The effect of loneliness on cancer mortality

Abstract

Background: Convergent findings indicate the need of broadening the vision of cancer beyond known prognostic factors, as many variables of different nature equally affect the course of disease. Loneliness has been found to be associated with various health outcomes, but its relationship with cancer remains unclear. Here we aimed to investigate the specific effect of loneliness and other demographic, psychological, and clinical variables on cancer mortality and to validate the Italian UCLA Loneliness Scale in cancer patients. Methods: This descriptive and correlational study was conducted at the Veneto Institute of Oncology in Padua. 400 cancer patients undergoing chemotherapy from 01/2014 to 06/2015 were enrolled. The sample was stratified by sex and age (4 groups, 40-80 y). We collected demographic, clinical (site and stage of cancer, type of chemotherapy, death date), and psychosocial [self-esteem (RSE), perceived social support (MSPSS), social interaction anxiety (SIAS), personality (EPQR), and depression (BDI)] data. Results GLM analyses: loneliness was higher in women than men (F(1,398) = 7.5, p= .006) and it linearly increased with age (F(1,398) = 10.9, p =.001). Loneliness was also influenced by marital status (F(3,396) = 2.9, p= .037), cohabitant offspring (F(1,398) = 7, p= .008), and educational level (F(3,396)=4.7, p= .003), but not by clinical variables (all ps>.05). Correlation analyses: loneliness was inversely related to RSE (r= -.51), MSPSS (r= -.52), and extroversion (r = -.32), and directly related to SIAS (r= .46), neuroticism (r =.43), and BDI (r =.44). More importantly, a hierarchical binomial logistic regression revealed that patients' mortality was reliably predicted by gender, stage of cancer at diagnosis, time from diagnosis to UCLA collection, BDI, and UCLA (HL? 2(8)= 3.53, p= .90). In particular, high BDI predicted higher mortality (Wald= 11.6, p