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Greater feelings of loneliness and social isolation were associated with a higher risk of mortality among cancer survivors, according to a retrospective longitudinal study.

Over the study period of 10 years, cancer survivors with higher loneliness scores on the UCLA Loneliness Scale had higher mortality risk compared with those who had low/no loneliness scores, following a dose-response association:

• Mild loneliness: adjusted HR 1.19 (95% CI 0.86-1.63)
• Moderate loneliness: aHR 1.41 (95% CI 1.01-1.96)
• Severe loneliness: aHR 1.67 (95% CI 1.25-2.23, P=0.004)

The adjusted HR was 1.03 (95% CI 1.01-1.06) when loneliness score was included in multivariable models as a continuous variable, noted Jingxuan Zhao, MPH, of the American Cancer Society, and colleagues in the .

"Our findings underscore the importance of incorporating loneliness screening as a routine part of cancer survivorship care," they wrote. "Healthcare providers should consider adding loneliness assessment tools to their standard practice, and these tools should be employed at multiple time points, from initial diagnosis throughout survivorship care."

Zha0 and colleagues said these findings are particularly relevant in light of last year's from the U.S. Surgeon General warning of an "epidemic of loneliness and isolation" in the U.S., even before the start of the COVID-19 pandemic, and highlighting the importance of relevant training for healthcare providers, as well as the need for research on loneliness to help increase public awareness.

"Early detection of loneliness is crucial because it may prevent the escalation and complications of loneliness among cancer survivors," Zhao and team wrote. "In addition, identification of survivors experiencing loneliness can inform needs for intervention, such as mental health counseling, community support, social network involvement, and integrating loneliness intervention into cancer treatment and cancer survivorship care. Future studies should focus on the optimal screening tools for loneliness and examine the effectiveness of loneliness screening and interventions."

The authors suggested that oncologists in particular should provide loneliness screening while treating their patients, furnish education about the emotional challenges that can accompany a diagnosis and treatment, and be ready to give referrals to psychologists who can provide more specialized assessment and tailored counseling.

For this study, Zhao and colleagues used data from the 2008-2018 Health and Retirement Study (HRS), a nationally representative longitudinal panel survey conducted biennially with questions about health, employment, and psychosocial well-being among individuals ages 50 and older.

They included 3,447 cancer survivors with 5,808 person-years of observation. Most had been diagnosed >2 years prior to the survey. Their analysis was adjusted for sex, marital status, education, number of health conditions, and years since cancer diagnosis.

Loneliness was measured using an abbreviated 11-item version of the . Respondents were asked to answer questions about feeling a lack of companionship or feelings of isolation.

Loneliness scores were assigned according to answers (1 for the least, 2 for moderate, and 3 for the loneliest response option), with a total score of 11-12 classified as low/no loneliness, 13-15 as mild loneliness, 16-19 as moderate loneliness, and 20-33 as severe loneliness.

Of the included survivors, 24.3%, 24.5%, 23.6%, and 27.6% reported low/no, mild, moderate, and severe loneliness, respectively.

Male sex, non-white race/ethnicity, unmarried status, less education, more health conditions (other than cancer), and feeling depressed in the past year were linked with a higher probability of being lonelier.

There were 686 deaths among the entire cohort during the study period. Cause of death was not available in this dataset.

Zhao and colleagues acknowledged several limitations to their study, including the use of an abbreviated measure to assess loneliness and the use of self-reported data.

Furthermore, cancer-related information -- cancer type and number of diagnoses, stage at diagnosis, and whether respondents were receiving cancer treatment at the time of the survey -- was not systematically collected in the HRS.

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