Childhood cancer survivors at risk for loneliness
Some childhood cancer survivors appeared at elevated risk for loneliness, according to study results presented during the virtual Oncology Nursing Society Congress.
“Timely detection and alleviating symptoms of loneliness may help childhood cancer survivors achieve their expected social roles, and reduce psychological and physical morbidities associated with loneliness,” Ameera Adel Amin Fayad, BSN, RN, PhD candidate at University at Buffalo, said during a presentation.
Encyclopedia of Mental Health defines loneliness as “the unpleasant experience that occurs when a person’s network of social relationships is significantly deficient in quantity or quality.”
The subjective experience, which is different from social isolation, can cause distress and originates from individual appraisal and perception, according to study background. The consequences of loneliness range from poor sleep, alcohol use and anxiety to increased risk for suicide or early mortality.
Childhood cancer survivors experience long periods of isolation due to the cancer experience and treatment, and this plays a key role in the development of loneliness, according to the researchers.
Prior studies showed childhood cancer survivors are less likely to develop friendships, have social interaction, establish intimate relationships or get married. Some also harbor concerns about being unable to fit in or being misunderstood by peers.
“Despite the advances in therapies and supportive care for childhood cancer survivors, the potential adverse effects of loneliness on psychological and physical health is an understudied phenomenon [among] childhood cancer survivors,” Fayad said. “Therefore, the purpose of the current study is to estimate the prevalence of loneliness and examine predictors of loneliness [in this population].”
In a cross-sectional, observational study, researchers performed a secondary data analysis of a de-identified data set obtained from a comprehensive cancer center in the southwestern United States.
The data set included 233 people (age range, 13-20 years; 54.5% male, 79.3% white) with a history of cancer or similar illness who were diagnosed prior to age 22 years. All members of the cohort were in remission and had been off therapy for at least 2 years.
The average age at diagnosis was 6.6 years, average age at survey completion was 16 years, and an average 9 years had passed since diagnosis.
About two-thirds of survivors had hematologic malignancies and nearly all (97.9%) had received chemotherapy. One-quarter of survivors (25.3%) had undergone surgery, about 11.5% had received cranial radiation, one-third (33.5%) had received radiation to other parts of the body and 29.6% had undergone bone marrow transplant.
Investigators measured loneliness by using a single item from the Minneapolis-Manchester Quality of Life Adolescent Questionnaire. Survivors used a five-point scale to rate the degree to which they would describe themselves as lonely. Those who indicated they endured loneliness at least some of the time were defined as lonely survivors.
Slightly more than one in five survivors (21.5%) reported loneliness.
Results revealed three key predictors of loneliness: parents’ marital status, treatment type and race.
Survivors whose parents were married and living together appeared significantly more likely to report loneliness than those whose patients were divorced or separated (OR = 2.04; 95% CI, 1.01-4.14). Researchers emphasized this variable requires further investigation because it may be due to unmeasured factors, such as parental conflict in married families, availability of resources or child coping strategies.
Survivors who received cranial radiation (OR = 4.99; 95% CI, 1.78-14.2) also appeared more likely to report loneliness. Investigators noted this treatment modality is associated with poor social functioning and adverse physical and mental health.
Results also showed non-white survivors were 72% less likely than white survivors to experience loneliness (OR = 0.28; 95% CI, 0.09-0.81), a finding that researchers said may reflect cultural or ethnic differences.
Future research should aim to identify cultural and interpersonal factors associated with loneliness among childhood cancer survivors, as well as examine the relationship between late treatment effects and loneliness, Fayad and colleagues concluded.
Longitudinal studies are needed, as preliminary evidence suggests loneliness survivors experience during childhood continues into adulthood, they added.
Additional studies also should explore the relationship between loneliness among childhood cancer survivors and their physical and mental well-being, investigators wrote.
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Fayad AAA, et al. Loneliness perception among childhood cancer survivors. Presented at: Oncology Nursing Society Congress (virtual meeting); April 20-29, 2021.
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