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Risk factors and health behaviors associated with loneliness among cancer survivors during the COVID-19 pandemic

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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.

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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.

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Author notes

  1. Cornelia M. Ulrich and Anita R. Peoples have contributed equally to this work.

Authors and Affiliations

  1. Huntsman Cancer Institute, Salt Lake City, UT, USA

    Elena S. Aßmann, Jennifer Ose, Sheetal Hardikar, Caroline Himbert, Vimalkumar Chellam, Tengda Lin, Bailee Daniels, Anne C. Kirchhoff, Douglas Grossman, Jonathan Tward, Thomas K. Varghese Jr., Anna Beck, Courtney Scaife, Christopher A. Barnes, Cindy Matsen, Debra S. Ma, Howard Colman, Jason P. Hunt, Kevin B. Jones, Catherine J. Lee, Mikaela Larson, Tracy Onega, Wallace L. Akerley, Cornelia M. Ulrich & Anita R. Peoples

  2. School of Medicine, Technical University of Munich, Munich, Germany

    Elena S. Aßmann

  3. Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA

    Jennifer Ose, Sheetal Hardikar, Caroline Himbert, Tengda Lin, Tracy Onega, Cornelia M. Ulrich & Anita R. Peoples

  4. Department of Cancer Epidemiology, Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    Cassandra A. Hathaway, Jessica Y. Islam, Erin M. Siegel & Shelley S. Tworoger

  5. Department of Health Outcomes and Behavior, Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    Laura B. Oswald & Brian D. Gonzalez

  6. Department of Pediatrics, Division of Hematology/Oncology, University of Utah School of Medicine, Salt Lake City, UT, USA

    Anne C. Kirchhoff

  7. Heidelberg University Hospital, Heidelberg, Germany

    Biljana Gigic & Martin Schneider

  8. Department of Dermatology, University of Utah, Salt Lake City, UT, USA

    Douglas Grossman

  9. Department of Radiation Oncology, University of Utah, Salt Lake City, UT, USA

    Jonathan Tward

  10. Department of Surgery, University of Utah, Salt Lake City, UT, USA

    Thomas K. Varghese Jr., Courtney Scaife, Cindy Matsen & Jason P. Hunt

  11. Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA

    David Shibata

  12. Department of Medicine, Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA

    Jane C. Figueiredo

  13. Washington University School of Medicine in St. Louis, St. Louis, MO, USA

    Adetunji T. Toriola

  14. Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA

    Anna Beck & Wallace L. Akerley

  15. Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA

    Christopher A. Barnes

  16. Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA

    Howard Colman

  17. Department of Orthopedics, University of Utah, Salt Lake City, UT, USA

    Kevin B. Jones

  18. Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA

    Catherine J. Lee

  19. Fred Hutchinson Cancer Center, Seattle, WA, USA

    Christopher I. Li & William M. Grady

  20. Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany

    Andreas Dinkel

  21. Sylvester Comprehensive Cancer Center, Miami, FL, USA

    Amy K. Otto & Frank J. Penedo

  22. Department of Public Health Sciences, University of Miami, Coral Gables, FL, USA

    Amy K. Otto

  23. Departments of Psychology and Medicine, University of Miami, Coral Gables, FL, USA

    Frank J. Penedo

Authors
  1. Elena S. Aßmann
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  2. Jennifer Ose
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  3. Cassandra A. Hathaway
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  4. Laura B. Oswald
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  9. Bailee Daniels
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  41. Anita R. Peoples
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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

Correspondence to Cornelia M. Ulrich or Anita R. Peoples.

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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.

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All participants provided written informed consent.

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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

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