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Social Influences on Clinical Outcomes of Patients With Ovarian Cancer
Open accessAbstract
Purpose: 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 and Methods: 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. Results: 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. Conclusion: 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.
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“Additionally, factors such as social isolation, stress, and depression are associated with key biological processes promoting tumor progression and poorer survival.”
From Living Well: Protocol for a web-based program to improve quality of life in rural and urban ovarian cancer survivors (2024) · cites this paper as [14]
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“and activator of transcription 3 (STAT3), the prolactin hormone and the prostaglandin E2 (PGE2) synthesis, all known to promote proliferation, migration, angiogenesis and apoptosis evasion in several cancers [2-5, 23-25].”
BackgroundNon-cancer life stressors contribute to impaired quality of life in ovarian cancer patients
Lutgendorf, S. K., Slavich, G. M., Degeest, K., Goodheart, M. J., Bender, D., Thaker, P. H., Penedo, F. J., Zimmerman, B. M., Lucci, J. A., Méndez, L., et al. (2013) · Gynecologic Oncology · doi:10.1016/j.ygyno.2013.09.025 · Cited by 25
“Inclusionwas confirmed by histologic diagnosis with primary invasive epithelial ovarian, primary peritoneal, or primary fallopian tube cancer as part of a larger study examining biobehavioral factors and QOL in ovarian cancer [22].”
BackgroundSelf-citationLutgendorf, S., Penedo, F., Goodheart, M., Dahmoush, L., Arevalo, J., Thaker, P., Slavich, G. M., Sood, A., & Cole, S. (2020) · Cancer · doi:10.1002/cncr.33060 · Cited by 25
Self-citationPrescott, L. S., Dickens, A. S., Guerra, S. L., Tanha, J., Phillips, D. G., Patel, K. T., Umberson, K. M., Lozano, M. A., Lowe, K. B., Brown, A. J., et al. (2015) · Gynecologic Oncology · doi:10.1016/j.ygyno.2015.11.006 · Cited by 24
“Integrating social networks into cancer treatment delivery is essential to improving patient care and quality of life [3].”
BackgroundAlimujiang, A., Khoja, L., Wiensch, A., Pike, M. C., Webb, P. M., Chenevix‐Trench, G., Chase, A., Richardson, J. L., & Pearce, C. L. (2019) · Gynecologic Oncology · doi:10.1016/j.ygyno.2019.10.007 · Cited by 24
Lowery, W. J., Stany, M. P., Phippen, N. T., Bunch, K. P., Oliver, K., Tian, C., Maxwell, G. L., Darcy, K. M., & Hamilton, C. A. (2014) · Gynecologic Oncology · doi:10.1016/j.ygyno.2014.12.027 · Cited by 24
“The extreme vulnerability of widows might be explained by the fact that they likely have low social attachment scores, a feature associated with poor survival in ovarian cancer patients regardless of relationship status [36].”
BackgroundKoh‐Bell, A., Chan, J. E., Mann, A. K., & Kapp, D. S. (2021) · BMC Public Health · doi:10.1186/s12889-021-11352-0 · Cited by 24
Targeting those with decreased meaning and peace: a supportive care opportunity
Brown, A. J., Sun, C. C., Urbauer, D. L., Zhukovsky, D. S., Levenback, C., Frumovitz, M., Thaker, P. H., Bodurka, D. C., & Ramondetta, L. M. (2014) · Supportive Care in Cancer · doi:10.1007/s00520-014-2568-6 · Cited by 24
“improved social relationships may improve overall survival through the alteration of the tumor microenvironment [31, 32].”
Self-citationLelorain, S., Cortot, A. B., Christophe, V., Pinçon, C., & Gidron, Y. (2018) · Journal of Clinical Medicine · doi:10.3390/jcm7100364 · Cited by 22
“Related to empathy, the role of social support in survival, including cancer survival, has been established [7,8].”
BackgroundJatoi, A., Muss, H. B., Allred, J., Cohen, H. J., Ballman, K. V., Hopkins, J. O., Gajra, A., Lafky, J. M., Wolff, A. C., Kottschade, L. A., et al. (2015) · Psycho-Oncology · doi:10.1002/pon.3850 · Cited by 20
“In contrast to our findings, Lutgendorf and others examined 168 ovarian cancer patients, who admittedly were contending with a more advanced and lethal malignancy [2].”
BackgroundResultAlobaidi, A., Nabulsi, N. A., Talon, B., Asfaw, A. A., Zhou, J., Sharp, L. K., Sweiss, K. I., Patel, P. R., Ko, N. Y., Chiu, B. C. ‐., et al. (2019) · Supportive Care in Cancer · doi:10.1007/s00520-019-05246-6 · Cited by 23
Why stress is BAD for cancer patients
Nagaraja, A. S., Armaiz-Peña, G. N., Lutgendorf, S. K., & Sood, A. K. (2013) · Journal of Clinical Investigation · doi:10.1172/jci67887 · Cited by 18
Self-citationCancer Prevention During Early Adulthood: Highlights From a Meeting of Experts
Holman, D. M., White, M. C., Shoemaker, M. L., Massetti, G. M., Puckett, M., & Brindis, C. D. (2017) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2017.04.020 · Cited by 20
“September 2017 protection of cancer cells from anoikis (a form of programmed cell death), increased nerve density, and altered tumor microenvironment; these mechanisms collectively can lead to poorer cancer outcomes.(35,36) Chronic inflammation may mediate the observed relationship between stressors such as social iso…”
BackgroundMaher, C., & Mendonca, R. J. (2018) · American Journal of Occupational Therapy · doi:10.5014/ajot.2018.023663 · Cited by 19
Kanesvaran, R., Wang, W., Yang, Y., Wei, Z., Jia, L., Li, F., Wu, S., Bai, C., Xie, H., Zhang, H., et al. (2014) · Journal of Geriatric Oncology · doi:10.1016/j.jgo.2014.01.004 · Cited by 18
“Studies have also shown close links between social support and survival in patients with cancer.(20) As such it will be”
BackgroundThe impact of social-emotional context in chronic cancer pain: patient-caregiver reverberations
Laurentis, M. D., Botto, R., Bovero, A., Riccardo, T., & Ieraci, V. (2018) · Supportive Care in Cancer · doi:10.1007/s00520-018-4530-5 · Cited by 19
Psychosocial factors and mortality in women with early stage endometrial cancer
Telepak, L. C., Jensen, S. E., Dodd, S. M., Morgan, L. S., & Pereira, D. B. (2013) · British Journal of Health Psychology · doi:10.1111/bjhp.12070 · Cited by 18
“In gynaecologic cancer populations, specifically ovarian cancer, better quality of life (Carey et al., 2008) and higher social attachment, a type of emotional support (Lutgendorf et al., 2012), are associated with longer survival times.”
BackgroundResultInfluentialPreserving Oneself in the Face of Uncertainty: A Grounded Theory Study of Women With Ovarian Cancer
Pozzar, R. A., & Berry, D. L. (2019) · Oncology nursing forum · doi:10.1188/19.onf.595-603 · Cited by 20
Online Social Networks - Opportunities for Empowering Cancer Patients
Mohammadzadeh, Z., Davoodi, S., & Ghazisaeidi, M. (2016) · Asian Pacific Journal of Cancer Prevention · doi:10.7314/apjcp.2016.17.3.933 · Cited by 17
“Studies show that providing different supportive activities through social networks may be able to increase survival rate and decrease mortality, disabilities and recurrence in cancer patients (Vogt et al., 1992; Kroenke et al., 2006; Lutgendorf et al., 2012).”
BackgroundPsychosocial interventions for ovarian cancer survivors: A systematic review
Yeoh, S. A., Webb, S., Phillips, A., Li, L. S. K., & Kumar, S. (2024) · Psycho-Oncology · doi:10.1002/pon.6280 · Cited by 17
“9,10 According to Lutgendorf and Sood, 9 addressing psychosocial conditions of perceived stress, distress and loneliness through psychosocial support may delay cancer progression.”
BackgroundInfluentialCuneo, M. G., Szeto, A., Schrepf, A., Kinner, E. M., Schachner, B. I., Ahmed, R., Thaker, P. H., Goodheart, M., Bender, D., Cole, S. W., et al. (2019) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2019.04.007 · Cited by 18
“While these studies are typically examining centrally released oxytocin, relationships between tumor microenvironment oxytocin and psychosocial factors should be investigated as both social isolation and stress have been linked to disease processes in ovarian cancer (Cole and Sood, 2012; Lutgendorf et al., 2012; Lutge…”
BackgroundSelf-citationImportance of adrenergic pathways in women's cancers
Thaker, P. H., Sood, A. K., & Ramondetta, L. M. (2013) · Cancer Biomarkers · doi:10.3233/cbm-130324 · Cited by 16
“This study highlights the importance of support activities during adjuvant therapy and how social support may act as stress buffer which leads to decreased adrenergic effects on the tumor [42].”
Self-citationTraumatic brain injury and neuro-endocrine disruption: Medical and psychosocial rehabilitation
Webb, N. E., Little, B., Loupee-Wilson, S., & Power, E. (2014) · Neurorehabilitation · doi:10.3233/nre-141074 · Cited by 18
““Psychosocial” stressors threaten neuroendocrine integrity, and visa versa – and they do so at a cellular and structural level (Lutgendorf et al., 2009, 2012; Miller et al., 1997, 2009; Piazza et al., 2013).”
Social vulnerability is associated with increased postoperative morbidity following esophagectomy
Stuart, C. M., Dyas, A. R., Byers, S., Velopulos, C. G., Randhawa, S. K., David, E. A., Pritap, A., Stewart, C. L., Mitchell, J. D., McCarter, M. D., et al. (2023) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2023.04.027 · Cited by 15
Chirico, A., Palombi, T., Alivernini, F., Lucidi, F., & Merluzzi, T. V. (2024) · Annals of Behavioral Medicine · doi:10.1093/abm/kaae025 · Cited by 15
Chronic stimulation desensitizes β2‐adrenergic receptor responses in natural killer cells
Jürgens, M., Claus, M., Wingert, S., Niemann, J. A., Picard, L. K., Hennes, E., Haasler, I., Hellwig, B., Overbeck, N., Reinders, J., et al. (2024) · European Journal of Immunology · doi:10.1002/eji.202451299 · Cited by 17
“In contrast to the effects of acute stress, chronic stress has negative effects on the immune system and can increase the risk of diseases, infections, and cancer [11, 64–66].”
Heo, J., Chun, M., Oh, Y., Noh, O. K., & Kim, L. (2017) · Psycho-Oncology · doi:10.1002/pon.4628 · Cited by 15
“The previous studies confirmed that emotional intervention was related to prognosis in ovarian cancer.(20) Also, ovarian cancer survivors receiving social support had lower tumor norepinephrine about tumor progression.”
ResultQuality of Life and Adverse Events: Prognostic Relationships in Long-Term Ovarian Cancer Survival
Wenzel, L. B., Osann, K., McKinney, C. O., Cella, D. F., Fulci, G., Scroggins, M. J., Lankes, H. A., Wang, V., Nephew, K. P., Maxwell, G. L., et al. (2021) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djab034 · Cited by 15
“cluding the importance of high social attachment (38), with strong implications for future directions.”
BackgroundPsychosocial risk and management of physical diseases
Schneiderman, N., McIntosh, R. C., & Antoni, M. H. (2019) · Journal of Behavioral Medicine · doi:10.1007/s10865-018-00007-y · Cited by 18
Disparities in Psychosocial Distress Screening and Management of Lung and Ovarian Cancer Survivors
Rohan, E. A., Gallaway, M., Huang, G. C., Ng, D., Boehm, J. E., Samarasinha, R., & Stachon, K. (2022) · JCO Oncology Practice · doi:10.1200/op.22.00078 · Cited by 12
“are components of quality cancer care,(18-20) and psychosocial support has been associated with longer survival.(21)”
BackgroundMultilevel Stressors and Systemic and Tumor Immunity in Black and White Women With Breast Cancer
Harris, A. R., Pichardo, C. M., Franklin, J., Liu, H., Wooten, W., Panigrahi, G., Lawrence, W. R., Pichardo, M. S., Jenkins, B. D., Dorsey, T. H., et al. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.59754 · Cited by 14
Slavich, G. M., & Toussaint, L. L. (2013) · Stress and Health · doi:10.1002/smi.2523 · Cited by 12
“…© 2013 John Wiley & Sons, Ltd. 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).”
Self-citationReiriz, M., González, M. D., Rodríguez-Expósito, B., Uceda, S., & Beltrán-Velasco, A. I. (2023) · Sustainability · doi:10.3390/su15043087 · Cited by 17
Cha, K. M., Kang, S. Y., Hyun, S. Y., Noh, J. S., Shin, Y., & Kim, N. H. (2018) · Palliative & Supportive Care · doi:10.1017/s1478951518000731 · Cited by 11
“, 2016); another stressed that emotional social support can offer beneficial effects on long-term survival outcomes in ovarian cancer patients (Lutgendorf et al., 2012).”
BackgroundKimmel, M., Melissa Fairbairn, P. A., Giuntoli, R. L., Jernigan, A. M., Belozer, A. S., Payne, J. L., Swartz, K., & Diaz-Montes, T. P. (2014) · International Journal of Gynecological Cancer · doi:10.1097/igc.0000000000000285 · Cited by 13
Social support and ovarian cancer incidence – A Swedish prospective population-based study
Idahl, A., Hermansson, A., & Lalos, A. (2018) · Gynecologic Oncology · doi:10.1016/j.ygyno.2018.03.042 · Cited by 11
Beattie, S., Lebel, S., & Tay, J. (2013) · PLoS ONE · doi:10.1371/annotation/9e6ee407-7782-4cf7-8e82-9f38c1d6739e · Cited by 11
Intergenerational resource sharing and mortality in a global perspective
Vogt, T. C., Kluge, F. A., & Lee, R. D. (2020) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1920978117 · Cited by 10
Social Support and Recovery from Disease and Medical Procedures
Stephens, M. H., & Petrie, K. J. (2015) · Elsevier eBooks · doi:10.1016/b978-0-08-097086-8.14129-7 · Cited by 10
Metadata
- Authors
- Lutgendorf, S. K., De Geest, K., Bender, D., Ahmed, A., Goodheart, M. J., Dahmoush, L., Zimmerman, M. B., Penedo, F. J., Lucci, J. A., Ganjei-Azar, P., Thaker, P. H., Mendez, L., Lubaroff, D. M., Slavich, G. M., Cole, S. W., & Sood, A. K.
- Affiliations
- University of Iowa (US)
- Susan K. Lutgendorf, Koen De Geest, David Bender, Amina Ahmed, Michael J. Goodheart, Laila Dahmoush, M. Bridget Zimmerman, and David M. Lubaroff, University of Iowa; Susan K. Lutgendorf and David M. Lubaroff, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; Frank J. Penedo, Joseph A. Lucci III, and Parvin Ganjei-Azar, Sylvester Comprehensive Cancer Center, University of Miami, Coral Gables, FL; Premal H. Thaker, Washington University School of Medicine, St Louis, MO; Luis Mendez,...
- ORCID
- Venue
- Journal of Clinical Oncology
- Published
- 2012-08-10
- Volume
- 30
- Issue
- 23
- Pages
- 2885-2890
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- PMC
- PMC3410403
- OpenAlex
- W2154496739
- Cited by
- 177
- References
- 64
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 13 · 2023: 12 · 2022: 21 · 2021: 13 · 2020: 9 · 2019: 14 · 2018: 16 · 2017: 16 · 2016: 10 · 2015: 13 · 2014: 11 · 2013: 14 · 2012: 2
- FWCI
- 14.90
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Oncology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Iowa Research Online (The University of Iowa) (submittedVersion)
- Funders
- National Cancer Institute (CA 109298, R21CA088293, CA-104825, R01CA109298, CA140933, R01CA116778, R01CA104825, CA-116778, R01CA140933, P50CA083639, P30CA016672)
- Topics
- Health Sciences › Medicine › Oncology › Ovarian cancer diagnosis and treatment
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Stress, Anesthesia, and Immune Response
- Keywords
- ovarian cancer, social support, social attachment, instrumental support, survival, epithelial ovarian cancer, emotional support, adjuvant therapy
- MeSH terms
- Carcinoma, Ovarian Epithelial, Aged, Female, Humans, Middle Aged, Neoplasms, Glandular and Epithelial, Ovarian Neoplasms, Prospective Studies, Social Support, Proportional Hazards Models, Outcome Assessment, Health Care
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