Social Interaction May Affect Patients’ Response to Chemotherapy

Key Points

  • When patients were around those during chemotherapy who died in less than 5 years following chemotherapy, they had a 72% chance of dying within 5 years following their chemotherapy.
  • The best outcome was when patients interacted with someone who survived for 5 years or longer: They had a 68% chance of dying within 5 years.
  • The researchers’ model also predicted that if patients were isolated from other patients, they would have a 69.5% chance of dying within 5 years.

How well patients with cancer fared after chemotherapy was affected by their social interaction with other patients during treatment, according to a new study by researchers at the National Human Genome Research Institute (NHGRI), part of the National Institutes of Health, and the University of Oxford. Patients were slightly more likely to survive for 5 years or more after chemotherapy if they interacted during chemotherapy with other patients who also survived for 5 years or more. Patients were slightly more likely to die in less than 5 years after chemotherapy when they interacted during chemotherapy with those who died in less than 5 years. The findings were published by Lienert et al in Network Science.

“People model behavior based on what’s around them,” Jeffrey Lienert, MS, lead author in NHGRI’s Social and Behavioral Research Branch and a National Institutes of Health Oxford-Cambridge Scholars Program fellow. “For example, you will often eat more when you’re dining with friends, even if you can’t see what they’re eating. When you’re bicycling, you will often perform better when you’re cycling with others, regardless of their performance.”

Researchers set out to see if the impact of social interaction extended to cancer patients undergoing chemotherapy. Joining this research effort were Mr. Lienert’s adviser, Felix Reed-Tsochas, PhD, at Oxford’s CABDyN Complexity Centre at the Saïd Business School, Laura Koehly, PhD, Chief of NHGRI’s Social and Behavioral Research Branch, and Christopher Marcum, PhD, a staff scientist also in the Social and Behavioral Research Branch at NHGRI.

Methods and Findings

They based their findings on electronic medical records data from 2000 to 2009 from two major hospitals in the United Kingdom’s National Health Service. The researchers examined the total time a patient spent with the same patients undergoing chemotherapy and their 5-year survival rate. They also reviewed a room schematic to confirm the assumption that patients were potentially positioned to interact.

“We had information on when patients checked in and out of the chemotherapy ward, a small intimate space where people could see and interact for a long period of time,” Mr. Lienert said. “We used time spent getting chemotherapy in a room with others as a proxy for social connection.”

When patients were around those during chemotherapy who died in less than 5 years following chemotherapy, they had a 72% chance of dying within 5 years following their chemotherapy. The best outcome was when patients interacted with someone who survived for 5 years or longer: They had a 68% chance of dying within 5 years. The researchers’ model also predicted that if patients were isolated from other patients, they would have a 69.5% chance of dying within 5 years.

“A 2% difference in survival—between being isolated during treatment and being with other patients—might not sound like a lot, but it’s pretty substantial,” Mr. Lienert said. “If you saw 5,000 patients in 9 years, that 2% improvement would affect 100 people.”

Study Implications

“Mr. Lienert’s research is the first to investigate, on a large scale, how social context in a treatment setting can play a significant role in disease outcomes,” said Dr. Koehly.  “As cancer care moves more towards targeted therapies based on genomic tumor assessments, NHGRI is interested in understanding how these social environmental factors might impact treatment efficacy.”

The researchers didn’t study why the difference occurred, but hypothesize that it may be related to stress response. “When you’re stressed, stress hormones such as adrenaline are released, resulting in a fight or flight response,” Mr. Lienert said. “If you are then unable to ‘fight or fly,’ such as [during] chemotherapy, these hormones can build up.”

While the researchers also didn’t investigate the impact of visitors on cancer patients undergoing therapy, the effect would likely be similar, he said. 

“Positive social support during the exact moments of greatest stress is crucial,” Mr. Lienert said. “If you have a friend with cancer, keeping him or her company during chemotherapy probably will help reduce their stress. The impact is likely to be as effective, and possibly more effective, than cancer patients interacting with other cancer patients.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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