Social Influences on Clinical Outcomes of Patients With Ovarian Cancer

Department of Psychology, University of Iowa, E11 Seashore Hall, Iowa City, IA 52242, USA.
Journal of Clinical Oncology (Impact Factor: 18.43). 07/2012; 30(23):2885-90. DOI: 10.1200/JCO.2011.39.4411
Source: PubMed


Previous research has demonstrated relationships of social support with disease-related biomarkers in patients with ovarian cancer. However, the clinical relevance of these findings to patient outcomes has not been established. This prospective study examined how social support relates to long-term survival among consecutive patients with ovarian cancer. We focused on two types of social support: social attachment, a type of emotional social support reflecting connections with others, and instrumental social support reflecting the availability of tangible assistance.
Patients were prospectively recruited during a presurgical clinic visit and completed surveys before surgery. One hundred sixty-eight patients with histologically confirmed epithelial ovarian cancer were observed from the date of surgery until death or December 2010. Clinical information was obtained from medical records.
In a Cox regression model, adjusting for disease stage, grade, histology, residual disease, and age, greater social attachment was associated with a lower likelihood of death (hazard ratio [HR], 0.87; 95% CI, 0.77 to 0.98; P = .018). The median survival time for patients with low social attachment categorized on a median split of 15 was 3.35 years (95% CI, 2.56 to 4.15 years). In contrast, by study completion, 59% of patients with high social attachment were still alive after 4.70 years. No significant association was found between instrumental social support and survival, even after adjustment for covariates.
Social attachment is associated with a survival advantage for patients with ovarian cancer. Clinical implications include the importance of screening for deficits in the social environment and consideration of support activities during adjuvant treatment.

12 Reads
  • Source
    • "Stress has also been implicated in accelerated biological aging and early mortality (Bennett, Fagundes, & Kiecolt-Glaser, 2013; Epel et al., 2004; Lutgendorf et al., 2012; Nielsen, Kristensen, Schnohr, & Grønbaek, 2008; O'Donovan, Slavich, Epel, & Neylan, 2013). Given the centrality of these concepts to psychology and the relevance of these effects for students' lives, it is not surprising that some high schools and many universities offer a course that discusses how stress affects health. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The ability to measure cumulative stress exposure is important for research and teaching in stress and health, but until recently, no structured system has existed for assessing exposure to stress over the lifespan. Here, we report the results of two experimental studies that examined the pedagogical efficacy of using an automated system for assessing life stress, called the Stress and Adversity Inventory (STRAIN), for teaching courses on stress and health. In Study 1, a randomized, wait-list controlled experiment was conducted with 20 college students to test whether the STRAIN, coupled with a related lecture and discussion, promoted learning about stress and health. Results showed that this experiential lesson led to significant learning gains. To disentangle the effects of completing the STRAIN from participating in the lecture and discussion, we subsequently conducted Study 2 on 144 students using a 2 (STRAIN versus control activity) by 2 (STRAIN-specific lecture versus general stress lecture) repeated-measures design. Although the STRAIN-specific lecture was sufficient for promoting learning, completing the STRAIN also generated significant learning gains when paired with only the general stress lecture. Together, these studies suggest that the STRAIN is an effective tool for promoting experiential learning and teaching students about stress and health. Copyright © 2013 John Wiley & Sons, Ltd.
    Stress and Health 10/2014; 30(4). DOI:10.1002/smi.2523 · 1.81 Impact Factor
  • Source
    • "Early detection of PTSD symptoms can therefore help both psychological health and medical prognosis. In particular, avoidant reactions seem to be more associated with poorer physical health while intrusive reactions seem to be related to poorer psychological health (Lutgendorf et al. 2012). Avoidant individuals are less likely to seek support, to complain about physical symptoms and, thus, to be compliant with the process of care (Ciechanowski et al. 2002). "
    [Show abstract] [Hide abstract]
    ABSTRACT: It is a well-established multidisciplinary practice at the European Institute of Oncology, that nurses and physicians often report their difficulties to clinical psychologists regarding adherence to hospital scheduling and procedures, when faced with women who, having been diagnosed with cancer, may be too overwhelmed to understand medical advice. We thus undertook an observational-prospective-cohort study, to investigate the prevalence and variation of PTSD symptomatology in women awaiting a mastectomy at a mean of 30 days after diagnosis and up to 2 years after discharge from hospital. The presence of any correlations between PTSD symptoms and medical and psycho-social variables was also investigated. Between March 2011 and June 2012, 150 women entered the study and were evaluated at four points in time: pre-hospital admission, admission for surgery, hospital discharge and two years later. The prevalence of distress at pre-hospital admission was 20% for intrusion symptoms, 19.1% for avoidance symptoms and 70.7% for state anxiety. Intrusion was negatively correlated with time from diagnosis independently of tumor dimensions, i.e. independently of the perceived seriousness of the illness. Even though at two-year follow up the prevalence of intrusion and avoidance is similar to that in the general population, patients with high levels of intrusion and avoidance at pre-hospital admission will maintain these levels, showing difficulties in adjusting to illness even two years later. As for psycho-social factors, the presence of a positive cancer family and relational history is associated with high levels of distress, in particular with intrusive thinking. Proper interventions aimed at the management of these issues and at their implications in clinical practice is clearly warranted.
    SpringerPlus 07/2014; 3(1):392. DOI:10.1186/2193-1801-3-392
  • Source
    • "This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. part by inflammation, such as asthma, rheumatoid arthritis, cardiovascular disease, chronic pain, and certain cancers (Bower, Crosswell, & Slavich, 2014; Chrousos, 2009; Cohen, Janicki- Deverts, & Miller, 2007; Cutolo & Straub, 2006; Kivimäki et al., 2006; Loeser & Melzack, 1999; Lutgendorf et al., 2012, 2013; A. H. Miller, 2008; Reiche, Nunes, & Morimoto, 2004; Steptoe & Kivimäki, 2012; Walker, Littlejohn, McMurray, & Cutolo, 1999; R. J. Wright, 2011). As a result, we turn now to the question of whether stress is associated with inflammation. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Major life stressors, especially those involving interpersonal stress and social rejection, are among the strongest proximal risk factors for depression. In this review, we propose a biologically plausible, multilevel theory that describes neural, physiologic, molecular, and genomic mechanisms that link experiences of social-environmental stress with internal biological processes that drive depression pathogenesis. Central to this social signal transduction theory of depression is the hypothesis that experiences of social threat and adversity up-regulate components of the immune system involved in inflammation. The key mediators of this response, called proinflammatory cytokines, can in turn elicit profound changes in behavior, which include the initiation of depressive symptoms such as sad mood, anhedonia, fatigue, psychomotor retardation, and social-behavioral withdrawal. This highly conserved biological response to adversity is critical for survival during times of actual physical threat or injury. However, this response can also be activated by modern-day social, symbolic, or imagined threats, leading to an increasingly proinflammatory phenotype that may be a key phenomenon driving depression pathogenesis and recurrence, as well as the overlap of depression with several somatic conditions including asthma, rheumatoid arthritis, chronic pain, metabolic syndrome, cardiovascular disease, obesity, and neurodegeneration. Insights from this theory may thus shed light on several important questions including how depression develops, why it frequently recurs, why it is strongly predicted by early life stress, and why it often co-occurs with symptoms of anxiety and with certain physical disease conditions. This work may also suggest new opportunities for preventing and treating depression by targeting inflammation. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Psychological Bulletin 01/2014; 140(3). DOI:10.1037/a0035302 · 14.76 Impact Factor
Show more

Koen De Geest