Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA.
Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA.
J Natl Compr Canc Netw. 2024 Apr 25;22(4):244-248. doi: 10.6004/jnccn.2023.7114.
Loneliness, a subjective feeling of being isolated, is a prevalent concern for elderly people and more so among cancer survivors because a cancer diagnosis and its subsequent treatment may result in long-term adverse health effects. This study aimed to examine the association of loneliness and mortality risk among cancer survivors in the United States.
We identified a longitudinal cohort of cancer survivors aged ≥50 years from the nationally representative panel surveys of the 2008-2018 Health and Retirement Study. Follow-up for vital status was through 2020. Loneliness was measured using an 11-item abbreviated version of the UCLA Loneliness Scale (Version 3), including questions about lacking companionship and feeling isolated from others. A score was assigned according to the responses to each question, with 1 for least lonely, 2 for moderately lonely, and 3 for the loneliest option. Items were summed to create total loneliness scores for each individual, which were categorized into 4 levels: 11-12 (low/no loneliness), 13-15 (mild loneliness), 16-19 (moderate loneliness), and 20-33 (severe loneliness) based on the sample distribution. Time-varying Cox proportional hazard models with age as a time scale were used to examine the association of loneliness and survival among cancer survivors.
A total of 3,447 cancer survivors with 5,808 person-years of observation were included, with 1,402 (24.3%), 1,445 (24.5%), 1,418 (23.6%), and 1,543 (27.6%) reporting low/no, mild, moderate, and severe loneliness, respectively. Compared with survivors reporting low/no loneliness, survivors reporting greater loneliness had a higher mortality risk, with the highest adjusted hazard ratios (aHRs) among the loneliest group (aHR, 1.67 [95% CI, 1.25-2.23]; P=.004) following a dose-response association.
Elevated loneliness was associated with a higher mortality risk among cancer survivors. Programs to screen for loneliness among cancer survivors and to provide resources and support are warranted, especially considering the widespread social distancing that occurred during the COVID-19 pandemic.
孤独感是一种孤立的主观感受，是老年人普遍关注的问题，在癌症幸存者中更为严重，因为癌症诊断及其随后的治疗可能会导致长期的不良健康影响。本研究旨在检验孤独感与美国癌症幸存者死亡风险之间的关联。
我们从全国代表性的 2008-2018 年健康与退休研究面板调查中确定了一个年龄≥50 岁的癌症幸存者的纵向队列。通过 2020 年对生存状态进行随访。孤独感使用 UCLA 孤独量表（第 3 版）的 11 项简化版进行测量，包括关于缺乏陪伴和与他人隔绝的问题。根据每个问题的回答分配一个分数，1 表示最不孤独，2 表示中度孤独，3 表示最孤独。为每个个体创建总孤独评分，根据样本分布将其分为 4 个等级：11-12（低/无孤独）、13-15（轻度孤独）、16-19（中度孤独）和 20-33（重度孤独）。使用时间变化的 Cox 比例风险模型，以年龄为时间尺度，研究癌症幸存者的孤独感与生存之间的关系。
共纳入 3447 名癌症幸存者，观察了 5808 人年，分别有 1402（24.3%）、1445（24.5%）、1418（23.6%）和 1543（27.6%）报告低/无、轻度、中度和重度孤独。与报告低/无孤独的幸存者相比，报告更严重孤独的幸存者死亡风险更高，最孤独组的调整后危险比（aHR）最高（aHR，1.67[95%CI，1.25-2.23]；P=.004），呈剂量反应关系。
孤独感升高与癌症幸存者的死亡率升高有关。有必要对癌症幸存者进行孤独感筛查，并提供资源和支持，特别是考虑到在 COVID-19 大流行期间广泛实施的社交距离措施。
