Loneliness as a mediator of the relationship of social cognitive variables with depressive symptoms and quality of life in lung cancer patients beginning treatment

Greater Social Isolation and Social Constraints Prior to Hematopoietic Stem Cell Transplant Are Associated with Greater Anxiety and Depressive Symptoms

BACKGROUND

Hematopoietic stem cell transplantation (hereafter "HCT") is a physically and psychologically difficult treatment for patients with hematological cancers. This study examined relationships among patients' reports of pre-transplant social isolation, social constraints, and psychological distress.

METHOD

We used baseline data from a multisite randomized controlled trial evaluating the effects of expressive helping writing to reduce physical and emotional symptoms in HCT patients. We collected data prior to randomization and before either allogenic or autologous HCT using validated scales to assess social constraints, social isolation, anxiety, and depressive symptoms. We analyzed data using bivariate analysis and multivariate linear regression. We also explored whether social isolation mediated the effect of social constraints on both of our outcomes: anxiety and depressive symptoms.

RESULTS

Among 259 adults recruited prior to transplant, 43.6% were women (mean age = 57.42 years, SD = 12.34 years). In multivariate analysis controlling for relevant covariates, both social isolation (β = 0.24, p < 0.001) and social constraints (β = 0.28, p < 0.001) were associated with anxiety. When both social constraints and social isolation were in the model, only greater social isolation (β = 0.79, p < 0.001) was associated with depressive symptoms. Social isolation fully mediated the association between social constraints and anxiety and depressive symptoms.

CONCLUSION

For patients awaiting either allogenic or autologous HCT, the negative association between social constraints and anxiety and depressive symptoms may be related, in part, to the mechanism of perceived social isolation. Interventions prior to and during HCT are needed to support patients' psychological health and sense of social connectedness.

Factors Influencing Social Isolation among Cancer Patients: A Systematic Review

(1) Background: Social isolation, which has numerous adverse effects on health status, is prevalent among cancer patients. This review proposes to identify the influencing factors of social isolation among cancer patients. (2) Methods: Articles published in English or Chinese from six electronic databases before December 2023 were identified via a systematic search. A manual search was also performed. (3) Results: Twenty-eight studies were identified in this systematic review. The factors associated with social isolation can be summarized into the following categories: demographic characteristics, having cancer, health status, coping, social support and social interaction. Despite the heterogeneity, 20 factors were significantly associated with social isolation, including age, gender, comorbidity burden, education level, residence, medical insurance, occupation status, personality, race, smoking status, having children, not living alone, household income level, marital status, the role of primary caregiver, physical health status, mental health status, social health status, coping styles, and the level of social support and social interaction. (4) Conclusions: The systematic review showed that cancer patients' social isolation was influenced by their demographic characteristics, cancer-related factors, physical condition, psychological status, social health status, coping styles, and level of social support and social interaction. In addition, future group intervention could be considered to improve social isolation.

Unraveling the dynamics of loneliness in the Baltic-Nordic region: a comparative analysis in the wake of COVID-19

Introduction

The primary aim of this study is to thoroughly investigate the prevalence and determinants of loneliness among older adults in the Baltic-Nordic region. Utilizing high-quality data sources and employing a methodologically rigorous approach, the study endeavors to enhance our understanding of how loneliness manifests and varies across different cultural and socio-economic contexts within these regions. By identifying key factors influencing loneliness, including demographic, social, and economic variables, the research seeks to contribute significantly to the existing body of knowledge on loneliness and inform targeted public health strategies and interventions tailored to the unique needs of older adults in the Baltic and Nordic countries.

Material and methods

This research, centered on older adults aged 67 and above within the Baltic-Nordic region, draws upon data from the Survey of Health, Ageing and Retirement in Europe (SHARE), specifically its eighth wave conducted between June and August 2020. The demographic analysis of this study covers a diverse sample of 5,313 participants from the Baltic and Nordic regions. Specifically, the sample includes 2,377 participants from Nordic countries, namely Sweden, Denmark, and Finland, and 2,936 from the Baltic countries of Estonia, Latvia, and Lithuania. The investigation extends to the financial well-being of households, involving an analysis of 3,925 individuals, with 1,748 from Nordic countries and 2,177 from Baltic countries. Although Iceland is categorized as a Nordic country, the analysis within this study is conducted separately due to the unavailability of SHARE data for this region. Instead, the HL20 study, focusing on the health and well-being of the older adult population in Iceland, contributes data for 1,033 respondents. This methodological distinction allows for a comprehensive understanding of regional differences, highlighting the importance of specialized approaches to examine the intricate dynamics of loneliness and well-being across the Baltic-Nordic region.

Results

The study reveals significant regional variations in loneliness among older adults during the COVID-19 outbreak, with the Baltic countries (Estonia, Latvia, Lithuania) reporting a lower prevalence of loneliness compared to the Nordic countries (Sweden, Denmark, Finland). Iceland, while grouped with the Nordic countries, was analysed separately. Employment emerges as a key factor in reducing loneliness across all regions, suggesting the benefits of social interactions and structured routines. Gender and marital status significantly influence loneliness, with notable disparities in the Baltic region and smaller gaps in the Nordic countries, reflecting the impact of societal and cultural norms. Additionally, educational attainment and health status show varied associations with loneliness, highlighting the complex interplay of individual and societal factors in these regions.

Factors Associated With Loneliness Among Chinese Patients With Cancer: A Cross-sectional Study

BACKGROUND

Loneliness has a significant impact on the physical and psychological well-being of patients with cancer. However, the specific factors contributing to loneliness among patients with cancer within the context of Chinese culture remain poorly understood.

OBJECTIVE

The objective of this study was to identify the factors associated with loneliness among patients with cancer in China.

METHODS

A cross-sectional study was conducted using convenience sampling, involving a sample of 205 patients with cancer from a tertiary hospital in Guangzhou, China. Participants completed several validated questionnaires, including the Cancer Loneliness Scale (CLS), Hospital Anxiety and Depression Scale (HADS), Cancer-Related Negative Social Expectations Scale (C-rNSES), and Social Support Rating Scale (SSRS). Multiple linear stepwise regression analysis was employed to explore the relationships between loneliness and psychosocial factors.

RESULTS

The median score for loneliness among patients with cancer was 13, with an interquartile range of 8. The multiple linear stepwise regression analysis revealed that negative social expectations, social support, and depression were significantly associated with loneliness in this population. Collectively, these factors accounted for 50.1% (R2 = .501) of the variance in loneliness.

CONCLUSIONS

The findings of this study highlight the importance of addressing negative social expectations and depression and improving social support to prevent or reduce loneliness among patients with cancer. Health care providers should consider these factors when developing interventions aimed at preventing or alleviating loneliness in this population.

Social media-based interventions for patients with cancer: a meta-analysis and meta-regression of randomised controlled trials

PURPOSE

This review aimed to (1) evaluate the effectiveness of social media-based interventions for improving the quality of life, anxiety and depressive symptoms of patients with cancer at post-intervention and follow-up; (2) identify the essential features of social media-based interventions and (3) explore the covariates of the treatment effect.

METHODS

All types of randomised controlled trials (RCTs) were included. Ten electronic databases, clinical trial registries and grey literature sources were searched from inception to 15 December 2021. Stata software was used to perform meta-analysis, subgroup analyses and meta-regression analyses. Individual quality assessment and certainty of evidence were assessed using Cochrane risk of bias tool version 1 and Grading of Recommendations Assessments, Development and Evaluation criteria, respectively.

RESULTS

This review included 43 RCTs, which comprised 6239 patients with a total mean age of 49.71 years old from across 11 countries. Social media-based interventions significantly improved the quality of life (g = 0.25, 95% CI = 0.05-0.45) and anxiety symptoms (g =  - 0.41, 95% CI =  - 0.76-0.07) but not depressive symptoms. The essential features based on the subgroup analysis concluded that using a mobile device with a flexible frequency had a remarkably greater effect on the quality of life and anxiety symptoms than their counterparts. The meta-regression showed the covariate features, where having more social media features in interventions significantly improved the quality of life (β = 0.21, p = 0.01). The certainty of evidence was very low for all outcomes.

CONCLUSIONS

Participants who received social media-based interventions may experience an increase in quality of life and reduction in anxiety symptoms.

IMPLICATIONS FOR CANCER SURVIVORS

Social media-based interventions may complement usual care in improving quality of life and anxiety symptoms. Registration in PROSPERO CRD42022297956.

The impact of cancer on psychosocial function and quality of life: A cross-sectional study in 18 pan-European countries

BACKGROUND

To improve psychosocial cancer care in Europe, more information is needed on psychosocial function and quality of life (QoL) among cancer patients in European countries.

AIMS

To investigate differences in psychosocial function between cancer survivors and the general population in Europe, in relation to national economic status and personal factors.

METHOD

Data were from the Survey of Health, Aging and Retirement in Europe (Wave 6). Main outcomes were psychosocial functioning: activity limitations, income adequacy, loneliness, depression, and QoL. Factors possibly associated with the main outcomes were ever having cancer, gross domestic product (GDP), and personal factors (age, gender, education, marriage status, employment status, number of children, number of chronic diseases).

RESULTS

The study sample featured 6238 cancer survivors and 60,961 individuals without cancer aged 50 or older in 17 European countries and Israel. Levels of depression were higher and QoL was lower among cancer survivors compared to individuals without cancer and worse in low GDP countries, whereas differences in income adequacy and loneliness were not statistically significant. The interaction of cancer groups and country groups indicated a significant interactional effect on activity limitations, loneliness, depression, and QoL. In a multivariate regression analysis, personal factors, GDP, and being a cancer survivor predicted the main outcome variables.

CONCLUSIONS

Cancer has a persistent negative effect on survivors that is related to a country's GDP. Cancer survivors in low-GDP countries are affected by the consequences of cancer intertwined with the hardships of living in a low-GDP country.

Influencing factors of suicidal ideation in lung cancer patients in Midland China: A mixed-method study

Introduction

The suicide risk of lung cancer patients is higher than that of patients with other cancers. However, as China is a large country for lung cancer, there are no relevant reports on lung cancer suicides. This study aimed to investigate the prevalence of suicidal ideation and explore its influencing factors in lung cancer patients.

Methods

In this cross-sectional study, between July to November 2019, 366 lung cancer patients from the oncology department of a general hospital in Wuhan were chosen as participants. Of these, eight with lung cancer and suicidal ideation were selected for in-depth interviews.

Results

A total of 22.68% of lung cancer patients reported suicidal ideation. Sex, cancer stage, number of uncomfortable symptoms, and satisfaction with treatment were independently associated with suicidal ideation. This qualitative study found that the experience of suicidal ideation in lung cancer patients includes physiological (heavy burden of symptoms),psychological (bad mood, thwarted belongingness, perceived burdensomeness, and stigma), and social factors (high economic pressure and negative life events).

Discussion

These findings suggest that the incidence of suicidal ideation in lung cancer patients is higher than that of other cancers and is affected by many factors. Therefore, there should be routine screening and assessment of suicidal ideation among lung cancer patients, and related mental health and suicide prevention education should be provided.

Impact of Loneliness on Functioning in Lung Cancer Patients

Lung cancer is the leading cause of cancer death and carries a greater degree of stigma. Lung cancer stigma contributes to social isolation and increases loneliness, which has an impact on quality of life, increases depressive symptoms and hence affects all aspects of functioning. Functioning is assessed in five dimensions (physical, psychological, cognitive, social and life roles). The aim of the study was to assess the impact of loneliness on the functioning, nutritional status and quality of life of patients with lung cancer.

METHODS

The survey study was conducted among 310 lung cancer patients. The patients were asked to complete the Mini-MAC, HADS-M, MNA, EORTC QoL, AIS and VAS questionnaires.

RESULTS

In total, 136 patients were lonely and 174 were married or in a relationship. Lonely patients had significant difficulty accepting their illness and demonstrated higher levels of depression. The factors most strongly associated with loneliness were being unemployed, age 61 or over and a less score in the constructive coping strategies.

CONCLUSIONS

Loneliness is a significant factor affecting the functioning of patients with lung cancer. It increases the risk of anxiety and depression, reduces levels of illness acceptance, reduces levels of constructive coping and increases the risk of malnutrition.

The influence of social constraints on the quality of life of hematopoietic stem cell transplantation survivors: The chain mediating effect of illness perceptions and the fear of cancer recurrence

Objective

This cross-sectional correlational study aims to explore the relationship between social constraints and the quality of life of hematopoietic stem cell transplantation (HCT) survivors. Additionally, we also seek to demonstrate the chain mediating effect of illness perceptions and the fear of cancer recurrence on this relationship.

Methods

Convenience sampling was employed in this study. A total of 232 HCT survivors were interviewed using the Social Constraints Scale, the Brief Illness Perception Questionnaire, the Fear of Cancer Recurrence Inventory (Short Form) and the Functional Assessment of Cancer Therapy-Bone Marrow Transplant. IBM SPSS 24.0 were used for data analyses, and PROCESS macro (Model 6) was used to examine the hypothesized chain mediation model.

Results

A positive relationship between social constraints and quality of life verified the mediating effect of illness perceptions and the fear of cancer recurrence on this relationship. Social constraints affect the quality of life of HCT survivors via three pathways: the mediating role of illness perceptions, the mediating role of fear of cancer recurrence and the chain mediating effect of both factors.

Conclusion

The chain mediating effect of illness perceptions and the fear of cancer recurrence on quality of life indicates that these two variables have important practical significance with respect to improving HCT survivors' physical and mental health. The study thus serves as a reference for health workers to improve HCT survivors' quality of life in the future.

Health-Related Quality of Life and Depression Symptoms in a Cross Section of Patients with Advanced Lung Cancer before and during the COVID-19 Pandemic

Background: Adults with advanced lung cancer experience reduced health-related quality of life (HRQOL) and psychological symptoms at diagnosis. Objective: This study aimed to evaluate whether the COVID-19 pandemic worsened HRQOL among patients recently diagnosed with cancer. Design: We analyzed baseline data from two randomized controlled trials of early palliative care to compare HRQOL and depression symptoms among those enrolled during the pandemic (January 2020 to January 2021) versus prepandemic (March 2018 to January 2019). Setting/Subjects: This cohort included patients recently diagnosed with advanced lung cancer in two multisite studies. Measurements: We used analysis of covariance to calculate adjusted mean differences between groups with the timeframe as an independent variable and HRQOL (using the Functional Assessment of Cancer Therapy-General) and depression symptoms (using the Patient Health Questionnaire-9) as dependent variables, adjusting for age, gender, relationship status, performance status, symptoms, and time since diagnosis. We tested for an interaction between the COVID-19 timeframe and relationship status. Results: Neither HRQOL (adjusted mean difference -1.78; p = 0.137) nor depression symptoms (0.06; p = 0.889) differed between patients enrolled pre-COVID-19 (n = 665) relative to those enrolled during COVID-19 (n = 191) in adjusted analyses. Relationship status moderated the effect of the COVID-19 timeframe on HRQOL; unmarried patients experienced worse HRQOL during COVID-19 (adjusted mean difference: -5.25; p = 0.011). Conclusions: The COVID-19 pandemic did not further reduce HRQOL or increase depression symptoms among patients recently diagnosed with lung cancer, but did worsen HRQOL for unmarried patients in moderation analysis. Psychosocial evaluation and supportive care are important for all patients, particularly those with limited social support. Clinical trial registration numbers: NCT03337399 and NCT03375489.

Perspectives of cancer patients during the COVID-19 outbreak in Israel: The long-term implications on support and well-being in an exploratory qualitative study

OBJECTIVES

The COVID-19 pandemic's ongoing effects and long-term implications for the mental and social state of cancer patients are not yet fully known. The current study examined cancer patients' feelings about the pandemic's long-term impact on daily life 1 year after its outbreak in Israel and after the patient's vaccination against the virus.

METHODS

Ten in-depth semi-structured interviews were conducted with cancer patients between February and April 2021.

RESULTS AND CONCLUSIONS

Findings indicated four main themes: (1) managing medical care and support from the medical staff, (2) the effect of the pandemic on social interactions; (3) the impact of the pandemic on family and social support and (4) the patients' psychological well-being. Despite the patients being vaccinated, the full impact of the pandemic on cancer patients' mental and social states is still fully apparent. The findings reflect the need to assess and monitor the patients' mental state and social and medical needs during this complex time and the importance of developing external support networks.

Effect of Network-Based Positive Psychological Nursing Model Combined With Elemene Injection on Negative Emotions, Immune Function and Quality of Life in Lung Cancer Patients Undergoing Chemotherapy in the Era of Big Data

Background

With the development of big data, big data interpenetrate in every person's life. Health care is no exception to this trend, especially in regard to nursing analytics. The data that is analyzed and leveraged in this field is gathered from a variety of sources, including electronic health records (EHRs), medical histories, provider notes and mobile applications, creating an accumulation of personalized health information around each individual.

Objective

To explore the effect of the network-based positive psychological nursing model combined with elemene injection on negative emotions, immune function and quality of life (QOL) in patients with lung cancer (LC) undergoing chemotherapy.

Methods

The clinical data of 90 LC patients who underwent chemotherapy in our hospital from December 2020 to December 2021 were retrospectively analyzed, and the patients were equally split into experimental group (EG) and control group (CG) according to the order of enrollment. The patients in CG received routine nursing intervention during chemotherapy, while those in EG received the network-based positive psychological nursing model combined with elemene injection to compare negative emotions, immune function and quality of life (QOL) between the two groups.

Results

Compared with CG, EG had notably higher immune function indexes (P < 0.001), lower serum VEGF and MMP-2 levels (P < 0.001), lower HAMA and HAMD scores (P < 0.05), and higher scores of PTGI, physiological function, psychological function, social function and physical function (P < 0.001).

Conclusion

The network-based positive psychological nursing model combined with elemene injection is a reliable method to enhance the immune function and QOL of LC patients undergoing chemotherapy and alleviate their negative emotions, which has a high clinical application value.

Influence of social isolation and loneliness on the prognosis of advanced lung cancer patients: a prospective cohort study

PURPOSE

The purpose of this study was to investigate the impact of social isolation and loneliness on the overall survival and death at home in patients with lung cancer.

METHODS

This prospective cohort study was conducted in a Japanese tertiary hospital. The enrollment period was from April 2018 to March 2020. Patients with pathologically diagnosed advanced lung cancer were included in this study. The primary outcome was overall survival, whereas the secondary outcome was death at home. The exposures were social isolation and loneliness.

RESULTS

A total of 211 patients were enrolled and divided into two groups and further into quartiles according to their social isolation and loneliness level, respectively. The hazard ratios of social isolation were 1.65 (95% confidence interval; 1.12 to 2.44) and 1.87 (95% confidence interval; 1.15 to 3.03) in the univariate analysis, while 1.40 (95% confidence interval; 0.92 to 2.13) in the multivariate analysis with complete case and multiple imputation. The odds ratio of death at home with social isolation was 3.47 (95% confidence interval; 1.08 to 11.1) in the multivariate analysis with multiple imputation. Loneliness was not associated with overall survival or death at home.

CONCLUSIONS

Our study suggests that social isolation may be related to overall survival and death at home among patients with advanced lung cancer. More attention should be given to such patients at the time of diagnosis.

Loneliness and Psychological Distress in Women Diagnosed with Ovarian Cancer: Examining the Role of Self-Perceived Burden, Social Support Seeking, and Social Network Diversity

The aim of the present study was to examine the role of self-perceived burden, social support seeking, and social network diversity in loneliness and psychological distress among women with ovarian cancer. A cross-sectional design was employed whereby 130 women diagnosed with ovarian cancer, recruited through various online sources (e.g., social media), completed the study via Qualtrics. Participants completed questionnaires that assessed self-perceived burden, social support seeking, social network diversity, loneliness, and psychological distress (anxiety, depressive symptoms). The models examined indicated that there were indirect effects of self-perceived burden and social network diversity on psychological distress via loneliness. Social support seeking was not significant in the models. Loneliness, self-perceived burden, and social network diversity should be of clinical concern among those working to support women with ovarian cancer. Future studies on longitudinal patterns or examining other factors associated with loneliness are needed to better understand the mental health of women with ovarian cancer.

Patient-Proxy Agreement Regarding Health-Related Quality of Life in Survivors with Lymphoma: A Propensity-Score Matching Analysis

Objective: To assess the difference between lymphoma survivors' self- and proxy-reported health-related quality of life (HRQoL) and its association with socioeconomic and health statuses. Methods: The data used in this study were obtained from a nationwide cross-sectional online survey in 2019. Information about participants' demographics, health status and HRQoL were collected. The propensity-score matching (PSM) method was used to control the effect of potential confounders on selection bias. A chi-squared test, one-way analysis of variance, and multiple linear regression models were used to assess the relationship between HRQoL and response type adjusted to respondents' background characteristics. Results: Out of the total 4400 participants, data of 2350 ones were elicited for analysis after PSM process. Patients' self-reported outcomes indicated a slightly better physical, role and emotional functioning than proxy-reported outcomes. Regression analysis showed that patients, who were older, unemployed, and who received surgery, were more likely to report a lower HRQoL. Further analysis demonstrated that proxy-reported patients who had completed treatment were more likely to report a higher HRQoL than those who were being treated. Conclusions: Our study demonstrates that the agreement between self- and proxy-reported HRQoL is low in patients with lymphoma and the heterogeneities of HRQoL among patients with different types of aggressive NHL (Non-Hodgkin's lymphoma) is large. Differences in self- and proxy-reported HRQoL should be considered by oncologists when selecting and deciding the optimal care plan for lymphoma survivors.

Validation of a Chinese version of the short-form Cataldo lung cancer stigma scale

BACKGROUND

Lung cancer stigma is a widespread psychosocial problem. We developed a short form of the Cataldo lung cancer stigma scale for Chinese people with lung cancer (CLCSS-C-SF) and compared its psychometric properties with those of the full and short versions.

METHODS

This was a secondary analysis using data from the full CLCSS-C, distress thermometer and perceived social support of Chinese people with lung cancer (N = 394). Exploratory and confirmatory factor analysis (CFA) were used to identify factor structure and assess construct validity. The internal consistency and concurrent and known-group validity were evaluated.

RESULTS

The 22-item CLCSS-C-SF comprised four factors. The convergent validity evaluated using average variance extracted and discriminant validity were acceptable. Cronbach's alphas, concurrent and known-group validity were satisfactory for three versions. Only the four-factor model proposed was validated by CFA.

CONCLUSION

The CLCSS-C-SF is reliable and valid and can be used in Chinese lung cancer populations.

How Compassionate Abilities Influence the Experience of Loneliness and Quality of Life of People with and without Chronic Physical Disease?

The current study aimed to test whether individuals with and without a chronic physical disease differ in levels of compassionate abilities, loneliness and quality of life (QoL); and to examine whether loneliness mediated the impact of self-compassion and of receiving compassion from others in physical, psychological, and social QoL. In this cross-sectional study, individuals with (n = 278) and without (n = 455) physical chronic disease were recruited through an online self-report protocol. The Compassionate Attributes and Engagement Scale, the UCLA Loneliness Scale, and the World Health Organization's QoL-BREF were used. Individuals with a chronic physical disease diagnosis reported lower compassionate abilities and QoL, as well as higher levels of loneliness, when compared to participants without a diagnosis. For both samples, compassionate abilities were negatively linked to loneliness, and positively linked to QoL. Path analysis results indicated that compassionate abilities have a direct effect on loneliness, which explains individuals' perceived QoL. Results highlight the crucial role of self-compassion skills and the ability to perceive others as compassionate, in loneliness and QoL, both in individuals with and without a chronic physical disease. These findings seem to have important research and clinical implications.

Association Between Loneliness and the Frequency of Using Online Peer Support Groups Among Cancer Patients With Minor Children: A Cross-Sectional Web-Based Study

CONTEXT

Cancer patients with minor children are increasing; however, they do not receive sufficient support.

OBJECTIVE

This study aimed to investigate the association between loneliness and the frequency of using online peer support groups among cancer patients with minor children.

METHODS

A cross-sectional web-based survey was conducted from April to May 2019. Cancer patients with minor children were recruited from an online peer support group called "Cancer Parents." Individuals diagnosed with cancer and whose youngest children were younger than 18 years were enrolled. Materials included: the UCLA Loneliness Scale version 3 (UCLA-LS), K6 scale, abbreviated Lubben Social Network Scale, and the sociodemographic/clinical characteristics questionnaire. Multivariate logistics regression analysis was performed to determine the factors associated with the high loneliness group (defined as those above the median score on the UCLA-LS).

RESULTS

A total of 334 patients participated (79.9% female; mean age 43.1 years, standard deviation 5.8). The most common primary cancer type was breast (34.1%). The median score of the UCLA-LS was 45 (interquartile range 37-53). The multivariate logistics regression analysis revealed that the high loneliness group was significantly associated with the frequent use of online peer support group less than once a week (odds ratio [OR] = 0.47; 95% CI = 0.26-0.85; P = 0.012), with a smaller social network (OR = 0.78; 95% CI = 0.73-0.83; P < 0.001), and higher psychological distress (OR = 1.16; 95% CI = 1.09-1.23; P < 0.001).

CONCLUSIONS

Frequent use of online peer support groups was associated with less loneliness among cancer patients with minor children.

A systematic review on social constraints in the context of cancer

This review aims to identify, summarise and critically evaluate studies that examined moderators or mediators of the relationship between social constraints and cancer adjustment. A database search was conducted to identify eligible studies published between inception and November 2019. A narrative synthesis of the included studies was conducted. We identified 18 papers, comprising 6933 participants (Mage = 55.70) with different types of cancer (mainly breast cancer). All of the studies used the Social Constraints Scale. Our synthesis shows that the association between social constraints and cancer adjustment is likely to be moderated or mediated by different cognitive (e.g. avoidant coping, intrusive thoughts) and emotional (e.g. emotionality, negative affect) variables. The importance of the moderators and mediators found in this study should be further examined by employing more sophisticated data analytic strategies to assess mediation and by collecting longitudinal data in order to better disentangle the complex associations among variables. However, some important variables were identified as potential targets of interventions for patients facing cancer.