Social Support as a Protective Factor for Patients with Cancer during the Pandemic

The past two years have been marked by unprecedented changes in healthcare services due to the COVID-19 pandemic. This has also been true in the field of oncology, with frequent adjustments and delays in treatment and the integration of remote appointments as part of a patient’s outpatient care. Further, marked restrictions on visitors in the inpatient setting have also had a notable impact on the experience of patients and providers in the hospital. In parallel, patients, especially those who are immunosuppressed, have needed to alter their daily activities, isolate, and request physical distancing from friends and family to remain safe. As a result of these changes, several studies have explored the psychosocial impact of the pandemic and have noted the heightened rates of anxiety among patients and caregivers, most often related to hospitalization, cancer management, and fear of cancer recurrence/progression (1–3).

In the study that follows this editorial, Velasco-Durantez et al. (4) have conducted a prospective, multicenter (Bioethics Group of the Spanish Society of Medical Oncology) study of the mediating role of social support between anxiety preoccupation and resilience among patients with advanced cancer during the first year of the pandemic. A total of 507 patients who were receiving either singular therapy chemotherapy, targeted therapy or immunotherapy, or a combination of these agents, were included in the analysis. Patients were assessed with the Brief Resilient Coping Scale, Duke_UNC-11 Functional Social Support Questionnaire, and the subscale of the anxious preoccupation of the Mini-Mental Adjustment to Cancer. Most notable among the findings was that social support was associated with enhanced resilience and reduced anxious preoccupation among patients with advanced cancer. There were no differences found between the total resilience score and clinical characteristics, including the type of treatment, despite newer agents possessing improved survival benefits and clinical outcomes. The authors suggested that a lack of knowledge (health literacy) may have potentially contributed to the absence of a significant difference in psychological outcomes between types of treatment (chemotherapy vs. targeted therapy and immunotherapy), a finding that perhaps warrants further investigation (4,5). In light of the myriad of changes that the COVID-19 pandemic has brought to the health care system, patients were potentially less able to acquire information regarding their treatment and prognosis. The potential impact of the pandemic on information sharing between patients and providers, including possible misinformation or disinformation, and its impact on treatment decision making and outcomes, remains an important avenue of investigation.

Social support has long been considered a protective factor during the cancer trajectory and one that can facilitate the psychosocial adjustment to this disease. As a result, limited access to a social support network, including health professionals and/or family and friends, may affect cancer outcomes (6,7). During the COVID-19, the study has also noted that this social support is associated with a lower risk of mental health outcomes, including anxiety, depression, and post-traumatic stress disorder (8). Patients and caregivers faced significant challenges in maintaining social support structures in an era of social distancing and remote medicine. Indeed, studies have shown that patients have tried to reduce loneliness through avenues, such as remote support, including telephone, email, and text message. For some patients, this strategy appeared to have worked well, while it was less successful for others. These patients have reported a lack of social isolation and feelings of loneliness (9–11).

Furthermore, it is important to consider the possible social and economic inequalities that may impact access to social support. Davis et al., for example, noted that social support was associated with receipt of chemotherapy, thus impacting clinical outcomes among those with less support (12). To address such unequal social support, the health care system must develop more effective ways by which to assist patients in navigating efforts, especially for those who possess more limited support outside of the clinical arena (13).

In recognition of the myriad of factors that can be impacted by a lack of social support, and the importance of achieving equity and equality in cancer care, targeted supportive strategies should be devised by organizations of cancer care, health care providers, and patient advocates. This will favor the development of comprehensive supportive care programs that can be implemented across health care systems to enhance access to social support and mitigate the negative impact of social isolation. Ideally, this should be fully integrated within healthcare systems across various countries, including those with resource restrictions (low- and middle-income countries). The integration of such efforts in different settings will be able to provide training programs, to reduce barriers in the access to such plan, and to promote well-established actions to assist people with cancer to navigate the cancer journey in this unprecedent era.

Cristiane Decat Bergerot
Centro de Câncer de Brasília (CETTRO), Instituto Unity de Ensino e Pesquisa, Brasília, Brazil
[email protected]

Rosario Costas-Muñiz
Memorial Sloan Kettering Cancer Center, New York, NY, USA

David Lee
University of New Mexico, Albuquerque, NM, USA

Errol J. Philip
University of California, San Francisco, San Francisco, CA, USA

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.