Journal of cancer survivorship : research and practice · 2026
Social isolation and overall well-being among cancer survivors in the Cancer Prevention Study-3.
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Peoples Anita R, Chantaprasopsuk Sicha, Westmaas J Lee, Rees-Punia Erika, Deubler Emily L, Teras Lauren R, Flanders W Dana, Zhong Charlie, Patel Alpa V
Аннотация
PURPOSE: Social isolation is associated with poor health and sleep in the general population. However, its impact among cancer survivors-particularly as more individuals are living longer after a cancer diagnosis-remains unclear. We examined cross-sectional associations of social isolation with mental and physical health and sleep among cancer survivors ≤ 3 years ("shorter-term") and > 3 years post-diagnosis ("longer-term"), and cancer-free participants, using data from the American Cancer Society's Cancer Prevention Study-3 (CPS-3).
METHODS: Among 2,290 shorter-term, 1,885 longer-term survivors, and 12,525 age-matched controls who completed the 2018 CPS-3 survey, multivariable-adjusted ANCOVAs evaluated associations between self-reported social isolation (Social Network Index), mental and physical health (PROMIS Global Health Scale), and sleep quality (single-item; PSQI).
RESULTS: Participants' mean age in 2018 was 60 years (SD = 8); 76% were female and 90% non-Hispanic White. Overall, 32% reported moderate-to-high social isolation, with similar proportions across shorter-term survivors, longer-term survivors, and controls. Higher social isolation was consistently associated with clinically meaningful lower mental health scores (poorer outcome) across all 3 groups. Longer-term survivors with high vs. low social isolation had significantly lower mental health scores by 5.8 units; this difference in mental health scores was statistically significantly larger than the corresponding differences among shorter-term survivors (-4.1 units; p < 0.001) and controls (-5.2 units; p = 0.03). Specifically, longer-term survivors who were older (≥ 65 years; difference = -7.0 units) or less physically active (< 15 MET-hr/wk; difference = -6.2 units) showed the largest differences in mental health scores when comparing high vs. low social isolation. No clinically meaningful associations were observed for physical health or sleep quality.
CONCLUSIONS: Higher social isolation had the strongest associations with worse mental health among longer-term survivors, especially those who were older or less active.
IMPLICATIONS FOR CANCER SURVIVORS: These findings highlight the importance of routine screening for social isolation and the need for targeted psychosocial programs to improve well-being among survivors, particularly those living longer who may be most affected.
METHODS: Among 2,290 shorter-term, 1,885 longer-term survivors, and 12,525 age-matched controls who completed the 2018 CPS-3 survey, multivariable-adjusted ANCOVAs evaluated associations between self-reported social isolation (Social Network Index), mental and physical health (PROMIS Global Health Scale), and sleep quality (single-item; PSQI).
RESULTS: Participants' mean age in 2018 was 60 years (SD = 8); 76% were female and 90% non-Hispanic White. Overall, 32% reported moderate-to-high social isolation, with similar proportions across shorter-term survivors, longer-term survivors, and controls. Higher social isolation was consistently associated with clinically meaningful lower mental health scores (poorer outcome) across all 3 groups. Longer-term survivors with high vs. low social isolation had significantly lower mental health scores by 5.8 units; this difference in mental health scores was statistically significantly larger than the corresponding differences among shorter-term survivors (-4.1 units; p < 0.001) and controls (-5.2 units; p = 0.03). Specifically, longer-term survivors who were older (≥ 65 years; difference = -7.0 units) or less physically active (< 15 MET-hr/wk; difference = -6.2 units) showed the largest differences in mental health scores when comparing high vs. low social isolation. No clinically meaningful associations were observed for physical health or sleep quality.
CONCLUSIONS: Higher social isolation had the strongest associations with worse mental health among longer-term survivors, especially those who were older or less active.
IMPLICATIONS FOR CANCER SURVIVORS: These findings highlight the importance of routine screening for social isolation and the need for targeted psychosocial programs to improve well-being among survivors, particularly those living longer who may be most affected.