A Closer Look at Social Support as a Moderator of Stress in Breast Cancer

Roberts, Cleora S., Cox, Charles E., Shannon, Vicki J., Wells, Nancy L., Health and Social Work

Assessment of the social support networks available to patients coping with illness is generally accepted as an integral function of health care social work. Knowledge of the impact, limitations, and mechanisms of social support for various patient populations leads to more accurate psychosocial assessments and, ultimately, better treatment plans.

The research study described in this article examined the effects of social support on psychological adjustment of newly diagnosed breast cancer patients. Because of increases in rates of incidence, prevalence, and survivorship of breast cancer, growing numbers of women are faced with the need to adapt to its diagnosis and treatments. Increased understanding of the role of social support in this adaptation process is of value to social workers involved with these patients.

REVIEW OF THE LITERATURE

Social Support and Illness

Studies have found that social support serves an ameliorating function during times of psychological distress in medical populations. Authors have proposed such a relationship in various populations including lung cancer patients (Quinn, Fontana, & Reznikoff, 1986), breast cancer patients (Ell, 1984; Funch & Mettlin, 1982; Hughes, 1982), and asthma and heart attack patients (Hammer, 1983). One explanatory model holds that the social network is a source of support in a crisis and thus a buffer against the harmful effects of stress (Hammer, 1983). Ell (1984) proposed that social relationships buffer individual perceptions of a stressor, provide resources to modify the environmental demand, and help manage individual affective response.

Social support has been positively associated with health status, but the specific pathways through which social support exerts its influence on health are not yet understood (Ell, 1984). Several sources have reported that social support may reduce the negative impact of stress on diverse health problems such as low birthweight, arthritis, and tuberculosis (Cobb, 1976; Hammer, 1983; Turner, 1981). Hammer postulated that the social network may be directly and causally involved in health outcomes, perhaps through the impact of social feedback on psychological processes. Social support is thought to help in reducing the amount of medication required, accelerating recovery, and facilitating compliance with prescribed medical regimens (Cobb, 1976). These effects may be due to an enhancement of self-esteem and sense of control, as well as an increased coping capacity, and may result in direct beneficial physical effects. Lipowski (1969) wrote, "the quality of the patient's interpersonal relationships at the time of onset of illness and during its course tend to have a profound effect on his experiencing illness and coping with it. The response of the family and other meaningful people to the patient's illness or disability, to his communications of distress, and to his inability to perform the usual social roles may spell the difference between optimal recovery or psychological invalidism". Lipowski cited three major sources of potential support: (1) physician or other medical personnel, (2) spouse and family, and (3) other patients.

Social Support and Cancer Patients

Social support and its effect on cancer patients' adjustment to diagnosis, treatment, and long-term survival have been studied extensively. Wortman (1984) and later Vernon and Jackson (1989) reviewed the literature in this area and summarized the fundamental constructs of social support as well as the findings and limitations of research available on this topic. Wortman pointed out that even though studies have found perceived support to be associated with positive outcomes, such as improved emotional adjustment or better coping, generally these studies have been correlational and have not provided evidence of a causal relationship between support and adjustment. Rather, social support has emerged as a predictor of adjustment (Wortman, 1984).

Although most of the empirical studies have focused on the effects of receiving support, some attention has also been given to factors that impede an individual's ability to mobilize and effectively use social support. Factors that deter support include prognosis, chronicity of illness, pain, type and location of symptoms, cultural and environmental influences, and characteristics of the provider (DiMatteo & Hays, 1981; House, 1981). Attention has also been given to the patient's psychological resources and the effect individual functioning has on the availability of social support as well as the effectiveness of this support in mitigating symptoms of distress and enhancing emotional adjustment (Schmale, 1984). Ell, Mantell, Hamovitch, and Niskomate (1989) used a multivariate approach to study the respective contributions of a sense of personal control and social support resources on the psychological outcomes of cancer patients. They concluded that personal control may be a more important coping mechanism than social support but that well-being is further enhanced by social resources.

Although most of the literature supports the belief that social support ameliorates stress, some empirical studies have not confirmed these findings. For example, Revenson, Wollman, and Felton (1983) found that supportive behaviors, defined as friendliness, understanding, useful information, and acts of tangible …

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Publication information: Article title: A Closer Look at Social Support as a Moderator of Stress in Breast Cancer. Contributors: Roberts, Cleora S. - Author, Cox, Charles E. - Author, Shannon, Vicki J. - Author, Wells, Nancy L. - Author. Journal title: Health and Social Work. Volume: 19. Issue: 3 Publication date: August 1994. Page number: 157+. © 1999 National Association of Social Workers. COPYRIGHT 1994 Gale Group.

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