The Science of Social Support
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Voices from the Field of Social Support
Decades of research have shown that social support can have a tremendous effect on the well-being and health outcomes of cancer survivors. Still, there are a lot of misconceptions around the definition of social support, and its benefits to patient health. In this series of short videos, our panel of clinicians, researchers, and other professionals in the field share our best understanding of social support and how cancer caregivers can make a measurable difference in the lives of their loved ones.
Support Matters!
Social support is the act of providing assistance, but it is also about being available to a person in a way that makes them feel cared for or that they could call on you for help.
Helping a loved one face a health challenge can make a difference for them. Science has shown that social support can affect not only a patient’s emotions during treatment, but their physical outcomes as well.
The Good Medicine Project was sparked by just such research, conducted by Candyce Kroenke, ScD “Fun and Friends Help Ease the Breast Cancer Journey,” and described in the newsletter of the Pathways Study of Breast Cancer Survivorship of the Kaiser Division of Research, Northern California.[1]Kroenke CH, Kwan ML, Neugut AI, Ergas IJ, Wright JD, Caan BJ, Hershman D, Kushi LH. Social networks, social support mechanisms, and quality of life after breast cancer diagnosis. Breast Cancer Res Treat. 2013 Jun;139(2):515-27. doi: 10.1007/s10549-013-2477-2. Epub 2013 May 9. PMID: 23657404; PMCID: PMC3906043. This team has also investigated how social networks and social support may influence cancer outcomes,[2]Candyce H Kroenke, A conceptual model of social networks and mechanisms of cancer mortality, and potential strategies to improve survival, Translational Behavioral Medicine, Volume 8, Issue 4, August 2018, Pages 629–642, https://doi.org/10.1093/tbm/ibx061 as well as social isolation and breast cancer survival.[3]Kroenke CH, Kubzansky LD, Schernhammer ES, Holmes MD, Kawachi I. Social networks, social support, and survival after breast cancer diagnosis. J Clin Oncol. 2006 Mar 1;24(7):1105-11. doi: 10.1200/JCO.2005.04.2846. PMID: 16505430.
The power of social support is universal.
Analysis of the Shanghai Breast Cancer Survival Study found that women with the highest social well-being scores, compared with those with the lowest scores, had a 38% lower risk of mortality.[4]Epplein M, Zheng Y, Zheng W, Chen Z, Gu K, Penson D, Lu W, Shu XO. Quality of life after breast cancer diagnosis and survival. J Clin Oncol. 2011 Feb 1;29(4):406-12. doi: 10.1200/JCO.2010.30.6951. Epub 2010 Dec 20. PMID: 21172892; PMCID: PMC3058286.
A 2021 study of positive and negative social support found that positive support, in particular, predicted higher mental well-being among African American Breast Cancer survivors.[5]Strayhorn SM, Bergeron NQ, Strahan DC, Villines D, Fitzpatrick V, Watson KS, Khanna A, Molina Y.Understanding the relationship between positive and negative social support and the quality of life among African American breast cancer survivors.Support Care Cancer. 2021 Sep;29(9):5219-5226. doi: 10.1007/s00520-021-06098-9. Epub 2021 Feb 25. PMID: 33630156; PMCID: PMC8295223.
It’s not just breast cancer ...
Social support does not benefit just breast cancer patients ... or cancer patients. A 2010 meta-analysis integrated the results of 87 studies (sampling over 10 million individuals) on associations between perceived social support, network size, marital status, and cancer survival. The investigators found that high levels of perceived social support, larger social networks, and being married were associated with of 25%, 20%, and 12% lower mortality risks, respectively.[6] Pinquart M, Duberstein PR. Associations of social networks with cancer mortality: a meta-analysis. Crit Rev Oncol Hematol. 2010 Aug;75(2):122-37. doi: 10.1016/j.critrevonc.2009.06.003. Epub 2009 Jul 14. PMID: 19604706; PMCID: PMC2910231.
A recent study investigated immigration and assimilation of Chinese and Korean American immigrants andhighlighted the centrality of social support in lowering perceived stress and distress, leading to better overall health.[7]Morey BN, Valencia C, Park HW, Lee S. The central role of social support in the health of Chinese and Korean American immigrants. Soc Sci Med. 2021 Sep;284:114229. doi: 10.1016/j.socscimed.2021.114229. Epub 2021 Jul 14. PMID: 34284265; PMCID: PMC8638775.
In Healthy People 2020, the US Department of Health and Human Services' 10-year agenda for improving the nation's health, social support is one of 15 key social determinants that affect overall health.[8] Healthy People 2020, US Department of Health and Human Services.
How does support affect a patient’s body?
How can a ride to the doctor, bringing dinner or a visit affect physiology?
First, research and anecdotal evidence indicate that patients with strong, healthy social networks are more likely to pursue and stick with their treatment plan — “follow the doctor’s orders” — and benefit from medical care.[9]Shelton RC, Clarke Hillyer G, Hershman DL, Leoce N, Bovbjerg DH, Mandelblatt JS, Kushi LH, Lamerato L, Nathanson SD, Ambrosone CB, Neugut AI. Interpersonal influences and attitudes about adjuvant therapy treatment decisions among non-metastatic breast cancer patients: an examination of differences by age and race/ethnicity in the BQUAL study. Breast Cancer Res Treat. 2013 Feb;137(3):817-28. doi: 10.1007/s10549-012-2370-4. Epub 2012 Dec 22. PMID: 23263696; PMCID: PMC3563273.
Other studies have focused on the stress buffering aspects of social support. When stress hormones are high, the body is less able to protect itself from cancer progression. Scientists have measured biomarkers known as "hallmarks of cancer",[10]Hanahan D, Weinberg RA. The hallmarks of cancer. Cell. 2000 Jan 7;100(1):57-70. doi: 10.1016/s0092-8674(00)81683-9. PMID: 10647931.[11]Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation Cell. 2011 Mar 4;144(5):646-74. doi: 10.1016/j.cell.2011.02.013. PMID: 21376230. and found that patients reporting higher social support had higher levels of protective markers and lower levels of damaging ones.[12-20]See footnotes 12–20 for details.