Abstract
Loneliness may exacerbate poor health outcomes particularly among cancer survivors during the COVID-19 pandemic. Little is known about the risk factors of loneliness among cancer survivors. We evaluated the risk factors of loneliness in the context of COVID-19 pandemic-related prevention behaviors and lifestyle/psychosocial factors among cancer survivors. Cancer survivors (n = 1471) seen at Huntsman Cancer Institute completed a survey between August–September 2020 evaluating health behaviors, medical care, and psychosocial factors including loneliness during COVID-19 pandemic. Participants were classified into two groups: ‘lonely’ (sometimes, usually, or always felt lonely in past month) and ‘non-lonely’ (never or rarely felt lonely in past month). 33% of cancer survivors reported feeling lonely in the past month. Multivariable logistic regression showed female sex, not living with a spouse/partner, poor health status, COVID-19 pandemic-associated lifestyle factors including increased alcohol consumption and marijuana/CBD oil use, and psychosocial stressors such as disruptions in daily life, less social interaction, and higher perceived stress and financial stress were associated with feeling lonely as compared to being non-lonely (all p < 0.05). A significant proportion of participants reported loneliness, which is a serious health risk among vulnerable populations, particularly cancer survivors. Modifiable risk factors such as unhealthy lifestyle behaviors and psychosocial stress were associated with loneliness. These results highlight the need to screen for unhealthy lifestyle factors and psychosocial stressors to identify cancer survivors at increased risk of loneliness and to develop effective management strategies.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs10865-023-00465-z/MediaObjects/10865_2023_465_Fig1_HTML.png)
Similar content being viewed by others
Data Availability
The data presented in this study are available in this article. Restrictions apply to the availability of supporting data to protect the privacy of participants.
References
American Cancer Society. (2020). COVID-19 Pandemic impact on cancer patients and survivors survey: Findings summary by the American cancer society. https://www.fightcancer.org/sites/default/files/National%20Documents/Survivor%20Views.COVID19%20Polling%20Memo.Final_.pdf
American Cancer Society. (2022). Cancer treatment and survivorship facts and figures 2022–2024. American Cancer Society.
Andrews, G., Basu, A., Cuijpers, P., Craske, M. G., McEvoy, P., English, C. L., & Newby, J. M. (2018). Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: An updated meta-analysis. Journal of Anxiety Disorders, 55, 70–78. https://doi.org/10.1016/j.janxdis.2018.01.001
Baddour, K., Kudrick, L. D., Neopaney, A., Sabik, L. M., Peddada, S. D., Nilsen, M. L., Johnson, J. T., Ferris, R. L., & Mady, L. J. (2020). Potential impact of the COVID-19 pandemic on financial toxicity in cancer survivors. Head and Neck, 42(6), 1332–1338. https://doi.org/10.1002/hed.26187
Barreto, M., Victor, C., Hammond, C., Eccles, A., Richins, M. T., & Qualter, P. (2021). Loneliness around the world: Age, gender, and cultural differences in loneliness. Personality and Individual Differences, 169, 110066. https://doi.org/10.1016/j.paid.2020.110066
Boland, L., Bennett, K., Cuffe, S., Gleeson, N., Grant, C., Kennedy, J., & Connolly, D. (2018, 2019). Cancer survivors experience of OptiMal, a 6-week, occupation-based, self-management intervention. British Journal of Occupational Therapy, 82(2), 90–100. https://doi.org/10.1177/0308022618804704
Borstelmann, N. A., Rosenberg, S. M., Ruddy, K. J., Tamimi, R. M., Gelber, S., Schapira, L., Come, S., Borges, V., Morgan, E., & Partridge, A. H. (2015). Partner support and anxiety in young women with breast cancer. Psychooncology, 24(12), 1679–1685. https://doi.org/10.1002/pon.3780
Brower, V. (2014). Evidence accumulating that depression may hinder survival. JNCI Journal of the National Cancer Institute, 106(1), djt446. https://doi.org/10.1093/jnci/djt446
Brown, J. C., & Gilmore, L. A. (2020). Physical activity reduces the risk of recurrence and mortality in cancer patients. Exercise and Sport Sciences Reviews, 48(2), 67–73. https://doi.org/10.1249/JES.0000000000000214
Bruine de Bruin, W., Parker, A. M., & Strough, J. (2020). Age differences in reported social networks and well-being. Psychology and Aging, 35(2), 159–168. https://doi.org/10.1037/pag0000415
Bu, F., Steptoe, A., & Fancourt, D. (2020). Who is lonely in lockdown? Cross-cohort analyses of predictors of loneliness before and during the COVID-19 pandemic. Public Health, 186, 31–34. https://doi.org/10.1016/j.puhe.2020.06.036
Callaghan, T., Lueck, J. A., Trujillo, K. L., & Ferdinand, A. O. (2021). Rural and urban differences in COVID-19 prevention behaviors. The Journal of Rural Health, 37(2), 287–295. https://doi.org/10.1111/jrh.12556
Choi, E. Y., Farina, M. P., Wu, Q., & Ailshire, J. (2021). COVID-19 social distancing measures and loneliness among older adults. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, gbab009. https://doi.org/10.1093/geronb/gbab009
Christiansen, J., Lund, R., Qualter, P., Andersen, C. M., Pedersen, S. S., & Lasgaard, M. (2021). Loneliness, social isolation, and chronic disease outcomes. Annals of Behavioral Medicine, 55(3), 203–215. https://doi.org/10.1093/abm/kaaa044
Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396. https://www.ncbi.nlm.nih.gov/pubmed/6668417
Cormie, P., Zopf, E. M., Zhang, X., & Schmitz, K. H. (2017). The impact of exercise on cancer mortality, recurrence, and treatment-related adverse effects. Epidemiologic Reviews, 39(1), 71–92. https://doi.org/10.1093/epirev/mxx007
Czaja, S. J., Moxley, J. H., & Rogers, W. A. (2021). Social support, isolation, loneliness, and health among older adults in the PRISM randomized controlled trial. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.728658
de Souza, J. A., Yap, B. J., Wroblewski, K., Blinder, V., Araujo, F. S., Hlubocky, F. J., Nicholas, L. H., O’Connor, J. M., Brockstein, B., Ratain, M. J., Daugherty, C. K., & Cella, D. (2017). Measuring financial toxicity as a clinically relevant patient-reported outcome: The validation of the comprehensive score for financial toxicity (COST). Cancer, 123(3), 476–484. https://doi.org/10.1002/cncr.30369
Dai, M., Liu, D., Liu, M., Zhou, F., Li, G., Chen, Z., Zhang, Z., You, H., Wu, M., Zheng, Q., **ong, Y., **ong, H., Wang, C., Chen, C., **ong, F., Zhang, Y., Peng, Y., Ge, S., Zhen, B., … Cai, H. (2020). Patients with cancer appear more vulnerable to SARS-CoV-2: A multicenter study during the COVID-19 outbreak. Cancer Discovery, 10(6), 783–791. https://doi.org/10.1158/2159-8290.CD-20-0422
Deckx, L., van den Akker, M., & Buntinx, F. (2014). Risk factors for loneliness in patients with cancer: a systematic literature review and meta-analysis. European Journal of Oncology Nursing, 18(5), 466–477. https://doi.org/10.1016/j.ejon.2014.05.002
Deckx, L., van den Akker, M., van Driel, M., Bulens, P., van Abbema, D., Tjan-Heijnen, V., Kenis, C., de Jonge, E. T., Houben, B., & Buntinx, F. (2015). Loneliness in patients with cancer: the first year after cancer diagnosis. Psycho-Oncology, 24(11), 1521–1528. https://doi.org/10.1002/pon.3818
Eastman, M. R., Finlay, J. M., & Kobayashi, L. C. (2021). Alcohol use and mental health among older American adults during the early months of the COVID-19 pandemic. Int J Environ Res Public Health, 18(8). https://doi.org/10.3390/ijerph18084222
Ferrari, A., Pagani Bagliacca, E., Veneroni, L., Silva, M., Gasparini, P., Signoroni, S., Luksch, R., Terenziani, M., Casanova, M., Spreafico, F., Meazza, C., Podda, M., Biassoni, V., Schiavello, E., Chiaravalli, S., Clerici, C. A., & Massimino, M. (2021, Jun). Experiencing Social Isolation (Even in the Era of COVID-19 Pandemic Lockdown): Teachings Through Arts from Adolescents with Cancer. Journal of Adolescent and Young Adult Oncology, 10(3), 346–350. https://doi.org/10.1089/jayao.2020.0075
Friedenreich, C. M., Shaw, E., Neilson, H. K., & Brenner, D. R. (2017). Epidemiology and biology of physical activity and cancer recurrence. Journal of Molecular Medicine (berlin), 95(10), 1029–1041. https://doi.org/10.1007/s00109-017-1558-9
Galea, S., Merchant, R. M., & Lurie, N. (2020). The mental health consequences of COVID-19 and physical distancing: The need for prevention and early intervention. JAMA Internal Medicine, 180(6), 817–818. https://doi.org/10.1001/jamainternmed.2020.1562
Gao, H., Hu, R., Yin, L., Yuan, X., Tang, H., Luo, L., Chen, M., Huang, D., Wang, Y., Yu, A., & Jiang, Z. (2020). Knowledge, attitudes and practices of the Chinese public with respect to coronavirus disease (COVID-19): An online cross-sectional survey. BMC Public Health, 20(1), 1816. https://doi.org/10.1186/s12889-020-09961-2
Gariepy, G., Honkaniemi, H., & Quesnel-Vallee, A. (2016). Social support and protection from depression: Systematic review of current findings in Western countries. British Journal of Psychiatry, 209(4), 284–293. https://doi.org/10.1192/bjp.bp.115.169094
Giannakoulis, V. G., Papoutsi, E., & Siempos, I. I. (2020). Effect of cancer on clinical outcomes of patients with COVID-19: A meta-analysis of patient data. JCO Global Oncology, 6, 799–808. https://doi.org/10.1200/GO.20.00225
Golden-Kreutz, D. M., Browne, M. W., Frierson, G. M., & Andersen, B. L. (2004). Assessing stress in cancer patients: A second-order factor analysis model for the perceived stress scale. Assessment, 11(3), 216–223. https://doi.org/10.1177/1073191104267398
Gutkind, S., Gorfinkel, L. R., & Hasin, D. S. (2022). Prospective effects of loneliness on frequency of alcohol and marijuana use. Addictive Behaviors, 124, 107115. https://doi.org/10.1016/j.addbeh.2021.107115
Harris, P. A., Taylor, R., Minor, B. L., Elliott, V., Fernandez, M., O’Neal, L., McLeod, L., Delacqua, G., Delacqua, F., Kirby, J., Duda, S. N., & Consortium, R. E. (2019). The REDCap consortium: Building an international community of software platform partners. Journal of Biomedical Informatics, 95, 103208. https://doi.org/10.1016/j.jbi.2019.103208
Hathaway, C. A., Chavez, M. N., Kadono, M., Ketcher, D., Rollison, D. E., Siegel, E. M., Peoples, A. R., Ulrich, C. M., Penedo, F. J., Tworoger, S. S., & Gonzalez, B. D. (2021). Improving electronic survey response rates among cancer center patients during the COVID-19 pandemic: Mixed methods pilot study. JMIR Cancer, 7(3), e30265. https://doi.org/10.2196/30265
Hathaway, C. A., Bloomer, A. M., Oswald, L. B., Siegel, E. M., Peoples, A. R., Ulrich, C. M., Penedo, F. J., Tworoger, S. S., & Gonzalez, B. D. (2022a). Factors associated with self-reported social isolation among patients with cancer during the COVID-19 pandemic. Health Psychology, 41(4), 311–318. https://doi.org/10.1037/hea0001172
Hathaway, C. A., Siegel, E. M., Gonzalez, B. D., Oswald, L. B., Peoples, A. R., Ulrich, C. M., Penedo, F. J., Tworoger, S. S., & Islam, J. Y. (2022b). Individual-level factors associated with COVID-19 vaccine acceptance among U.S. patients with cancer. Vaccine, 40(46), 6649–6657. https://doi.org/10.1016/j.vaccine.2022.09.063
Hawkley, L. C., & Cacioppo, J. T. (2010). Loneliness matters: a theoretical and empirical review of consequences and mechanisms. Annals of Behavioral Medicine, 40(2), 218–227. https://doi.org/10.1007/s12160-010-9210-8
Himbert, C., Hathaway, C. A., Daniels, B., Salas, K., Ashworth, A., Gigic, B., Lin, T., Viskochil, R., Kirchhoff, A. C., Grossman, D., Ose, J., Tward, J., Scaife, C., Figueiredo, J. C., Toriola, A. T., Beck, A., Shibata, D., Gonzalez, B. D., Matsen, C., Christenson, C., Ma, D. S., Colman, H., Hunt, J. P., Jones, K. B., Lee, C. J., Larson, M., Onega, T., Akerley, W. L., Li, C. I., Schneider, M., Penedo, F. J., Siegel, E. M., Tworoger, S. S., Ulrich, C. M., & Peoples, A. R. (2022). Factors associated with changes in exercise behaviors during the COVID-19 pandemic. Cancer Causes and Control. https://doi.org/10.1007/s10552-022-01580-z
Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10(2), 227–237. https://doi.org/10.1177/1745691614568352
Holt-Lunstad, J. (2021). A pandemic of social isolation? World Psychiatry, 20(1), 55–56. https://doi.org/10.1002/wps.20839
Horigian, V. E., Schmidt, R. D., & Feaster, D. J. (2021). Loneliness, mental health, and substance use among US young adults during COVID-19. Journal of Psychoactive Drugs, 53(1), 1–9. https://doi.org/10.1080/02791072.2020.1836435
Ingram, I., Kelly, P. J., Deane, F. P., Baker, A. L., Goh, M. C. W., Raftery, D. K., & Dingle, G. A. (2020). Loneliness among people with substance use problems: A narrative systematic review. Drug and Alcohol Review, 39(5), 447–483. https://doi.org/10.1111/dar.13064
Islam, J. Y., Camacho-Rivera, M., & Vidot, D. C. (2020). Examining COVID-19 preventive behaviors among cancer survivors in the United States: An analysis of the COVID-19 impact survey. Cancer Epidemiology, Biomarkers and Prevention, 29(12), 2583–2590. https://doi.org/10.1158/1055-9965.EPI-20-0801
Islam, J. Y., Vidot, D. C., & Camacho-Rivera, M. (2021). Evaluating mental health-related symptoms among cancer survivors during the COVID-19 pandemic: An analysis of the COVID impact survey. JCO Oncology Practice, 17(9), e1258-e1269. https://doi.org/10.1200/op.20.00752
Kassas, B., Morgan, S. N., Lai, J. H., Kropp, J. D., & Gao, Z. (2021). Perception versus preference: The role of self-assessed risk measures on individual mitigation behaviors during the COVID-19 pandemic. PLoS ONE, 16(8), e0254756. https://doi.org/10.1371/journal.pone.0254756
Killgore, W. D. S., Cloonan, S. A., Taylor, E. C., Lucas, D. A., & Dailey, N. S. (2020). Loneliness during the first half-year of COVID-19 lockdowns. Psychiatry Research, 294, 113551. https://doi.org/10.1016/j.psychres.2020.113551
Killgore, W. D. S., Cloonan, S. A., Taylor, E. C., & Dailey, N. S. (2021). Mental health during the first weeks of the COVID-19 pandemic in the United States. Front Psychiatry, 12, 561898. https://doi.org/10.3389/fpsyt.2021.561898
Kind, A. J. H., & Buckingham, W. R. (2018). Making neighborhood-disadvantage metrics accessible—The neighborhood atlas. New England Journal of Medicine, 378(26), 2456–2458. https://doi.org/10.1056/NEJMp1802313
Kotwal, A. A., Cenzer, I. S., Waite, L. J., Smith, A. K., Perissinotto, C. M., & Hawkley, L. C. (2022). A single question assessment of loneliness in older adults during the COVID-19 pandemic: A nationally-representative study. Journal of the American Geriatrics Society, 70(5), 1342–1345. https://doi.org/10.1111/jgs.17700
van der Krieke, L., Wunderink, L., Emerencia, A. C., de Jonge, P., & Sytema, S. (2014). E-mental health self-management for psychotic disorders: State of the art and future perspectives. Psychiatric Services, 65(1), 33–49. https://doi.org/10.1176/appi.ps.201300050
Leigh-Hunt, N., Bagguley, D., Bash, K., Turner, V., Turnbull, S., Valtorta, N., & Caan, W. (2017). An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health, 152, 157–171. https://doi.org/10.1016/j.puhe.2017.07.035
Liang, W., Guan, W., Chen, R., Wang, W., Li, J., Xu, K., Li, C., Ai, Q., Lu, W., Liang, H., Li, S., & He, J. (2020). Cancer patients in SARS-CoV-2 infection: A nationwide analysis in China. The Lancet Oncology, 21(3), 335–337. https://doi.org/10.1016/S1470-2045(20)30096-6
Lim, M. H., Eres, R., & Vasan, S. (2020). Understanding loneliness in the twenty-first century: An update on correlates, risk factors, and potential solutions. Social Psychiatry and Psychiatric Epidemiology, 55(7), 793–810. https://doi.org/10.1007/s00127-020-01889-7
Malcolm, M., Frost, H., & Cowie, J. (2019). Loneliness and social isolation causal association with health-related lifestyle risk in older adults: A systematic review and meta-analysis protocol. Systematic Reviews, 8(1), 48. https://doi.org/10.1186/s13643-019-0968-x
Marashi, M. Y., Nicholson, E., Ogrodnik, M., Fenesi, B., & Heisz, J. J. (2021). A mental health paradox: Mental health was both a motivator and barrier to physical activity during the COVID-19 pandemic. PLoS ONE, 16(4), e0239244. https://doi.org/10.1371/journal.pone.0239244
Martinez-Ferran, M., de la Guia-Galipienso, F., Sanchis-Gomar, F., & Pareja-Galeano, H. (2020). Metabolic impacts of confinement during the COVID-19 pandemic due to modified diet and physical activity habits. Nutrients, 12(6). https://doi.org/10.3390/nu12061549
Martins, S. S., Segura, L. E., Levy, N. S., Mauro, P. M., Mauro, C. M., Philbin, M. M., & Hasin, D. S. (2021). Racial and ethnic differences in cannabis use following legalization in US states with medical Cannabis laws. JAMA Network Open, 4(9), e2127002. https://doi.org/10.1001/jamanetworkopen.2021.27002
Martins, S. S., Mauro, C. M., Santaella-Tenorio, J., Kim, J. H., Cerda, M., Keyes, K. M., Hasin, D. S., Galea, S., & Wall, M. (2016). State-level medical marijuana laws, marijuana use and perceived availability of marijuana among the general U.S. population. Drug and Alcohol Dependence, 169, 26–32. https://doi.org/10.1016/j.drugalcdep.2016.10.004
McDowell, C. P., Meyer, J. D., Russell, D. W., Sue Brower, C., Lansing, J., & Herring, M. P. (2021). Bidirectional associations between depressive and anxiety symptoms and loneliness during the COVID-19 pandemic: Dynamic panel models with fixed effects. Frontiers in Psychiatry, 12, 738892. https://doi.org/10.3389/fpsyt.2021.738892
McElfresh, J. J., Skiba, M. B., Segrin, C. G., Badger, T. A., Crane, T. E., Crist, J. D., & Thomson, C. A. (2021). Interventions for loneliness among adult cancer survivors: A systematic review and meta-analysis. Journal of Psychosocial Oncology, 39(4), 509–533. https://doi.org/10.1080/07347332.2020.1867690
McGeough, A., Edwards, J., Chamberlain, R. M., & Nogeire, C. (1980). Social isolation in lung cancer patients. Social Work in Health Care, 5(4), 433–436. https://doi.org/10.1300/J010v05n04_08
McGinty, E. E., Presskreischer, R., Han, H., & Barry, C. L. (2020). Psychological distress and loneliness reported by US adults in 2018 and April 2020. JAMA, 324(1), 93–94. https://doi.org/10.1001/jama.2020.9740
Mendoza-Jimenez, M. J., Hannemann, T. V., & Atzendorf, J. (2021). Behavioral risk factors and adherence to preventive measures: Evidence from the early stages of the COVID-19 pandemic. Frontiers in Public Health, 9, 674597. https://doi.org/10.3389/fpubh.2021.674597
Miaskowski, C., Paul, S. M., Snowberg, K., Abbott, M., Borno, H. T., Chang, S. M., Chen, L. M., Cohen, B., Cooper, B. A., Hammer, M. J., Kenfield, S. A., Kober, K. M., Laffan, A., Levine, J. D., Pozzar, R., Rhoads, K., Tsai, K. K., Van Blarigan, E. L., & Van Loon, K. (2021b). Loneliness and symptom burden in oncology patients during the COVID-19 pandemic. Cancer, 127(17), 3246–3253. https://doi.org/10.1002/cncr.33603
Miaskowski, C., Paul, S. M., Snowberg, K., Abbott, M., Borno, H., Chang, S., Chen, L. M., Cohen, B., Cooper, B. A., Hammer, M. J., Kenfield, S. A., Laffan, A., Levine, J. D., Pozzar, R., Tsai, K. K., Van Blarigan, E. L., & Van Loon, K. (2021a). Oncology patients’ perceptions of and experiences with COVID-19. Support Care in Cancer, 29(4), 1941–1950. https://doi.org/10.1007/s00520-020-05684-7
Narici, M., De Vito, G., Franchi, M., Paoli, A., Moro, T., Marcolin, G., Grassi, B., Baldassarre, G., Zuccarelli, L., Biolo, G., di Girolamo, F. G., Fiotti, N., Dela, F., Greenhaff, P., & Maganaris, C. (2020). Impact of sedentarism due to the COVID-19 home confinement on neuromuscular, cardiovascular and metabolic health: Physiological and pathophysiological implications and recommendations for physical and nutritional countermeasures. European Journal of Sport Science, 1–22. https://doi.org/10.1080/17461391.2020.1761076
National Academies of Sciences, E., & Medicine. (2020). Social isolation and loneliness in older adults: Opportunities for the health care system. The National Academies Press. https://doi.org/10.17226/25663
Nekhlyudov, L., Duijts, S., Hudson, S. V., Jones, J. M., Keogh, J., Love, B., Lustberg, M., Smith, K. C., Tevaarwerk, A., Yu, X., & Feuerstein, M. (2020). Addressing the needs of cancer survivors during the COVID-19 pandemic. Journal of Cancer Survivorship, 14(5), 601–606. https://doi.org/10.1007/s11764-020-00884-w
Ose, D. J., Viskochil, R., Holowatyj, A. N., Larson, M., Wilson, D., Dunson, W. A., Deshmukh, V. G., Butcher, J. R., Taylor, B. R., Svoboda, K., Leiser, J., Tingey, B., Haaland, B., Wetter, D. W., Fisher, S. J., Hashibe, M., & Ulrich, C. M. (2021). Understanding the prevalence of prediabetes and diabetes in patients with cancer in clinical practice: A real-world cohort study. Journal of the National Comprehensive Cancer Network, 19(6), 709–718. https://doi.org/10.6004/jnccn.2020.7653
Pagan, R. (2020). Gender and age differences in loneliness: Evidence for people without and with disabilities. International Journal of Environmental Research and Public Health, 17(24). https://doi.org/10.3390/ijerph17249176
Peoples, A. R., Oswald, L. B., Ose, J., Daniels, B., Himbert, C., Hathaway, C. A., Gigic, B., Kirchhoff, A. C., Lin, T., Grossman, D., Tward, J., Varghese, T. K., Jr., Figueiredo, J. C., Toriola, A. T., Beck, A., Scaife, C., Shibata, D., LaStayo, P., Gonzalez, B., Salas, K., Ashworth, A., Matsen, C., Christenson, C., Ma, D. S., Colman, H., Hunt, J. P., Jones, K. B., Lee, C. J., Larson, M., Onega, T., Akerley, W. L., Li, C. I., Schneider, M., Penedo, F. J., Siegel, E. M., Tworoger, S. S., & Ulrich, C. M. (2022). Impact of the COVID-19 pandemic on rural and urban cancer patients’ experiences, health behaviors, and perceptions. The Journal of Rural Health. https://doi.org/10.1111/jrh.12648
Peplau, L. A., & Perlman, D. (1982). Perspectives on loneliness. In L. A. Peplau, & Perlman, D. (Ed.), Loneliness: A sourcebook of current theory, research and practice. (pp. 1–17). Wiley.
Perissinotto, C. M., Stijacic Cenzer, I., & Covinsky, K. E. (2012). Loneliness in older persons: A predictor of functional decline and death. Archives of Internal Medicine, 172(14), 1078–1083. https://doi.org/10.1001/archinternmed.2012.1993
Poscia, A., Stojanovic, J., La Milia, D. I., Duplaga, M., Grysztar, M., Moscato, U., Onder, G., Collamati, A., Ricciardi, W., & Magnavita, N. (2018). Feb). Interventions targeting loneliness and social isolation among the older people: An update systematic review. Experimental Gerontology, 102, 133–144. https://doi.org/10.1016/j.exger.2017.11.017
Raile, A. N. W., Raile, E. D., Parker, D. C. W., Shanahan, E. A., & Haines, P. (2020). Women and the weight of a pandemic: A survey of four Western US states early in the Coronavirus outbreak. Gender, Work and Organization. https://doi.org/10.1111/gwao.12590
Robilotti, E. V., Babady, N. E., Mead, P. A., Rolling, T., Perez-Johnston, R., Bernardes, M., Bogler, Y., Caldararo, M., Figueroa, C. J., Glickman, M. S., Joanow, A., Kaltsas, A., Lee, Y. J., Lucca, A., Mariano, A., Morjaria, S., Nawar, T., Papanicolaou, G. A., Predmore, J., Redelman-Sidi, G., Schmidt, E., Seo, S. K., Sepkowitz, K., Shah, M. K., Wolchok, J. D., Hohl, T. M., Taur, Y., & Kamboj, M. (2020). Determinants of COVID-19 disease severity in patients with cancer. Nature Medicine, 26(8), 1218–1223. https://doi.org/10.1038/s41591-020-0979-0
Rodriguez, L. M., Litt, D. M., & Stewart, S. H. (2020). Drinking to cope with the pandemic: The unique associations of COVID-19-related perceived threat and psychological distress to drinking behaviors in American men and women. Addictive Behaviors, 110, 106532. https://doi.org/10.1016/j.addbeh.2020.106532
Rumas, R., Shamblaw, A. L., Jagtap, S., & Best, M. W. (2021). Predictors and consequences of loneliness during the COVID-19 Pandemic. Psychiatry Research, 300, 113934. https://doi.org/10.1016/j.psychres.2021.113934
Rural Health Research Center. Rural urban commuting area codes data 2017. Seattle WA: Department of Family Medicine, University of Washington; 2005. Available from: http://depts.washington.edu/uwruca/ruca-urban.php
Salinas, J., Beiser, A. S., Samra, J. K., O’Donnell, A., DeCarli, C. S., Gonzales, M. M., Aparicio, H. J., & Seshadri, S. (2022). Association of loneliness with 10-year dementia risk and early markers of vulnerability for neurocognitive decline. Neurology, 98(13), e1337–e1348. https://doi.org/10.1212/WNL.0000000000200039
Salsman, J. M., Butt, Z., Pilkonis, P. A., Cyranowski, J. M., Zill, N., Hendrie, H. C., Kupst, M. J., Kelly, M. A., Bode, R. K., Choi, S. W., Lai, J. S., Griffith, J. W., Stoney, C. M., Brouwers, P., Knox, S. S., & Cella, D. (2013). Emotion assessment using the NIH toolbox. Neurology, 80(11 Suppl 3), S76–86. https://doi.org/10.1212/WNL.0b013e3182872e11
Sarkar, S., Braun, I. M., Nayak, M., Bryan, A. D., & Poghosyan, H. (2023). Cannabis use among cancer survivors before and during the COVID-19 pandemic, 2019–2021. JNCI Cancer Spectrum, 7(3). https://doi.org/10.1093/jncics/pkad031
Schrempft, S., Jackowska, M., Hamer, M., & Steptoe, A. (2019). Associations between social isolation, loneliness, and objective physical activity in older men and women. BMC Public Health, 19(1), 74. https://doi.org/10.1186/s12889-019-6424-y
Smith, B. J., & Lim, M. H. (2020). How the COVID-19 pandemic is focusing attention on loneliness and social isolation. Public Health Research and Practice, 30(2). https://doi.org/10.17061/phrp3022008
Stanton, R., To, Q. G., Khalesi, S., Williams, S. L., Alley, S. J., Thwaite, T. L., Fenning, A. S., & Vandelanotte, C. (2020). Depression, anxiety and stress during COVID-19: Associations with changes in physical activity, sleep, tobacco and alcohol use in Australian adults. International Journal of Environmental Research and Public Health, 17(11). https://doi.org/10.3390/ijerph17114065
Stickley, A., Koyanagi, A., Koposov, R., Schwab-Stone, M., & Ruchkin, V. (2014). Loneliness and health risk behaviours among Russian and U.S. adolescents: A cross-sectional study. BMC Public Health, 14, 366. https://doi.org/10.1186/1471-2458-14-366
Tull, M. T., Edmonds, K. A., Scamaldo, K. M., Richmond, J. R., Rose, J. P., & Gratz, K. L. (2020). Psychological outcomes associated with stay-at-home orders and the perceived impact of COVID-19 on daily life. Psychiatry Research, 289, 113098. https://doi.org/10.1016/j.psychres.2020.113098
Ulrich, C. M., Himbert, C., Boucher, K., Wetter, D. W., Hess, R., Kim, J., Lundberg, K., Ligibel, J. A., Barnes, C. A., Rushton, B., Marcus, R., Finlayson, S. R. G., LaStayo, P. C., & Varghese, T. K. (2018). Precision-exercise-prescription in patients with lung cancer undergoing surgery: rationale and design of the PEP study trial. BMJ Open, 8(12), e024672. https://doi.org/10.1136/bmjopen-2018-024672
Ulrich, C. M., Gigic, B., Böhm, J., Ose, J., Viskochil, R., Schneider, M., Colditz, G. A., Figueiredo, J. C., Grady, W. M., Li, C. I., Shibata, D., Siegel, E. M., Toriola, A. T., & Ulrich, A. (2019). The colocare study: A paradigm of transdisciplinary science in colorectal cancer outcomes. Cancer Epidemiology, Biomarkers and Prevention, 28(3), 591–601. https://doi.org/10.1158/1055-9965.EPI-18-0773
University of Wisconsin School of Medicine and Public Health. (2019) Area Deprivation Index v3.0. Downloaded from https://www.neighborhoodatlas.medicine.wisc.edu/ 2021
Vahia, I. V., Jeste, D. V., & Reynolds, C. F., 3rd. (2020). Older adults and the mental health effects of COVID-19. JAMA, 324(22), 2253–2254. https://doi.org/10.1001/jama.2020.21753
Van der Weele, T. J., Hawkley, L. C., & Cacioppo, J. T. (2012). On the reciprocal association between loneliness and subjective well-being. American Journal of Epidemiology, 176(9), 777–784. https://doi.org/10.1093/aje/kws173
Ware, J., Jr., Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233. https://doi.org/10.1097/00005650-199603000-00003
Zhou, B., Heather, D., Cesare, A. D., & Ryder, A. G. (2017). Ask and you might receive: The actor–partner interdependence model approach to estimating cultural and gender variations in social support. European Journal of Social Psychology, 47(4), 412–428. https://doi.org/10.1002/ejsp.2251
Acknowledgements
We would like to thank all the study participants as well as the German foundation Stiftung LebensBlicke for supporting E. Aßmann in conducting this work.
Funding
This study was supported by the National Institutes of Health (NIH)/National Cancer Institute (NCI) grants (U01 CA206110, R01 CA211705, R01 CA189184, R01 CA207371, P30 CA042014 to C. M. Ulrich), the Stiftung LebensBlicke, and the Huntsman Cancer Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, and the sponsors had no role in the National Institutes of Health (NIH)/National Cancer Institute (NCI) grants design or conducting of this research. ClinicalTrials.gov identifiers: NCT02328677 and NCT03306992.
Author information
Authors and Affiliations
Contributions
All of the authors participated in the revisions to this paper, the interpretation of the results, and approved the final paper. Study concept, design: Peoples, Ulrich, Tworoger, Penedo, Oswald, Siegel, Kirchhoff, Hathaway, Gonzalez, Daniels, Himbert. Provided patients: Ulrich, Beck, Matsen, Scaife, Grossman, Colman, Hunt, Tward, Jones, Lee, Barnes, Varghese, Akerley. Data acquisition and extraction: Daniels, Lin, Larson, Chellam, Ma. Statistical analysis: Aßmann, Peoples, Lin, Ulrich. Drafting of the manuscript: Aßmann, Peoples, Ulrich. Critical revisions of the manuscript for important intellectual content: Aßmann, Peoples, Ulrich, Tworoger, Penedo, Oswald, Hardikar, Kirchhoff, Gonzalez, Hathaway, Otto, Ose, Lin, Shibata, Figueiredo, Toriola, Li, Grady, Gigic, Schneider, Dinkel, Siegel, Himbert, Grossman, Tward, Varghese, Beck, Scaife, Barnes, Matsen, Colman, Hunt, Jones, Lee, Onega, Akerley, Chellam, Daniels, Larson, Ma, Islam. Supervision: Peoples, Ulrich.
Corresponding authors
Ethics declarations
Conflicts of Interest
Dr. Ulrich has as HCI Cancer Center Director oversight over research funded by several pharmaceutical companies but has not received funding directly herself. Dr. Tward has served on an advisory board and consulted for Myriad Genetics, Inc., Decipher Biosciences, and Boston Scientific; he has received research funding from Bayer for work outside of the present manuscript. Dr. Colman has served on advisory boards and consulted for Best Doctors/Teladoc, Orbus Therapeutics, Adastra Pharmaceuticals, and Bristol Myers Squibbs. Dr. Lee has served on advisory boards and/or consulted for Jazz Pharmaceuticals, Kite Pharma, Kadmon Corporation. Fresenius Kabi, and CareDx; she has received research funding from Incyte for work outside of the present manuscript. Dr. Islam has received consulting fees from Flatiron Health as a member of the COVID-19 and Cancer Advisory Board. Dr. Gonzalez has served on an advisory board for Elly Health, Inc. and previously consulted for SureMed Compliance, neither of which is relevant to this manuscript. Other authors declare that they have no conflict of interest.
Ethical Approval
Ethics approval was provided by the institutional review board of the University of Utah.
Consent to Participate
All participants provided written informed consent.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Aßmann, E.S., Ose, J., Hathaway, C.A. et al. Risk factors and health behaviors associated with loneliness among cancer survivors during the COVID-19 pandemic. J Behav Med 47, 405–421 (2024). https://doi.org/10.1007/s10865-023-00465-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10865-023-00465-z