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Cancer. 2020 Apr 15;126(8):1766-1775. doi: 10.1002/cncr.32710. Epub 2020 Jan 23.

Prediagnosis social support, social integration, living status, and colorectal cancer mortality in postmenopausal women from the women's health initiative.

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Division of Research, Kaiser Permanente Northern California, Oakland, California.
Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.
Department of Medicine, Division of General Internal Medicine, University of North Carolina, Chapel Hill, North Carolina.
Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, Indiana.
Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, California.
Department of Epidemiology, University of Washington, Seattle, Washington.
Fred Hutchinson Cancer Research Center, Seattle, Washington.
Department of Biochemistry and Molecular Medicine, University of California, Davis, California.
Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York.
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.



We evaluated associations between perceived social support, social integration, living alone, and colorectal cancer (CRC) outcomes in postmenopausal women.


The study included 1431 women from the Women's Health Initiative who were diagnosed from 1993 through 2017 with stage I through IV CRC and who responded to the Medical Outcomes Study Social Support survey before their CRC diagnosis. We used proportional hazards regression to evaluate associations of social support (tertiles) and types of support, assessed up to 6 years before diagnosis, with overall and CRC-specific mortality. We also assessed associations of social integration and living alone with outcomes also in a subset of 1141 women who had information available on social ties (marital/partner status, community and religious participation) and living situation.


In multivariable analyses, women with low (hazard ratio [HR], 1.52; 95% CI, 1.23-1.88) and moderate (HR, 1.21; 95% CI, 0.98-1.50) perceived social support had significantly higher overall mortality than those with high support (P [continuous] < .001). Similarly, women with low (HR, 1.42; 95% CI, 1.07-1.88) and moderate (HR, 1.28; 95% CI, 0.96-1.70) perceived social support had higher CRC mortality than those with high social support (P [continuous] = .007). Emotional, informational, and tangible support and positive interaction were all significantly associated with outcomes, whereas affection was not. In main-effects analyses, the level of social integration was related to overall mortality (P for trend = .02), but not CRC mortality (P for trend = .25), and living alone was not associated with mortality outcomes. However, both the level of social integration and living alone were related to outcomes in patients with rectal cancer.


Women with low perceived social support before diagnosis have higher overall and CRC-specific mortality.


colorectal cancer; social networks; social support; social ties; women


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