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Postdiagnosis social networks and breast cancer mortality in the After Breast Cancer Pooling Project
Author(s) -
Kroenke Candyce H.,
Michael Yvonne L.,
Poole Elizabeth M.,
Kwan Marilyn L.,
Nechuta Sarah,
Leas Eric,
Caan Bette J.,
Pierce John,
Shu XiaoOu,
Zheng Ying,
Chen Wendy Y.
Publication year - 2017
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30440
Subject(s) - spouse , breast cancer , medicine , demography , hazard ratio , cohort , friendship , proportional hazards model , gerontology , cohort study , confidence interval , interpersonal ties , cancer , oncology , psychology , social psychology , sociology , anthropology
BACKGROUND Large social networks have been associated with better overall survival, though not consistently with breast cancer (BC)–specific outcomes. This study evaluated associations of postdiagnosis social networks and BC outcomes in a large cohort. METHODS Women from the After Breast Cancer Pooling Project (n = 9267) provided data on social networks within approximately 2 years of their diagnosis. A social network index was derived from information about the presence of a spouse/partner, religious ties, community ties, friendship ties, and numbers of living first‐degree relatives. Cox models were used to evaluate associations, and a meta‐analysis was used to determine whether effect estimates differed by cohort. Stratification by demographic, social, tumor, and treatment factors was performed. RESULTS There were 1448 recurrences and 1521 deaths (990 due to BC). Associations were similar in 3 of 4 cohorts. After covariate adjustments, socially isolated women (small networks) had higher risks of recurrence (hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.15‐1.77), BC‐specific mortality (HR, 1.64; 95% CI, 1.33‐2.03), and total mortality (HR, 1.69; 95% CI, 1.43‐1.99) than socially integrated women; associations were stronger in those with stage I/II cancer. In the fourth cohort, there were no significant associations with BC‐specific outcomes. A lack of a spouse/partner ( P = .02) and community ties ( P = .04) predicted higher BC‐specific mortality in older white women but not in other women. However, a lack of relatives ( P = .02) and friendship ties ( P = .01) predicted higher BC‐specific mortality in nonwhite women only. CONCLUSIONS In a large pooled cohort, larger social networks were associated with better BC‐specific and overall survival. Clinicians should assess social network information as a marker of prognosis because critical supports may differ with sociodemographic factors. Cancer 2017;123:1228–1237. © 2016 American Cancer Society .