People with aggressive blood cancers who require unplanned hospitalizations tend to live longer if they have strong social support from friends or family, according to a recent study published in the Journal of the National Comprehensive Cancer Network.
Aggressive blood cancers often require toxic treatments that make daily life difficult. Research indicates that strong interpersonal relationships can help reduce stress and improve patients’ quality of life, but whether social support also extends survival has been unclear.
“Many of us have had a sense that social support is critical for people with aggressive hematologic malignancies because these are cancers that often have a difficult illness course,” first author Patrick Connor Johnson, MD, a hematologist and oncologist at Massachusetts General Hospital, Boston, Massachusetts, told Medscape Medical News. “But there actually hasn’t been any good data to definitively or, at least, add stronger evidence that there’s an association with survival and social support.”
To determine whether such a connection exists, Johnson and colleagues studied the medical records of 251 adult patients with an aggressive hematologic malignancy with an unplanned admission to Massachusetts General Hospital between 2014 and 2017. Patients who had planned to come to the hospital for treatment or surgery were excluded. Almost 90% of patients were White, and more than two thirds were men.
The team searched the medical records for documentation of social support by a healthcare practitioner within the 6 months following hospital admission, using software developed at the Dana-Farber Cancer Institute that analyzes large amounts of text in clinical records. This natural language processing tool picked up phrases such as “many friends” or “close with their” as indicative of strong social support. Phrases such as “limited support” and “lives alone” were regarded as signs of weak support.
Johnson and colleagues determined that 229 patients (91%) had adequate social support and that 22 (9%) had limited support. Most patients had leukemia (42%) and lymphoma (38%); about 20% had myelodysplastic syndrome or a myeloproliferative neoplasm.
Of the 251 patients, 85 patients passed away over a 6-month follow-up period. Of those, 45 died at the hospital or within 90 days of their admission. Johnson and colleagues found that the patients with limited social support were twice as likely to die after an unplanned hospitalization as others (hazard ratio, 2.00). They also faced a much great risk for death or readmission within 90 days of discharge (odds ratio, 3.11).
Given the small sample of patients and the lack of diversity in the study population, the researchers caution against extrapolating these findings too broadly. Johnson noted that the study does not break down the association between social support and overall survival by type of hematologic cancer.
Still, the study underlines the importance of providing direct social support after hospitalization to people with aggressive blood cancer, according to Karen Syrjala, PhD, co-director of the Survivorship Program at the Fred Hutchinson Cancer Research Center, in Seattle, Washington, who was not involved in the research. “It’s great to have evidence that having people to help and support a patient going through such an aggressive form of treatment is invaluable,” Syrjala said.
Syrjala would like to see research that identifies whether practical or emotional support is most beneficial for people with aggressive forms of cancer. However, she noted that a more immediate intervention to help patients facing aggressive treatment would be to make sure that a caretaker was available to provide companionship and help with daily activities.
Johnson believes this study sets the stage for further research. Areas of research include means of recognizing patients with minimal social support and interventions to augment that support, he noted.
J Natl Compr Canc Netw. Published online October 15, 2021. Full text
The research was supported by funding from the Leukemia and Lymphoma Society. The authors and Syrjala have disclosed no relevant financial relationships.
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