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). …