‘Health implications of loneliness’ manifest as higher mortality risk in cancer survivors
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Key takeaways:
- Adults reporting mild, moderate or severe loneliness had higher mortality risk than those reporting low/no loneliness.
- Clinicians should screen their patients for loneliness.
The number of cancer survivors continues to rise in the U.S., but that population can be at risk for premature death if clinicians do not acknowledge their mental health in addition to their physical well-being.
Older cancer survivors who identified as severely lonely had a higher mortality risk compared with those who had no or lower levels of loneliness, according to study results published in Journal of the National Comprehensive Cancer Network.
“Doctors should be aware that loneliness is common among cancer survivors, and it is important to talk to their patients or find the right person or team to talk to their patients to see if they have concerns related to loneliness,” Jingxuan Zhao, MPH, senior associate scientist of health service research at American Cancer Society, told Healio.
Background and methodology
More than 18 million cancer survivors lived in the U.S. in 2022, and that number could rise to 22 million by 2030 thanks to early detection and available and effective treatments, according to background information provided by researchers.
However, prolonged life does not always indicate a healthy one.
“Cancer survivors can experience unique sources of loneliness associated with their diagnosis and treatment history,” Zhao said. “For example, they may hesitate to share their cancer-related fears and worries, and they may not have received the support they expected or needed during their cancer experience. Understanding the health implications of loneliness among cancer survivors can have important clinical implications.”
Zhao and colleagues wanted to determine whether loneliness could have an impact on mortality.
They conducted a population-based longitudinal study in survivors aged at least 50 years.
The investigators created their study cohort using the 2008-2018 Health and Retirement Study, a national panel survey given twice a year, which includes questions about individuals’ health, employment and psychosocial well-being.
The Health and Retirement Study measured loneliness every 4 years beginning in 2008.
Researchers used an abbreviated version of the UCLA Loneliness Scale to determine whether adults had low/no, mild, moderate or severe loneliness.
The study cohort consisted of 3,447 survivors (24.3% low/no loneliness; 24.5% mild; 23.6% moderate; 27.6% severe), which encompassed 5,808 person-years of observation.
Results and next steps
Survivors who reported experiencing severe loneliness had greater mortality risk than those in the low/no group (adjusted HR = 1.67; 95% CI, 1.25-2.23).
Both the mild and moderate loneliness cohorts also had increased risk for death compared with the low/no group.
“Findings from this study indicated that programs to screen for loneliness among cancer survivors and to provide resources and support are warranted,” Zhao said. “[They] underscore the importance of incorporating loneliness screening as a routine part of cancer survivorship care. Our findings also highlight the importance of care coordination by cancer care clinicians and other specialty care providers and primary care to ensure cancer survivors receive timely screening and effective intervention for loneliness.”
Researchers noted the Surgeon General’s Advisory on the healing effects of social connection and community, which indicated loneliness can lead to worse survival due to experiencing negative emotions, unhealthy behaviors like smoking or substance abuse, or physiologic pathways.
Study limitations include the use of an abbreviated loneliness scale, self-reported data and missing information on cancer demographics.
Zhao believes research can still be conducted regarding loneliness and this patient population.
“The prevalence of loneliness and its impact on cancer survivors are still understudied,” she said. “Questions such as how loneliness can affect access to cancer care and cancer outcomes, how loneliness can affect cancer screening, and access to general care will be important topics for future studies.”
For more information:
Jingxuan Zhao, MPH, can be reached at jingxuan.zhao@cancer.org.
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