Abstract P2-13-12: Predictors of social function and feelings of isolation among metastatic breast cancer survivors
Authors: Zaleta Alexandra K , Miller Melissa F , McManus Shauna , Clark Kelly , Saxton M. Claire 
Published: March 2020

Introduction: Living with cancer can present physical and emotional challenges. The symptoms and side effects of breast cancer and its treatment can be intensive and long lasting and may interfere with spending time with family, friends, and community. The aims of the present analysis were to 1) describe social functioning and isolation among metastatic breast cancer (MBC) survivors who received chemotherapy, and 2) identify factors related to poorer social functioning and greater concern about feeling isolated among survivors. Methods: 273 female MBC survivors from the Cancer Support Community’s Cancer Experience Registry® reported a history of chemotherapy, completed the PROMIS-29v2.0 health-related quality of life survey, and rated their level of concern (0=not at all; 4 = very serious) about key areas of life, including social isolation (CancerSupportSource®). We used multiple regression analysis to identify significant correlates of 1) social functioning (T-scores for PROMIS Ability to Participate in Social Roles and Activities scale), and 2) level of concern about “feeling lonely or isolated.” Independent variables included socio-demographic factors (age, employment, income, and race), clinical history (time since diagnosis, time between initial and metastatic diagnoses), treatment history (currently receiving chemotherapy or radiation; method of chemotherapy administration ever received), and physical symptom burden (daily interference from peripheral neuropathy (PN) and fatigue). Results: Participants were 86% White, 9% Black; mean age 53.4 (SD=11.2) years. Time between initial cancer diagnosis and metastatic diagnoses averaged 3.3 (SD=5.2; range 0-27) years. 56% were currently receiving chemotherapy; 24% radiation. 60% ever received both IV and oral chemotherapy, 30% IV only, 9% oral only. Scores for the 4-item PROMIS social functioning scale were significantly (p&lt;.001) worse for MBC patients and survivors than the national average of T=50 for the U.S. population (95% CI=44.5-46.9, n = 246). When considering individual responses, 23.6% of MBC respondents reported substantially worse social functioning (&gt;1SD) than the national average. 32.4% of MBC participants were moderately to very seriously concerned about feelings of social isolation. About two in three reported they have trouble doing want they want to do (% sometimes, often, or always) regarding their usual work (70%), activities with friends (67%), family activities (64%), and regular leisure activities with others (63%). In multivariate regression analysis, predictors of poorer social functioning (R2 = .564, p&lt; .001, n = 134) included currently receiving chemotherapy (semipartial r = -.19, p &lt; .01), greater PN interference (semipartial r = -.22, p &lt; .001), and greater fatigue interference (semipartial r = -.49, p &lt; .001). Predictors of concern about feeling lonely or isolated (R2 = .35, p&lt; .001, n = 143) included greater PN interference (semipartial r = .16, p &lt; .05) and fatigue interference (semipartial r = .37, p &lt; .001). Significant associations with social functioning and concern about feeling isolated in bivariate analysis but not multivariate included lower income, unemployment, less time since diagnosis, and shorter interval between initial and metastatic diagnoses. Conclusion: Symptom burden, including peripheral neuropathy and fatigue, are associated with poorer social functioning and increased isolation among metastatic breast cancer survivors. Currently undergoing chemotherapy treatment is also associated with poorer social function, even after accounting for the contributions of symptom burden. Our results highlight the significant social impact of living with metastatic breast cancer and the value of tailored supportive care to address survivors’ unmet physical and socioemotional needs.

Citation Format: Alexandra K Zaleta, Melissa F Miller, Shauna McManus, Kelly Clark, M. Claire Saxton. Predictors of social function and feelings of isolation among metastatic breast cancer survivors [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-13-12.