Social Well-Being during Cancer Survivorship: A Cross-Sectional Examination of Self-Reported Positive and Negative Effects of the Illness in the Context of Close Relationships

Background and Purpose: Improvements in early screening and treatment options have contributed to the continued increase in the number of cancer survivors in the United States. To date, estimates from the National Cancer Institute and the American Cancer Society indicate that 16.9 million survivors live in the country. By 2030, cancer survivors are expected to increase to 22.2 million. As a result of this expected growth, it becomes imperative to better understand this heterogeneous group's experience and identify strategies to best mitigate the multifaceted adverse outcomes at the functional, psychosocial, and economic levels. While quality of life is a broad multidimensional concept, social well-being refers to the health and quality of the relationships with family members and significant others. A cancer diagnosis affects the social support system of the individual, with partners/spouses often assuming the role of caregivers providing practical and emotional support. Close relationships are crucial to sustaining quality of life after diagnosis; however, limited literature exists about variations in close relationships during survivorship. This study examined positive and negative self-reported changes in relationships with partners/spouses, children, or significant others by sociodemographic and clinical factors.

Methods: Survey data collected from 504 cancer survivors were utilized. Cancer survivors were recruited through consumer panels, as part of a national survey conducted by CancerCare from July to December 2015. Fourteen items assessed positive or negative changes in communication, closeness with partner and children, stability of the relationship, and caregiver burden. An Exploratory Factor Analysis (EFA) was conducted using a robust weighted least square procedure. Then, the resulting factors were compared by sociodemographic and clinical characteristics using Chi-square tests and ANOVAs. Mplus version 7.31 was utilized for data management and data analysis.

Results: Participants were mostly male, middle-aged adults, non-Hispanic white and 4 years or more since diagnosis. Two factors emerged from the exploratory factor analysis, labeled Closeness and Ambivalence. Women reported greater positive and negative changes in close relationships. Hispanics and Non-Hispanic whites reported greater closeness than did Black/African Americans. Older survivors (≥ 66 y.o.) had lower negative changes and ambivalence in their relationships than those diagnosed during young adulthood. Cancer survivors from low socioeconomic backgrounds were more likely to report worse effects in their close relationships. Finally, greater ambivalence in close relationships existed for those diagnosed within the past 2-4 years, in active treatment, and those treated at community hospitals compared to academic cancer centers.

Conclusions and Implications: The present work further extends the current understanding of the effects of cancer on close relationships and identifies groups of survivors at risk of long-term affected social well-being. Women, younger survivors, individuals from minority groups, and those with lower income presented greater vulnerability for adverse outcomes. Additionally, variations by treatment status, time since diagnosis and institutional characteristics were reported. Results emphasize the need to enhance social workers’ preparation in addressing psychosocial issues across the cancer care continuum, and to develop interventions to sustain the quality of interpersonal relationships and overall social well-being.