Social support predicts inflammation, pain, and depressive symptoms: Longitudinal relationships among breast cancer survivors
Section snippets
Understanding potential mechanisms
Immune dysregulation may be one mechanism linking low social support to the development of pain and depression over time (Uchino et al., 2012). Indeed, depressive symptoms, pain, and low social support are all related to heightened concurrent inflammation (Maes et al., 1997, Costanzo et al., 2005, Marsland et al., 2007). For example, lower social support was associated with higher inflammation among ovarian cancer patients, middle aged adults, and older adults (Lutgendorf et al., 2000, Loucks
Current study
Pain and depressive symptoms, two common and health-relevant symptoms among cancer survivors, are linked to inflammation. Social support may be a risk factor for these symptoms. Accordingly, we measured breast cancer survivors’ social support, pain, depressive symptoms, and inflammation before treatment began and 6 months after primary treatment completion. We hypothesized that survivors with lower social support prior to treatment would experience higher levels of pain and depressive symptoms
Setting and participants
Women (N = 164) were recruited from local breast cancer and mammography clinics an average of 3 weeks after their breast cancer diagnosis as part of an ongoing prospective study of fatigue among cancer survivors. Individuals were ineligible if they had HIV/AIDS, any prior history of cancer except basal or squamous cell skin carcinomas, or significant visual, auditory, or cognitive impairments. The women in our sample had stage 0-IIIA breast cancer, were primarily Caucasian (81%), and their
Results
All reported beta coefficients are unstandardized. IL-6 scores were log10 transformed prior to analyses because their distribution was positively skewed. Change in R2 refers to the proportion of variance in the outcome accounted for by the key predictor. Means and standard deviations for the primary outcomes and covariates can be found in Table 2.
Discussion
Breast cancer survivors with lower social support prior to treatment experienced higher levels of pain and depressive symptoms over time than their more socially connected counterparts. Furthermore, women with lower pretreatment social support had higher levels of IL-6 over time, and these elevations in IL-6 marginally predicted larger increases in depressive symptoms. Contrary to expectations, pretreatment IL-6 levels were unrelated to changes in pain over time, suggesting that other
Role of funding source
Work on this project was supported by NIH grants CA131029, UL1TR000090, CA016058 and K05 CA172296, American Cancer Society Postdoctoral Fellowship Grant 121911-PF-12-040-01-CPPB, and a Pelotonia Postdoctoral Fellowship from the Ohio State University Comprehensive Cancer Center.
Conflicts of interest statement
All authors declare that there are no financial conflicts of interest.
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