Sharing Love
and Support

Are you a health professional?

This section does not replicate the other information on this topic but provides additional details or context most relevant to professionals.

Assessing social isolation in patients

Loneliness is common among cancer survivors and is seldom expressed to health care providers due to patients’ tendency to self-censure discussions of their feelings and try to comply with the social pressure to be an “ideal patient.” Different layers of loneliness due to cancer have been identified among survivors:¹Raque-Bogdan TL, Lamphere B, Kostiuk M, Gissen M, Beranek M. Unpacking the layers: a meta-ethnography of cancer survivors’ loneliness. Journal of Cancer Survivorship. 2019 Feb;13(1):21-33; Rajagopal L, Liamputtong P, McBride KA. The lived experience of Australian women living with breast cancer: a meta-synthesis. Asian Pacific Journal of Cancer Prevention. 2019 Nov 1;20(11):3233-3249.

• Loneliness resulting from feelings of inauthenticity, of being alone in their cancer experience, and of lack of control
• Loneliness in social networks due to others’ avoidance, misperceptions of cancer, and others’ failure to recognize the effects of cancer after active treatment
• Loneliness within the healthcare system from unmet needs after treatment or from a lack of empathy from male healthcare providers toward women
• Loneliness from societal stigma around cancer and pressures to experience growth after cancer 

Patients in one study identified the following specific contributors to their loneliness on the healthcare systems level:²Raque-Bogdan TL, Lamphere B, Kostiuk M, Gissen M, Beranek M. Unpacking the layers: a meta-ethnography of cancer survivors’ loneliness. Journal of Cancer Survivorship. 2019 Feb;13(1):21-33.

• Lack of patient-centered communication
• Lack of clarity or confusion among healthcare providers regarding who is responsible for addressing survivors’ psychosocial needs
• Difficulties supporting patient transitions from active treatment to posttreatment
• Difficulties in helping survivors manage uncertainty and responding to survivors’ emotions

Counseling patients

Of course, one health professional cannot address all these layers alone, but including information about support groups and professional therapy among the resources you share with your patients can provide an avenue to finding support for those who need help. A direct referral will be even more powerful.

Beyond providing resources, you may be able to provide more direct support to your patients. Women with breast cancer with stronger patient-provider relationships reported higher adherence to use of oral anticancer medications.³Lin C, Clark R, Tu P, Bosworth HB, Zullig LL. Breast cancer oral anti-cancer medication adherence: a systematic review of psychosocial motivators and barriers. Breast Cancer Research and Treatment. 2017 Sep;165(2):247-260. A meta-synthesis found that women with breast cancer who felt supported emotionally and informationally by their healthcare providers reported feeling safer when in hospital. Some women felt that interacting with healthcare providers helped them cope better with their cancer. However, some women felt their emotional safety net was removed once their treatment was over.⁴Rajagopal L, Liamputtong P, McBride KA. The lived experience of Australian women living with breast cancer: a meta-synthesis. Asian Pacific Journal of Cancer Prevention. 2019 Nov 1;20(11):3233-3249.

Recommendations for providing more support to your patients

Improve the care setting:

• Get training in effectively communicating with patients, particularly training in empathic listening. 
• Encourage your patients to express feelings and tell you of unmet needs within the healthcare system.
• Identify survivors’ experiences. Link them with patients who have the same diagnosis and similar treatment and are doing well; see Bringing more love and support into your life ›
• Establish clarity within the care team as to who is responsible for addressing survivors’ psychosocial needs.
• Advocate for survivors who report distress from feelings of loneliness. Consider referring to a reputable cancer survivor support group or to a counselor, preferably with experience counseling people with cancer.
• Link your patient to a team member who can educate and help them navigate diagnosis, treatment and/or survivorship, such as an oncology nurse, peer or social work navigator, paying particular attention to helping the patient transition from active treatment into survivorship.

Depending on your training, consider providing the following interventions or referring to a professional such as a psycho-oncologist or other qualified counselor:

• Work with survivors to identify and challenge maladaptive social cognitions contributing to loneliness.
• Determine if a patient perceives that they are isolated.
• Help patients identify opportunities for more flexible interpretations and actions to avoid triggering loneliness. Developing skills such as mindfulness, cognitive restructuring strategies and effective communication strategies may be helpful.

Educate and support people in your patient’s social network. Provide or refer for help with the these issues: 

• Educating loved ones about cancer treatment, the importance of social connection initiated by others, and communication strategies
• Providing direct interventions for improving partner communication
• Psychoeducation, therapeutic counseling and skills training for caregivers
• Emotion-focused therapy for cancer survivors and their partners
• Support groups

Helpful links for professionals

De Jong Gierveld J, Van Tilburg T. The De Jong Gierveld short scales for emotional and social loneliness: tested on data from 7 countries in the UN generations and gender surveys. European Journal of Ageing. 2010 Jun;7(2):121-130.

Loneliness scales

These scales include guidance for administering and scoring the scales and interpreting the scores.

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