title: Prediagnostic self-assessed health and extent of social networks predict survival in older individuals with cancer: a population based cohort study.
abstract: OBJECTIVE
  To assess the association between social networks on survival after cancer diagnosis in a population-based sample of elderly Israelis (>60 yo) living in the community in 1985 and followed for up to 20 years.
  
  
  METHODS
  We conducted a historical prospective study, using baseline measurements from a 1985 survey of a representative sample of community-dwelling population. Five distinct social networks were defined using information regarding number and intensity of social contacts: traditional-family (reference category), friends and neighbors, narrow-family, diverse, and attenuated. Cancer was ascertained through the Israel Cancer Registry, and mortality through the Population Registry after 20 years of follow-up.
  
  
  RESULTS
  The final study population included 676 participants diagnosed with cancer after 1985. Persons in the diverse network showed a lower risk of death (HR=0.74, 95% CI: 0.56-0.98) after adjusting for age, sex, smoking and self-assessed health. On the other hand, poor self-rated health at baseline (HR=1.39, 95% CI: 1.10-1.74 poor vs. all other categories of self-assessed health) was associated with increased risk of death. After excluding cancers amenable to early detection (breast, prostate, and colon) a borderline significant decreased risk of death following a diagnosis of cancer (HR=0.72, 95% CI: 0.52-1.01) was found.
  
  
  CONCLUSIONS
  There is evidence of a significant protective association between diverse social networks present before a cancer diagnosis and survival after the onset of disease. Social support from a variety of sources may be an important element in improving cancer survival in older individuals.
authors.affiliation: Dept of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel. Electronic address: ryakir@hadassah.org.il.
authors.forename: Yakir
authors.initials: Y
authors.lastname: Rottenberg
authors.affiliation: Paul Baerwald School of Social Work, The Hebrew University of Jerusalem, 91905, Israel.
authors.forename: Howard
authors.initials: H
authors.lastname: Litwin
authors.affiliation: School of Public Health, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel.
authors.forename: Orly
authors.initials: O
authors.lastname: Manor
authors.affiliation: Central Bureau of Statistics, P.O.B. 34525, Jerusalem 91342, Israel.
authors.forename: Ari
authors.initials: A
authors.lastname: Paltiel
authors.affiliation: School of Public Health, Haifa University, Haifa 31905, Israel.
authors.forename: Micha
authors.initials: M
authors.lastname: Barchana
authors.affiliation: School of Public Health, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel; Dept of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel.
authors.forename: Ora
authors.initials: O
authors.lastname: Paltiel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods* / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000401:mortality; D057566:Self Report; D012944:Social Support; D016019:Survival Analysis
keywords: Cancer; Cohort study; Mortality; Older people; Prognosis; Self assessed health; Social networks; Social support