Cancer Survivors with Greater Loneliness Face a Higher Risk of Death

Cancer treatment can be physically and psychologically challenging. However, people who have survived cancer—cancer survivors—continue to face difficulties after treatment. Recent research suggests that their levels of loneliness may increase their risk of death.

Published on April 24, 2024, in the Journal of the National Comprehensive Cancer Network, a study found higher mortality risk among cancer survivors with greater loneliness. The findings highlight loneliness's adverse effects on physical health and the need for healthcare services to address it.

The COVID-19 pandemic has made the importance of loneliness as a medical issue even clearer.

In 2022, the United States alone had more than 18 million cancer survivors, a number expected to reach 22 million by 2030. Cancer diagnosis and treatment can cause physical problems such as cognitive difficulties and hearing loss, as well as emotional challenges such as anxiety and depression. These effects may harm survivors' social relationships and increase feelings of loneliness.

The Health Effects of Loneliness – Previous Research

Observational population studies have linked loneliness to higher morbidity, or illness, and mortality. A Swedish study, for example, found a 27% higher risk of death in healthy people reporting high loneliness than in those who did not feel lonely. Another study in older adults in the United States also linked loneliness to higher mortality. Further research published in 2021 showed that loneliness increased cancer risk in middle-aged men .

Why Cancer Survivors May Feel Lonely

Depending on their diagnosis and treatment history, cancer survivors may have specific reasons for feeling lonely .

• Family and friends may not understand their concerns about the illness,
• They may hesitate to share cancer-related fears and worries, and
• They may not have received the support they expected or needed during their cancer experience.

These experiences can further increase feelings of social isolation. Understanding the prevalence and health effects of loneliness among cancer survivors has important clinical implications for both cancer care and primary healthcare.

Study Overview

The researchers analyzed cancer survivors aged 50 and older from the 2008-2018 Health and Retirement Study. Loneliness was assessed with a shortened version of the 20-item UCLA Loneliness Scale containing 11 items. Scores were summed to produce a total loneliness score, divided into four categories:

• 11-12 points: low/no loneliness
• 13-15 points: mild loneliness
• 16-19 points: moderate loneliness
• 20-33 points: severe loneliness

This survey examined data from 3447 cancer survivors over a total of 5808 person-years of observation. Participants reported low/no loneliness (24.3%), mild loneliness (24.5%), moderate loneliness (23.6%), or severe loneliness (27.6%).

The 11-Item Shortened UCLA Loneliness Scale, Translated from the Turkish Version

Findings

Adjusted analyses showed a higher risk of death in patients with higher loneliness scores. Compared with those reporting low or no loneliness, the mortality risk ratios were:

• Mild loneliness: 1.2-fold (95% CI, 0.86–1.63)
• Moderate loneliness: 1.4-fold (95% CI, 1.01–1.96)
• Severe loneliness: 1.7 -fold (95% CI, 1.25–2.23)

Conclusion

This study makes an important contribution to the evidence linking loneliness with higher mortality risk in cancer survivors. The findings may provide a foundation for research identifying the best ways to assess and manage loneliness and inform interventions to reduce its adverse health outcomes.

Recommended Practices

• Include loneliness screening in routine health checks.
• Improve collaboration and coordination among healthcare providers.
• Develop support programs for cancer survivors.

These findings again highlight the need to broaden post-cancer care and consider psychosocial factors such as loneliness. This would be an important step toward improving survivors' quality of life.

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Cancer Survivors in Turkey May Have Different Reasons for Feeling Lonely

Cancer survivors in Turkey may feel lonely for different reasons than those in other countries. Contributing factors may include inadequate information about their illness, a lack of honesty from loved ones, or loss of trust. People facing cancer may find it difficult to communicate openly about the seriousness of their illness and the treatment process. This may leave them feeling isolated and increasingly lonely.

Research on this issue in Turkey is limited, and more studies are needed to understand cancer survivors' psychosocial needs and challenges. There is evidence that psychological support for patients and survivors may help reduce loneliness. Increasing psychosocial support during cancer treatment could therefore be an important step toward alleviating these feelings.