariotti C, Cascinu S, Rossini S. Social support networks and depression of women suffering from early-stage breast cancer: a case control study. J Psychosoc Oncol. 2009;27(2):216–29. Scholar
  33. 33.
    Ochayon L, Tunin R, Yoselis A, Kadmon I. Symptoms of hormonal therapy and social support: is there a connection? Comparison of symptom severity, symptom interference and social support among breast cancer patients receiving and not receiving adjuvant hormonal treatment. Eur J Oncol Nurs. 2015;19(3):260–7. Scholar
  34. 34.
    Boinon D, Sultan S, Charles C, Stulz A, Guillemeau C, Delaloge S, et al. Changes in psychological adjustment over the course of treatment for breast cancer: the predictive role of social sharing and social support. Psychooncology. 2014;23(3):291–8. Scholar
  35. 35.
    Hughes S, Jaremka LM, Alfano CM, Glaser R, Povoski SP, Lipari AM, et al. Social support predicts inflammation, pain, and depression: longitudinal relationships among breast cancer survivors. Psychoneuroendocrinology. 2014;42:38–44. Scholar
  36. 36.
    Servaes P, Verhagen C, Bleijenberg G. Fatigue in cancer patients during and after treatment: prevalence, correlates and interventions. Eur J Cancer Oxf Engl 1990. 2002;38:27–43.Google Scholar
  37. 37.
    Fong AJ, Scarapicchia TMF, McDonough MH, Wrosch C, Sabiston CM. Changes in social support predict emotional well-being in breast cancer survivors. Psychooncology. 2017;26(5):664–71. Scholar
  38. 38.
    Cacioppo JT, Hughes ME, Waite LJ, Hawkley LC, Thisted RA. Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses. Psychol Aging. 2006;21(1):140–51. Scholar
  39. 39.
    Cacioppo JT, Hawkley LC, Thisted RA. Perceived social isolation makes me sad: 5-year cross-lagged analyses of loneliness and depressive symptomatology in the Chicago Health, Aging, and Social Relations Study. Psychol Aging. 2010;25(2):453–63. Scholar
  40. 40.
    Tilvis RS, Kähönen-Väre MH, Jolkkonen J, Valvanne J, Pitkala KH, Strandberg TE. Predictors of cognitive decline and mortality of aged people over a 10-year period. J Gerontol A Biol Sci Med Sci. 2004;59(3):268–74.CrossRefPubMedGoogle Scholar
  41. 41.
    Shankar A, McMunn A, Banks J, Steptoe A. Loneliness, social isolation, and behavioral and biological health indicators in older adults. Health Psychol. 2011;30(4):377–85. Scholar
  42. 42.
    Peirce RS, Frone MR, Russell M, Cooper ML, Mudar P. A longitudinal model of social contact, social support, depression, and alcohol use. Health Psychol. 2000;19:28–38.CrossRefPubMedGoogle Scholar
  43. 43.
    Seeman TE, Lusignolo TM, Albert M, Berkman L. Social relationships, social support, and patterns of cognitive aging in healthy, high-functioning older adults: MacArthur studies of successful aging. Health Psychol. 2001;20:243–55.CrossRefPubMedGoogle Scholar
  44. 44.
    Reynolds P, Boyd PT, Blacklow RS, Jackson JS, Greenberg RS, Austin DF, et al. The relationship between social ties and survival among black and white breast cancer patients. National Cancer Institute Black/White Cancer Survival Study Group. Cancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res Cosponsored Am Soc Prev. 1994;3:253–9.Google Scholar
  45. 45.
    Soler-Vila H, Kasl SV, Jones BA. Prognostic significance of psychosocial factors in African-American and white breast cancer patients: a population-based study. Cancer. 2003;98(6):1299–308. Scholar
  46. 46.
    Weihs KL, Simmens SJ, Mizrahi J, Enright TM, Hunt ME, Siegel RS. Dependable social relationships predict overall survival in stages II and III breast carcinoma patients. J Psychosom Res. 2005;59(5):299–306. Scholar
  47. 47.
    Lehto U-S, Ojanen M, Dyba T, Aromaa A, Kellokumpu-Lehtinen P. Baseline psychosocial predictors of survival in localised breast cancer. Br J Cancer. 2006;94(9):1245–52. Scholar
  48. 48.
    Uchino BN. Understanding the links between social support and physical health: a life-span perspective with emphasis on the separability of perceived and received support. Perspect Psychol Sci. 2009;4(3):236–55. Scholar
  49. 49.
    Cacioppo S, Capitanio JP, Cacioppo JT. Toward a neurology of loneliness. Psychol Bull. in press;140(6):1464–504.
  50. 50.
    Sugisawa H, Liang J, Liu X. Social networks, social support, and mortality among older people in Japan. J Gerontol. 1994;49(1):S3–S13. Scholar
  51. 51.
    Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010;7(7):e1000316. Scholar
  52. 52.
    Ershler WB, Keller ET. Age-associated increased Interleukin-6 gene expression, late-life diseases, and frailty. Annu Rev Med. 2000;51(1):245–70. Scholar
  53. 53.
    Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med. 2005;352(16):1685–95. Scholar
  54. 54.
    Hotamisligil GS. Inflammation and metabolic disorders. Nature. 2006;444(7121):860–7. Scholar
  55. 55.
    Nabipour I, Vahdat K, Jafari SM, Pazoki R, Sanjdideh Z. The association of metabolic syndrome and Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus, and herpes simplex virus type 1: The Persian Gulf Healthy Heart Study. Cardiovasc Diabetol. 2006;5(1):25. Scholar
  56. 56.
    Parkin DM. The global health burden of infection-associated cancers in the year 2002. Int J Cancer. 2006;118(12):3030–44. Scholar
  57. 57.
    Raison CL, Capuron L, Miller AH. Cytokines sing the blues: inflammation and the pathogenesis of depression. Trends Immunol. 2006;27(1):24–31. Scholar
  58. 58.
    Dantzer R, O’Connor JC, Freund GG, Johnson RW, Kelley KW. From inflammation to sickness and depression: when the immune system subjugates the brain. Nat Rev Neurosci. 2008;9(1):46–56. Scholar
  59. 59.
    De Jongh RF, Vissers KC, Meert TF, Booij L, De Deyne CS, Heylen RJ. The role of interleukin-6 in nociception and pain. Anesth Analg. 2003;96:1096–103.CrossRefPubMedGoogle Scholar
  60. 60.
    Watkins LR, Maier SF. Beyond neurons: evidence that immune and glial cells contribute to pathological pain states. Physiol Rev. 2002;82(4):981–1011. Scholar
  61. 61.
    Bower JE, Ganz PA, Irwin MR, Kwan L, Breen EC, Cole SW. Inflammation and behavioral symptoms after breast cancer treatment: do fatigue, depression, and sleep disturbance share a common underlying mechanism? J Clin Oncol. 2011;29(26):3517–22. Scholar
  62. 62.
    Glaser R, Jones J. Human herpesvirus infections. New York: Dekker; 1994.Google Scholar
  63. 63.
    Glaser R, Kiecolt-Glaser JK, Speicher CE, Holliday JE. Stress, loneliness, and changes in herpesvirus latency. J Behav Med. 1985;8(3):249–60. Scholar
  64. 64.
    Jaremka LM, Fagundes CP, Peng J, Bennett JM, Glaser R, Malarkey WB, et al. Loneliness promotes inflammation during acute stress. Psychol Sci. 2013;24(7):1089–97. Scholar
  65. 65.
    Hackett RA, Hamer M, Endrighi R, Brydon L, Steptoe A. Loneliness and stress-related inflammatory and neuroendocrine responses in older men and women. Psychoneuroendocrinology. 2012;37(11):1801–9. Scholar
  66. 66.
    Jaremka LM, Belury MA, Andridge RR, Lindgren ME, Habash D, Malarkey WB, et al. Novel links between troubled marriages and appetite regulation: marital distress, ghrelin, and diet quality. Clin Psychol Sci. 2016;4(3):363–75. Scholar
  67. 67.
    Jaremka LM, Belury MA, Andridge RR, Malarkey WB, Glaser R, Christian L, et al. Interpersonal stressors predict ghrelin and leptin levels in women. Psychoneuroendocrinology. 2014;48:178–88. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Psychological and Brain SciencesUniversity of DelawareNewarkUSA

Personalised recommendations