The lived experiences of social isolation among cancer patients: a systematic review and meta-synthesis.

What is already known • Social isolation remains a significant concern among cancer patients, adversely affecting physical and psychological well-being and hindering reintegration into society. • Although previous studies have explored social isolation among cancer patients, the available evidence remains fragmented. Existing studies have focused on specific aspects of social isolation, such as emotional distress, stigma, or reduced social participation, limiting a holistic understanding of cancer patients’ experiences of social isolation. What this paper adds • This study provides a comprehensive understanding of social isolation among cancer patients by identifying both its underlying triggers and core manifestations. • Disruptions in individual, interpersonal, and societal functioning were identified as key triggers of social isolation among cancer patients. • Social isolation among cancer patients manifested as individual social withdrawal and disengagement, disrupted supportive interpersonal connections, and restricted societal inclusion.

Introduction

Cancer represents a major global public health challenge, with its incidence rate increasing annually ( Bray et al., 2024 ). Advances in early screening, targeted therapies, and comprehensive nursing care have substantially improved survival outcomes among patients with cancer ( Harding et al., 2023 ; Morrison-Jones and West, 2023 ; Salim et al., 2024 ). However, the diagnosis and treatment of cancer can cause physical symptoms, psychological distress, and social burdens on patients ( Marzorati et al., 2025 ). These challenges highlight the broader impact of cancer on social well-being. Within this context, social isolation has drawn increasing attention as an important determinant of health and a barrier to social recovery ( Liang et al., 2022 ). Social isolation is defined as a state in which an individual lacks interaction, contact, and/or relationships with other individuals and/or society at large ( Holt-Lunstad et al., 2017 ). It is characterized by limited social interactions and negative emotional experiences ( Liang et al., 2022 ), distinguishing it from solitude. Specifically, solitude refers to the physical situation of being alone without other people and does not involve negative affective experiences such as loneliness ( Weinstein et al., 2023 ).

Approximately 27%–33% of cancer patients self-report social isolation, indicating that the problem is widespread enough to warrant clinical attention ( Moore et al., 2018 ). Previous studies have shown that social isolation among cancer patients is associated with reduced treatment adherence and increased mortality risk ( Leigh-Hunt et al., 2017 ). Cancer patients experiencing social isolation are more likely to report higher levels of anxiety and depressive symptoms ( Liu et al., 2021 ). Furthermore, greater social isolation has been linked to poorer social well-being and reduced social participation among cancer patients ( Dunsmore and Neupert, 2024 ; Li et al., 2024 ). Thus, social isolation is associated with adverse physical, psychological, and social consequences that can hinder social recovery among patients with cancer.

Existing evidence suggests that patients with cancer who experience social isolation often exhibit reduced social engagement, smaller social networks, and feelings of loneliness ( Al-Azri et al., 2024 ; Hu et al., 2025 ). Treatment-related side effects and frequent hospital visits may limit patients’ energy and opportunities for social activities ( Nwozichi et al., 2025 ; Yang et al., 2025 ). In addition, patients’ psychological responses and social environments may further contribute to social isolation. For example, some patients may intentionally withdraw from social interactions because of physical disfigurement and altered self-perception following cancer treatment ( Zhu et al., 2024 ). Family members and friends may distance themselves from patients because they are uncertain about how to provide appropriate support ( Laidsaar et al., 2024 ). Cancer-related stigma may also reinforce social exclusion by generating negative societal attitudes toward cancer patients ( Ettridge et al., 2018 ). Importantly, social isolation is not solely a passive consequence of disease and treatment but is also shaped by factors at the individual, interpersonal, and societal levels.

Previous qualitative studies have provided rich insights into the lived experiences of social isolation among cancer patients and its contributing factors ( Dong et al., 2023 ; Hu et al., 2025 ; Song and Yao, 2024 ; Yang et al., 2025 ). In this review, these individual-, interpersonal-, and societal-level contributing factors are operationally defined as “triggers.” However, findings from individual qualitative studies are often fragmented and context-dependent, limiting their transferability across settings and their applicability to clinical practice. Although systematic reviews of psychosocial adaptation experiences exist, no synthesis has focused specifically on the lived experience of social isolation in cancer populations ( Boland et al., 2020 ). A meta-synthesis of qualitative studies can integrate findings across contexts to identify common patterns. Therefore, this study aimed to conduct a systematic review and meta-synthesis of qualitative studies on the lived experiences and triggers of social isolation among patients with cancer. The findings may help healthcare providers understand patients’ experiences, identify contributing factors, and support the early identification of patients at risk.

Methods

Aims and study design

This study systematically integrated qualitative evidence on the lived experiences of social isolation among patients with cancer. To enhance transparency in reporting the qualitative meta-synthesis, the review adhered to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement ( Tong et al., 2012 ) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines ( Page et al., 2021 ). The meta-synthesis protocol was registered with PROSPERO (CRD420251143574).

Eligibility criteria

Included studies were required to satisfy the following conditions: (1) participants were adult cancer patients diagnosed at age ≥18 years, including individuals receiving active cancer treatment and those who had completed treatment; (2) the phenomenon of interest focused on lived experiences concerning social isolation and psychosocial adjustment; (3) qualitative or mixed-methods studies with qualitative findings, including but not limited to descriptive qualitative studies, phenomenology, grounded theory, ethnography, and case studies; and (4) published in English or Chinese.

Exclusion criteria were defined as follows: (1) patients at the end of life or receiving palliative care; (2) studies that merely described the physical situation of being alone without reporting negative affective experiences; (3) studies assessed as having a high risk of bias based on the Joanna Briggs Institute (JBI) critical appraisal tool for qualitative research ( Porritt et al., 2024 ).

Search strategy

A systematic search was conducted across six databases: PubMed, CINAHL, the Cochrane Library, PsycINFO, Embase, and Web of Science. The search period extended from database inception to August 15, 2025. The search strategy was developed around three main concepts: cancer, social isolation, and qualitative research. Medical Subject Headings (MeSH) and free-text terms were identified in PubMed and adapted for the other databases. The reference lists of relevant reviews were also screened manually to identify additional eligible publications.

Study screening and selection

The initial search results were imported into Rayyan for management and screening ( Ouzzani et al., 2016 ). Two independent reviewers (WG and JZ) then screened studies for potential eligibility by reviewing titles and abstracts, followed by a detailed full-text assessment based on the predefined inclusion and exclusion criteria. Articles failing to meet the eligibility criteria were excluded, with reasons for exclusion documented. To maintain objectivity and minimize bias, Rayyan’s blind mode was maintained until both reviewers had completed their assessments. Any discrepancies arising from the screening process were resolved through discussion with another researcher (Pre Nach). The study selection process was reported using a PRISMA flow diagram.

Quality assessment

Two reviewers (WG and JZ) independently appraised the included studies using the JBI critical appraisal tool for qualitative research ( Porritt et al., 2024 ). Disagreements were resolved through discussion with a third reviewer (JH). The checklist comprises 10 criteria, each rated as “yes,” “no,” “unclear,” or “not applicable.” Studies meeting all applicable criteria were classified as high quality; those meeting only some criteria were classified as moderate quality; and those meeting none were classified as having a high risk of bias. Studies rated as having a high risk of bias were excluded from the review.

Data extraction

A predefined data extraction form was used to collect key study characteristics, including authors, year of publication, country, research methods, participant characteristics, and phenomena of interest. The extraction was conducted independently by two authors (WG and JZ) and verified by another author (FZ), with any inconsistencies resolved through group deliberation.

Data synthesis

This study employed the JBI meta-aggregation approach to synthesize findings from the included studies ( Porritt et al., 2024 ). The JBI meta-aggregation approach is an aggregative, minimally interpretive, and pragmatic method. Compared with more interpretive qualitative synthesis approaches, such as thematic synthesis, this approach was considered more appropriate for the present review because it is designed to preserve the original meanings of primary study findings while generating synthesized evidence relevant to clinical practice.

The procedure comprised four phases: (1) Findings along with quotations and statements relevant to the research objectives were extracted. (2) To ensure methodological rigor, each finding was independently appraised for credibility and classified as unequivocal, credible, or unsupported. When multiple illustrations supported a single finding, the highest level of credibility (unequivocal > credible > unsupported) was assigned to maintain consistency in the appraisal process. (3) Findings rated as unequivocal or credible were grouped into categories based on similarity of meaning, while unsupported findings were excluded from subsequent analysis. (4) Categories with similar meanings were further aggregated to generate synthesized findings. All team members engaged in iterative reviews of both the analytical and synthetic phases, with discrepancies resolved through consensus discussions to ensure the adequacy and coherence of the synthesized evidence.

Confidence in the findings

This study used the ConQual approach to assess confidence in the synthesized findings ( Munn et al., 2014 ). Each synthesized finding was initially assigned a high confidence rating and was then downgraded according to assessments of dependability and credibility.

Dependability was assessed using five criteria (Q2, Q3, Q4, Q6, and Q7) from the JBI critical appraisal checklist for qualitative research. The original rating was retained when 4–5 criteria were rated “yes,” downgraded by 1 level when 2–3 criteria were rated “yes,” and downgraded by 2 levels when 0–1 criterion was rated “yes.” For the credibility component, each synthesized finding was assessed according to the credibility ratings of the individual findings underpinning it. The initial confidence rating was retained when all contributing findings were rated as unequivocal. It was downgraded by one level when the synthesized finding comprised either a combination of unequivocal and credible findings or credible findings only.

Results

Search results

The initial search yielded 3691 records. After duplicate removal, 2215 records underwent title and abstract screening, resulting in the exclusion of 2021 studies. After 27 reports could not be retrieved, 167 reports underwent full-text assessment. Following rigorous evaluation, 35 studies were included in the meta-synthesis. The complete search strategy and screening process are detailed in the Appendix.

Quality appraisal

No study was rated as being at high risk of bias, and all 35 studies were included in the synthesis. Specifically, 4 studies met 9 appraisal criteria, 10 met 8 criteria, 15 met 7 criteria, and 6 met 6 criteria ( Fig. 1 ). 23 studies did not demonstrate congruity between the stated philosophical perspective and the research methodology, and 1 study provided insufficient information to assess congruity between the qualitative methodology and the interpretation of the results. Only 1 study located the researcher culturally or theoretically, and only 6 addressed the researchers’ influence on the research process. Insufficient information regarding ethical approval was reported in 5 studies. Fig. 1 Quality assessment results for the included studies. Note: Green blocks = “Yes,” Yellow blocks = “Unclear,” Red blocks = “No.” Q1: Is there congruity between the stated philosophical perspective and the research methodology? Q2: Is there congruity between the research methodology and the research question or objectives? Q3: Is there congruity between the research methodology and the methods used to collect data? Q4: Is there congruity between the research methodology and the representation and analysis of data? Q5: Is there congruity between the research methodology and the interpretation of results? Q6: Is there a statement locating the researcher culturally or theoretically? Q7: Is the influence of the researcher on the research, and vice versa, addressed? Q8: Are participants, and their voices, adequately represented? Q9: Is the research ethical according to current criteria or, for recent studies, is there evidence of ethical approval by an appropriate body? Q10: Do the conclusions drawn in the research report flow from the analysis or interpretation of the data?. Fig 1 dummy alt text

Characteristics of included studies

Table 1 summarizes the key characteristics of the included studies. The studies were published between 2001 and 2025 and were conducted in 15 countries: China ( Dong et al., 2023 ; He et al., 2021 ; Hu et al., 2025 ; Jiang et al., 2025 ; Song and Yao, 2024 ; Sun et al., 2024 ; Wang et al., 2025b ; Yang et al., 2025 ; Zhu et al., 2024 ), Ireland ( Gillman et al., 2025 ; Jefferies et al., 2011 ; Power et al., 2010 ), Denmark ( Pedersen et al., 2021 ), Australia ( Ettridge et al., 2018 ; Gately et al., 2020 ; Mazariego et al., 2021 ; Laidsaar et al., 2024 ; Parton et al., 2017 ; Warren et al., 2018 ), the USA ( Adams et al., 2016 ; Bonanno et al., 2010 ; Cohen et al., 2001 ), Belgium ( Goossens et al., 2015 ), Sweden ( Browall et al., 2009 ; Ekwall et al., 2007 ; Lilliehorn et al., 2018 ; Ståhl et al., 2024 ), Ethiopia ( Asefa et al., 2025 ), Pakistan ( Banning et al., 2009 ), Nigeria ( Nwozichi et al., 2025 ), Korea ( Shin et al., 2024 ), Jordan ( Abu, 2019 ), Oman ( Al-Azri et al., 2024 ), Norway ( Ueland et al., 2021 ), and France ( Starkbaum et al., 2025 ). Study designs included phenomenology, descriptive qualitative research, grounded theory, and mixed-methods approaches. Most studies used semi-structured or unstructured in-person interviews; three used focus group discussions, and two used telephone interviews. The review included 748 patients with cancer, comprising 470 women and 278 men. Individual study sample sizes ranged from 6 to 75 participants, and participants’ ages ranged from 19 to 97 years. Cancer types included breast, ovarian, prostate, lung, colorectal, bladder, esophageal, oral, and hematological cancers. Table 1 Characteristics of the included studies. Table 1 dummy alt text Author(s) (year) Country Research methods Participant characteristics Phenomena of interest Adams et al. (2016) USA Qualitative study; individual semi-structured interviews 15 patients undergoing treatment for multiple myeloma or non-Hodgkin’s lymphoma 8 men and 7 women Age 43–77 years Situations and thoughts that may precipitate or protect against cancer patients’ loneliness Abu (2019) Jordan Interpretative phenomenological research; semi-structured individual interviews 10 colorectal cancer patients 9 men and 1 women Age 45–60 years Jordanian colorectal cancer patients’ experience during the recurrence phase Al-Azri et al. (2024) Oman Descriptive phenomenological study; in-depth one-to-one interviews 13 cancer patients 9 women and 4 men Age 32–63 years The experiences of health-related stigma among cancer patients in Oman and its sociocultural influences Asefa et al. (2025) Ethiopia Phenomenological research; face-to-face and in-depth interviews 14 esophageal cancer patients 10 men and 4 women Age 42–97 years The lived experiences of dysphagia-related quality of life among esophageal cancer patients Banning et al. (2009) Pakistan Qualitative study; semi-structured interviews 30 women with breast cancer Age 22–60 years Women’s experiences of breast cancer and the coping strategies that they utilized to manage the illness Bonanno et al. (2010) USA Grounded theory; in-depth telephone interviews 12 orbital or periorbital cancer patients who had undergone orbital exenteration 7 men and 5 women Age 51–81 years 8 spouses and 4 children or siblings Age 50–78 years The interaction of cancer patients with family members and friends (primary groups) and with acquaintances and strangers (secondary groups) in small and large groups Browall et al. (2009) Sweden Mixed-methods study; daily coping assessments 75 post-menopausal women with breast cancer treated with adjuvant chemotherapy Mean age 65 years Types of daily stressful events experienced by postmenopausal women with breast cancer during adjuvant chemotherapy, how bothersome these events were, and the coping strategies used to manage them Cohen et al. (2001) USA Hermeneutic phenomenological research; interviews with open-ended questions 20 cancer patients who had undergone and survived blood and marrow transplantation in a relatively new, small hospital unit 5 men and 15 women Age 28–65 years The perceptions of patients who had undergone an autologous bone marrow transplantation Dong et al. (2023) China Descriptive qualitative study; in-person semi-structured interviews 20 cancer patients undergoing follow-up treatment in the hospital 9 men and 11 women Age 31–74 years The experiences of social alienation in cancer patients Ekwall et al. (2007) Sweden Descriptive phenomenological research; interviews with open-ended follow-up questions 12 women who were undergoing or had just completed chemotherapy Age 50–74 years The understanding of how women having a recurrence of ovarian cancer experience living with this knowledge, and what it means in their daily lives Ettridge et al. (2018) Australia Qualitative descriptive approach; semi-structured interviews 20 men diagnosed with prostate cancer Age 28–82 years The experiences and perceptions of men with prostate cancer Gately et al. (2020) Australia Qualitative study; semi-structured interviews 6 long-term cancer patients 4 men and 2 women Age 35–78 years 4 caregivers The lived experience of long-term patients of glioblastoma Gillman et al. (2025) Ireland Qualitative study; individual face-to-face interviews 40 patients who received curative transhiatal/transthoracic surgery for oesophageal cancer 30 men and 10 women Age 43–84 years The long-term impact of aerodigestive symptoms on quality of life in adults post-oesophagectomy Goossens et al. (2015) Belgium Grounded theory; semi-structured face-to-face interviews 28 cancer patients with potential fertility problems 7 men and 21 women Age 19–44 years The underlying processes and influencing factors of communication difficulties and the experience of loneliness among patients with cancer who are dealing with fertility issues He et al. (2021) China Qualitative study; semi-structured and in-depth interviews 18 rectal cancer patients newly living with colostomy 9 men and 9 women Age 28–77 years The immediate postoperative experiences before discharge among patients with rectal cancer and a permanent colostomy Hu et al. (2025) China Phenomenological research; one-on-one, face-to-face semi-structured interviews 19 young women with gynecologic cancer Age 19–39 years The lived experiences of social isolation in young patients with gynecological cancer Jefferies et al. (2011) Ireland Interpretive phenomenological research; semi-structured interviews 13 women between 6 months and 5 years after their surgery Age 27–53 years The experiences of women with vulval cancer living in the UK Jiang et al. (2025) China Qualitative study; semi-structured interviews 20 nasopharyngeal carcinoma patients 12 men and 8 women Age 24–57 years The lived experiences of nasopharyngeal carcinoma patients regarding psychosocial adjustment. Laidsaar et al. (2024) Australia Qualitative study; one-on-one telephone interviews 20 adult lung cancer patients, 6–24 months post-completion of initial active treatment 10 men and 10 women Age 30–84 years The impacts of lung cancer on life domains such as employment, finances, relationships, and healthcare needs Lilliehorn et al. (2018) Sweden Grounded theory; repeated face-to-face interviews 52 women with breast cancer Age 36–60 years Experiences at a patient hotel and the rehabilitative potential of the stay for subgroups of patients Mazariego et al. (2021) Australia Qualitative study; semi-structured interviews 37 men diagnosed with localised prostate cancer Insights into prostate cancer patients’ adjustment to diagnosis and any persisting or emerging cancer/treatment-related issues over 15 years Nwozichi et al. (2025) Nigeria Phenomenological research; semi-structured, in-depth interviews 22 women with breast cancer who had completed treatment at least 5 years earlier Age 35–67 years The suffering perceived by long-term breast cancer patients in Nigeria, focusing on their lived experiences during and after treatment Parton et al. (2017) Australia Mixed-methods study; one-to-one semi-structured interviews 61 women with a diagnosis of cancer Mean age 42.53 years How women construct their gendered subjectivities following cancer Pedersen et al. (2021) Denmark Phenomenological research; semi-structured interviews 8 colorectal cancer patients 4 men and 4 women Age 57–76 years An understanding of how patients experience and give meaning to the embodied phenomenon of chronic sensory disturbances in everyday life after oxaliplatin treatment for colorectal cancer Power et al. (2010) Ireland Descriptive qualitative study; focus groups 8 women with primary breast cancer participated in pre- and post-program focus groups Age 30–60 years A pre- and post-program evaluation of a 7-week facilitated breast cancer peer support program in a cancer support house Shin et al. (2024) Korea Qualitative study; semi-structured interviews 21 adult lung cancer patients 14 men and 7 women Age 50–86 years (1) The multidimensional aspects of cancer-related fatigue experienced by patients with lung cancer after cancer treatment (2) Whether these experiences vary based on treatment-related factors in the post-treatment period and the type of cancer treatment (3) The factors from a patient-centered perspective that alleviate or exacerbate CRF Song and Yao (2024) China Phenomenological research; one-on-one and semi-structured interviews 16 elderly lung cancer patients 5 men and 11 women Age 60–76 years The experience of social alienation in elderly lung cancer patients Ståhl et al. (2024) Sweden Qualitative inductive approach; semi-structured interviews 12 patients with IDH-wildtype glioblastoma 7 men and 5 women Age 32–78 years 10 relatives 3 men and 7 women Age 31–67 years The experiences of living with glioblastoma from the perspective of patients themselves as well as their closest relatives, focusing on the changes in the life situation and the need for support Starkbaum et al. (2025) France Grounded theory; semi-structured interviews 6 cancer patients receiving 177Lu-Dotatate treatment 3 men and 3 women Age 58–82 years The experiences of patients with neuroendocrine tumors in France who were treated with systemic radionuclide therapy Sun et al. (2024) China Descriptive qualitative study; face-to-face semi-structured interviews 22 men with prostate cancer who underwent radical prostatectomy and experienced urinary incontinence after surgery Age 63–88 years The experiences and needs of patients with early urinary incontinence following radical prostatectomy for prostate cancer Ueland et al. (2021) Norway Exploratory phenomenological-hermeneutical design; in-depth semi-structured interviews 21 patients who had undergone cancer treatment 6 men and 15 women Age 28–72 years The existential experiences of those treated for different cancers Wang et al. (2025b) China Descriptive phenomenological research; face-to-face semi-structured interviews 11 women who underwent oocyte or embryo cryopreservation after diagnosis of breast cancer Age 22–43 years The experiences and psychological needs of women with breast cancer who have undergone fertility preservation Warren et al. (2018) Australia Qualitative research; semi-structured interviews 7 women with gynecological cancer Age 35–65 years The lived experiences of patients with gynecological cancer and the factors underlying psychosocial distress Yang et al. (2025) China Phenomenological research; face-to-face semi-structured interviews 14 patients with bladder cancer 12 men and 2 women Age 35–82 years The experience of social isolation in patients with bladder cancer Zhu et al. (2024) China Qualitative study; face-to-face semi-structured interviews 25 postoperative oral cancer patients 24 men and 1 woman Age 32–56 years The characteristics of stigma in postoperative oral cancer patients

Review findings

Table 2 presents the individual findings and their credibility appraisals, the categories into which the findings were grouped, and the resulting synthesized findings. Representative quotations supporting each finding are provided in the Appendix. Across the 35 included studies, 22 findings were aggregated into 7 categories, which further generated 2 synthesized findings: (1) disruptions in individual, interpersonal, and societal functioning were triggers of social isolation among cancer patients; and (2) social isolation among cancer patients manifested as individual social withdrawal and disengagement, disrupted supportive interpersonal connections, and restricted societal inclusion. Table 2 Synthesized findings. Table 2 dummy alt text Synthesized findings Categories Findings Disruptions in individual, interpersonal, and societal functioning were triggers of social isolation among cancer patients Physical and psychological vulnerabilities Impaired physical function (U) Debilitating physical side effects of treatment (U) Body image disturbance (U) Disease-related existential pessimism (U) Introverted and sensitive personalities (U) Dysfunctional support from family and friends Disrupted intimate relationships (U) Overprotection from family (U) Misunderstanding from family and friends (U) Inadequate support from healthcare providers and fellow patients Insufficient professional support (U) Ineffective support from fellow patients (U) Constrained societal functioning Barriers to accessing healthcare and social resources (U) Employment instability (U) Cancer-related social stigma (U) Social isolation among cancer patients manifested as individual social withdrawal and disengagement, disrupted supportive interpersonal connections, and restricted societal inclusion Individual social withdrawal and disengagement Diminished motivation for social engagement (U) Self-concealment and communication avoidance (U) Declining social skills (U) Reduced social participation (U) Disrupted supportive and caring interpersonal connections Perceived relational distancing by family and friends (U) Perceived absence of companionship and emotional support (U) Perceived lack of humanistic care in clinical settings (U) Restricted societal inclusion Loss of occupational engagement (U) Perceived social rejection (U) Note: U = unequivocal, the highest JBI credibility rating assigned to an individual finding.

Synthesized finding 1

Disruptions in individual, interpersonal, and societal functioning are triggers of social isolation among cancer patients. This synthesized finding was derived from 13 findings and organized into 4 categories: physical and psychological vulnerabilities, dysfunctional support from family and friends, inadequate support from healthcare providers and fellow patients, and constrained societal functioning.

Physical and psychological vulnerabilities represented individual-level triggers of social isolation among cancer patients. Patients reported that impaired physical functioning, including oral dysfunction, dysphagia, sensory loss, urinary incontinence, visual impairment, cognitive slowing, and sexual dysfunction, limited their ability to participate in daily and social activities ( Zhu et al., 2024 ; Asefa et al., 2025 ; Shin et al., 2024 ; Pedersen et al., 2021 ; Ettridge et al., 2018 ; Sun et al., 2024 ; Jefferies et al., 2011 ). They also described debilitating treatment-related physical side effects, including nausea, fatigue, insomnia, pain, diarrhea, and premature menopause. These effects reduced their energy and made participation in social life difficult ( Dong et al., 2023 ; Nwozichi et al., 2025 ; Song and Yao, 2024 ; Abu, 2019 ; Gillman et al., 2025 ; Parton et al., 2017 ). Body image disturbance, including abnormal breast morphology, surgical scars, hair loss, skin deterioration, and ostomy-related concerns, was accompanied by reluctance to engage in social interactions ( Mazariego et al., 2021 ; Zhu et al., 2024 ; Ekwall et al., 2007 ; Dong et al., 2023 ; Yang et al., 2025 ). Some cancer patients reported disease-related existential pessimism, including hopelessness, despair, and thoughts of death, alongside reduced social engagement ( Ekwall et al., 2007 ; Shin et al., 2024 ; Song and Yao, 2024 ). Some patients with introverted and sensitive personality traits reported social withdrawal related to concerns about burdening others and exposing their vulnerability ( Cohen et al., 2001 ).

Dysfunctional support from family and friends was identified as an interpersonal-level trigger of social isolation among cancer patients. Disrupted intimate relationships were reported, with patients describing reduced sexual intimacy with partners and experiences of being left alone in social settings, particularly among patients who were divorced or single ( Jefferies et al., 2011 ; Wang et al., 2025b ). Family overprotection was also described, including restrictions on going out, reduced autonomy in daily activities, and family members taking over communication with healthcare professionals, leaving patients feeling out of touch with society ( Yang et al., 2025 ; Hu et al., 2025 ). Patients also felt misunderstood by family and friends, particularly when their illness-related struggles and emotional needs were not acknowledged. These experiences were associated with feelings of isolation and a reduced willingness to communicate with others ( Zhu et al., 2024 ; Jiang et al., 2025 ; Ueland et al., 2021 ; Cohen et al., 2001 ).

Inadequate support from healthcare providers and fellow patients represented another interpersonal-level trigger of social isolation among cancer patients. Patients reported that healthcare providers sometimes failed to provide adequate professional guidance on cancer rehabilitation and self-management ( Jiang et al., 2025 ; Sun et al., 2024 ; Goossens et al., 2015 ), emotional support ( Zhu et al., 2024 ), and continuous support across different treatment phases, leaving them feeling unsupported and alone during treatment ( Power et al., 2010 ). Ineffective support from fellow patients was further described. Some patients reported difficulty finding age-matched peers with similar cancer experiences, while others perceived patient support groups as settings focused on emotional venting rather than constructive support ( Ettridge et al., 2018 ).

Constrained societal functioning was identified as a societal-level trigger of social isolation among cancer patients. Barriers to accessing healthcare and social resources contributed to patients’ involuntary isolation. These barriers included long travel distances to receive medical care ( Jiang et al., 2025 ), difficulty having family members accompany them because of geographic separation ( Adams et al., 2016 ), and limited access to financial assistance ( Asefa et al., 2025 ). Employment instability was a common concern. Some patients described frequent absences from work for medical appointments, which created workplace tensions ( Yang et al., 2025 ), while others expressed persistent fear of job loss ( Zhu et al., 2024 ). Furthermore, cancer-related social stigma contributed to social isolation among patients with cancer. Reported experiences included malicious gossip from neighbors ( Hu et al., 2025 ), avoidance by friends because of fears of contagion ( Zhu et al., 2024 ), and limited discussion of cancer in public contexts ( Jefferies et al., 2011 ).

Synthesized finding 2

Social isolation among cancer patients manifested as individual social withdrawal and disengagement, disrupted supportive interpersonal connections, and restricted societal inclusion. This synthesized finding was derived from 9 findings and organized into 3 categories.

At the individual level, social isolation among cancer patients manifested as voluntary social withdrawal and disengagement. Diminished motivation for social engagement was commonly reported, with some patients expressing reduced interest in maintaining existing relationships, forming new connections, or participating in social gatherings ( Dong et al., 2023 ; Sun et al., 2024 ; Ettridge et al., 2018 ). Patients described self-concealment and communication avoidance. They tended to withhold information about illness-related experiences and communicate less with family and friends ( Dong et al., 2023 ; Warren et al., 2018 ; Mazariego et al., 2021 ; Wang et al., 2025b ). Some patients further reported declining social skills, including challenges explaining their illness experiences, reduced emotional self-control, and feelings of being unable to participate in social situations in the same way as before ( Asefa et al., 2025 ; Shin et al., 2024 ; Nwozichi et al., 2025 ). Reduced social participation was also reported, characterized by reduced contact with family members, avoidance of crowded environments, and withdrawal from previously enjoyed recreational and social activities ( Ståhl et al., 2024 ; Asefa et al., 2025 ; Yang et al., 2025 ; Hu et al., 2025 ).

At the interpersonal level, disrupted supportive interpersonal connections were reported by cancer patients experiencing social isolation. Patients perceived relational distancing from family members and friends, including feelings of awkwardness and exclusion within family relationships ( Adams et al., 2016 ; Nwozichi et al., 2025 ), and active distancing by friends following cancer diagnosis ( Zhu et al., 2024 ; Song and Yao, 2024 ). Patients also perceived an absence of companionship and emotional support, characterized by insufficient visits from family and friends during hospitalization ( Yang et al., 2025 ; Jefferies et al., 2011 ), reluctance among family members to discuss illness-related concerns ( Lilliehorn et al., 2018 ), and a gradual decline in support from family and friends over the course of treatment ( Hu et al., 2025 ). In addition, patients perceived a lack of humanistic care in clinical settings, with loneliness related to visitor restrictions and isolated treatment environments, as well as inadequate communication and respect in healthcare encounters ( Starkbaum et al., 2025 ; Cohen et al., 2001 ; Warren et al., 2018 ; Wang et al., 2025b ).

At the societal level, social isolation among cancer patients manifested as restricted societal inclusion. Patients described loss of occupational engagement, including involuntary job loss, difficulty returning to work following treatment, and premature retirement, which disrupted their workforce participation ( Zhu et al., 2024 ; Gately et al., 2020 ). Patients also reported experiences of social rejection, characterized by being viewed as abnormal or socially undesirable, as well as avoidance and exclusion by others due to fears and misconceptions about cancer ( He et al., 2021 ; Ettridge et al., 2018 ; Nwozichi et al., 2025 ). Some patients further reported feeling scrutinized in public settings because of visible illness-related changes, including unwanted attention, staring, and judgment ( Song and Yao, 2024 ; Bonanno et al., 2010 ).

ConQual summary

Dependability was downgraded by one level because only 6 of the 35 included studies met 4–5 criteria rated “yes,” whereas the remaining studies met 2–3 criteria. Credibility was not downgraded because both synthesized findings were supported by unequivocal evidence. Overall, the 2 synthesized findings were rated as moderate-confidence evidence. The ConQual summary is presented in Table 3 . Table 3 ConQual summary of the findings. Table 3 dummy alt text Synthesized findings Dependability Credibility ConQual score Synthesized finding 1: Disruptions in individual, interpersonal, and societal functioning are triggers of social isolation among cancer patients Downgrade 1 level No change Moderate Synthesized finding 2: Social isolation among cancer patients manifested as individual social withdrawal and disengagement, disrupted supportive interpersonal connections, and restricted societal inclusion Downgrade 1 level No change Moderate Note: Dependability was downgraded by one level because only 6 of the 35 included studies met 4–5 criteria rated “yes.”.

Discussion

To our knowledge, this is the first meta-synthesis to integrate evidence on the lived experience of social isolation among patients with cancer following diagnosis. Using the JBI meta-aggregation approach, we analyzed 35 studies and generated 2 synthesized findings that map the triggers and manifestations of social isolation across individual, interpersonal, and societal domains. Previous interventions, such as psychoeducation and supportive care programs, have been implemented to alleviate social isolation in cancer populations ( Zhao et al., 2026 ). These approaches were often delivered after the onset of social isolation and focused on individual psychological adaptation and behavioral change. Our findings highlight the urgent need for early screening to identify patients at high risk of social isolation, followed by prompt implementation of targeted preventive and supportive strategies. Future interventions should extend beyond the individual level by incorporating family members, healthcare professionals, and fellow patients, alongside societal support resources to address the full complexity of social isolation in cancer patients.

This study revealed that social isolation among cancer patients was triggered by intersecting disruptions at the individual, interpersonal, and societal levels. Impaired physical functioning and treatment-related adverse effects may objectively restrict patients’ daily activities and opportunities for social participation. Consistent with this interpretation, Wei et al. (2025) reported that greater cancer-related symptom burden was associated with higher levels of social isolation. These findings suggest that integrated symptom cluster management may improve patients’ social outcomes. Body image disturbance may induce anxiety about one’s social appearance and adversely affect interpersonal relationships ( Arıkan et al., 2024 ), which is consistent with the findings of this review. Furthermore, disease-related existential pessimism, such as hopelessness, may exacerbate subjective feelings of social isolation. A previous study also identified social isolation as a predictor of depression among patients with cancer ( Chowdhury et al., 2025 ), indicating a mutually reinforcing relationship between negative psychological states and social isolation. Therefore, healthcare professionals should routinely assess negative emotional states and provide timely psychological support to help interrupt this cycle. In addition, patients with introverted and sensitive personalities tend to withdraw socially to avoid burdening others. Tailored communication and support strategies that take personality characteristics into account may help improve patients’ access to social support. Taken together, these findings underscore the importance of a multidisciplinary approach that integrates physical rehabilitation, psychological support, and body image interventions to reduce the risk of social isolation among patients with cancer.

Dysfunctional support from family and friends may contribute to social isolation among cancer patients. Overprotective family behaviors were found to undermine patients’ autonomy in social engagement, thereby exacerbating their experience of social isolation. Although family-centered interventions are widely used in oncology practice ( Becqué et al., 2023 ), these findings suggest that such approaches should balance support provision with the preservation of patient autonomy. In addition, insufficient professional guidance and discontinuity of care may increase the risk of social isolation. A prior study has shown that adequate informational support throughout the cancer trajectory facilitates psychosocial adjustment ( Husson et al., 2011 ). Moreover, the lack of effective support from fellow patients represents an important interpersonal trigger of social isolation. Stafford et al. (2021) similarly reported that women with gestational cancer faced challenges in accessing suitable peer support resources. Peers with similar cancer experiences can provide emotional support and share lived experiences, thereby alleviating patients’ feelings of loneliness and facilitating social integration ( Clougher et al., 2024 ). These findings highlight the important role of peer support in alleviating social isolation. At the societal level, limited access to healthcare, financial, and other social resources, along with workplace discrimination and persistent cancer-related stigma, may hinder patients from resuming social roles and reintegrating into society. Overall, these findings provide an evidence base for the early identification of cancer patients at high risk of social isolation. In future clinical practice, healthcare professionals should implement integrated interventions that address patients’ physical and psychological well-being, strengthen support networks involving family, friends, healthcare professionals, and fellow patients, and promote supportive policies, thereby reducing cancer-related social isolation.

The social isolation experienced by cancer patients is shaped by individual, interpersonal, and societal factors. Following cancer diagnosis and treatment, patients often withdraw from social interactions and become less engaged with others. Some may conceal their thoughts and feelings or avoid communication because they do not want to be perceived as a burden to their families, consistent with findings reported by Rothausen et al. (2023) . Communication difficulties in the cancer context may extend beyond a simple lack of interaction. Concealment behaviors among couples affected by cancer have been associated with greater psychological distress ( Sella-Shalom et al., 2023 ). These findings suggest that communication interventions should focus on creating emotionally safe environments that facilitate voluntary expression rather than simply encouraging greater disclosure. Interpersonal relationships are essential for coping with illness and facilitating social reintegration. Nevertheless, many socially isolated patients reported relational distancing from family and friends, as well as a lack of companionship and emotional support. Liao et al. (2024) also found that highly isolated cancer patients experienced reduced family interactions and greater interpersonal marginalization. Some patients also perceived a lack of humanistic care in clinical settings, highlighting that healthcare professionals should not only focus on disease treatment but also provide supportive and empathetic interactions that address psychosocial needs and help alleviate social isolation. In addition, cancer patients may experience social exclusion in broader social settings, consistent with findings from a qualitative meta-synthesis of patients with sarcoma ( Wang et al., 2025a ). For example, after returning to work, some patients may have their competence questioned or may lose their jobs, further limiting their social reintegration ( Ueland et al., 2021 ).

This study found that social isolation among cancer patients is a complex phenomenon that can be interpreted within the socio-ecological model (SEM). Originating from Bronfenbrenner’s ecological systems theory, SEM conceptualizes health outcomes as the result of interactions across nested systems, including the microsystem (direct interpersonal environments), mesosystem (interactions between social settings), and macrosystem (broader sociocultural and policy contexts) ( Bronfenbrenner, 1979 ). Although this meta-synthesis was conducted inductively without a predefined framework, the findings suggest that both the triggers and manifestations of social isolation can be mapped onto these three levels. Social isolation thus arises from the interplay of individual behaviors (microsystem), interpersonal relationships (mesosystem), and societal conditions (macrosystem). From an SEM perspective, this highlights social isolation as a multidimensional, system-level phenomenon rather than a single-level psychosocial response. It further suggests that future interventions should support physical and psychological recovery at the individual level, strengthen interpersonal support networks, and promote supportive policies.

Strengths and limitations

This review used a comprehensive and systematic search strategy to identify a wide range of relevant studies. The JBI meta-aggregation approach supported the systematic integration of the findings, while the ConQual framework was used to assess the credibility and dependability of the synthesized evidence. The inclusion of 35 studies allowed for an in-depth examination of social isolation experiences among patients with cancer following diagnosis and strengthened confidence in the meta-synthesis. The findings may help healthcare professionals better understand this phenomenon and inform the development of interventions at the individual, family, and societal levels to support patients’ social reintegration and rehabilitation.

There are several limitations to this review. First, the studies included in this review primarily focused on patients with gynecological cancers, particularly breast cancer, as well as prostate and digestive system cancers. The overrepresentation of specific cancer populations may have introduced selection bias and limited the generalizability of the findings. Second, female participants accounted for 62.8% of the overall sample. This gender imbalance may have influenced the findings, as experiences of social isolation can vary according to gender. Third, although all included studies met the predefined methodological quality threshold, all were assessed as being of moderate quality, with no studies rated as high quality. Therefore, the synthesized findings should be interpreted with appropriate caution. Finally, this review was limited to studies published in English or Chinese and to searches of six major databases. The exclusion of studies published in other languages may have limited the comprehensiveness and representativeness of the evidence base.

Conclusion

This meta-synthesis advances understanding of the triggers and manifestations of social isolation among patients with cancer following diagnosis. Social isolation was shaped by disruptions across individual, interpersonal, and societal domains and was characterized by social withdrawal and disengagement, disrupted supportive and caring interpersonal connections, and restricted societal inclusion. These findings may inform the early identification and routine screening of patients at high risk of social isolation. Future research should develop multilevel interventions that address influences across individual, interpersonal, and societal levels by integrating support from family members, healthcare professionals, fellow patients, and broader social resources. Such interventions may help prevent or alleviate social isolation and provide more comprehensive and sustained support throughout the cancer trajectory.

Ethics approval and informed consent

Ethics approval and informed consent were not required because this study was a systematic review.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

CRediT authorship contribution statement

Wenjuan Gao: Writing – review & editing, Writing – original draft, Methodology, Formal analysis, Data curation. Jiayi Zhao: Writing – original draft, Methodology, Formal analysis, Data curation. Precious Nachula: Methodology, Formal analysis, Data curation. Jing Zhang: Methodology, Formal analysis, Data curation, Conceptualization. Ying Zhu: Writing – review & editing, Supervision, Methodology, Conceptualization. Shuo Wang: Writing – review & editing, Visualization, Methodology, Conceptualization. Fang Zhou: Writing – review & editing, Supervision, Funding acquisition. Jing Han: Writing – review & editing, Supervision, Project administration, Funding acquisition.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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Acknowledgments

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Supplementary material associated with this article can be found, in the online version, at doi:10.1016/j.ijnsa.2026.100641 .