title: Social networks, social support, and survival after breast cancer diagnosis.
abstract: OBJECTIVE
  We prospectively examined social ties and survival after breast cancer diagnosis.
  
  
  METHODS
  Participants included 2,835 women from the Nurses' Health Study who were diagnosed with stages 1 to 4 breast cancer between 1992 and 2002. Of these women, 224 deaths (107 of these related to breast cancer) accrued to the year 2004. Social networks were assessed in 1992, 1996, and 2000 with the Berkman-Syme Social Networks Index. Social support was assessed in 1992 and 2000 as the presence and availability of a confidant. Cox proportional hazards models were used in prospective analyses of social networks and support, both before and following diagnosis, and subsequent survival.
  
  
  RESULTS
  In multivariate-adjusted analyses, women who were socially isolated before diagnosis had a subsequent 66% increased risk of all-cause mortality (HR = 1.66; 95% CI, 1.04 to 2.65) and a two-fold increased risk of breast cancer mortality (HR = 2.14; 95% CI, 1.11 to 4.12) compared with women who were socially integrated. Women without close relatives (HR = 2.65; 95% CI, 1.03 to 6.82), friends (HR = 4.06; 95% CI, 1.40 to 11.75), or living children (HR = 5.62; 95% CI, 1.20 to 26.46) had elevated risks of breast cancer mortality and of all-cause mortality compared with those with the most social ties. Neither participation in religious or community activities nor having a confidant was related to outcomes. Effect estimates were similar in analyses of postdiagnosis networks.
  
  
  CONCLUSIONS
  Socially isolated women had an elevated risk of mortality after a diagnosis of breast cancer, likely because of a lack of access to care, specifically beneficial caregiving from friends, relatives, and adult children.
authors.affiliation: Robert Wood Johnson Health and Society Scholars, University of California, San Francisco, Center for Health and Community, San Francisco, CA 94118, USA. ckroenke@berkeley.edu
authors.forename: Candyce H
authors.initials: CH
authors.lastname: Kroenke
authors.forename: Laura D
authors.initials: LD
authors.lastname: Kubzansky
authors.forename: Eva S
authors.initials: ES
authors.lastname: Schernhammer
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Holmes
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000523:psychology; D019058:Community Networks; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012934:Social Isolation; D012944:Social Support; D016019:Survival Analysis; D015996:Survival Rate; D014481:United States / Q000453:epidemiology