Social support and its implications in older, early‐stage breast cancer patients in CALGB 49907 (Alliance A171301)

Abstract

Background Most studies point to a direct association between social support and better cancer outcomes. This study examined whether baseline social support is associated with better survival and fewer chemotherapy-related adverse events in older, early-stage breast cancer patients. Methods This study is part of a pre-planned secondary analysis of CALGB 49907/Alliance A171301, a randomized trial that compared standard adjuvant chemotherapy versus capecitabine in breast cancer patients 65 years of age or older. A subset of patients reported on the extent of their social support. Results The median age of this 331-patient cohort was 72 years (range: 65, 90); 179 (55%) were married, and 210 (65%) lived with someone. 145 patients (46%) described a social network of 0-10 people; 110 (35%) of 11-25; and 58 (19%) of 26 or more. The Medical Outcomes Study (MOS) social support survey revealed the median scores (range) for emotional/informational, tangible, positive social interaction, and affectionate social support were 94 (3, 100), 94 (0, 100), 96 (0, 100), and 100 (8, 100), respectively. Social support scores appeared stable over time and higher (more support) than in other cancer settings. No statistically significant associations were observed between social support and the outcomes of survival and adverse events in multivariate analyses. However, married patients had smaller tumors, and those with arthritis reported less social support. Conclusion Although social support did not predict survival and adverse events, the exploratory but plausible inverse associations with larger tumors and arthritis suggest social support merits further study in older breast cancer patients.

Unmet social support needs among older adults with cancer

“…In a qualitative study of older women with breast cancer, participants highlighted the need to strengthen and rely on supportive networks at the time of diagnosis as well as during and after cancer treatment . However, another recent secondary analysis of older women with early‐stage breast cancer from the Cancer and Leukemia Group B (CALGB) 49907 (Alliance A171301) trial did not find an association between social support and outcomes of survival and adverse events in multivariate analyses using a similar version of the Medical Outcomes Study Social Support Survey . This contrasted finding may be due to the highly selective population of older adults able to commit to extra testing as part of a cooperative group clinical trial and the relatively small sample size.…”

“…Social support commonly is defined as a network of either close relatives or friends who can potentially help a participant during illness . Social support enables older adults with cancer to attend appointments, undergo diagnostic tests and procedures, and feel emotionally sustained during cancer therapy . Modern cancer care routinely provides state‐of‐the‐science medical treatment, but frequently fails to address the psychosocial aspects of illness .…”

“…Although the importance of social support in clinical care is intuitive, its overall impact on cancer outcomes such as survival and adverse outcomes remains mixed. To our knowledge, the majority of research regarding social support to date predominantly has focused on adults with breast cancer; frequently involves small samples; and mainly has examined the presence, not the specific need, of social support . A recent review of unmet psychosocial needs in participants with hematologic malignancies identified a high number of unmet psychological, physical, and informational needs .…”

“…Cancer February 1, 2019 diagnostic tests and procedures, and feel emotionally sustained during cancer therapy. 8 Modern cancer care routinely provides state-of-the-science medical treatment, but frequently fails to address the psychosocial aspects of illness. 9 Unmet psychosocial problems can negatively impact a participant's ability to cope and manage their illness, as well as limit their ability to access and receive necessary health care resources.…”

“…To our knowledge, the majority of research regarding social support to date predominantly has focused on adults with breast cancer; frequently involves small samples; and mainly has examined the presence, not the specific need, of social support. 8,[10][11][12] A recent review of unmet psychosocial needs in participants with hematologic malignancies identified a high number of unmet psychological, physical, and informational needs. 13 To the best of our knowledge, few studies to date have focused specifically on the role of social support in older adults with cancer, a population of participants who are likely to have more support needs than their younger counterparts and who are at increased risk of disruptions to their support systems.…”