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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

Hughes ME, Waite LJ, Hawkley LC, Cacioppo JT. A short scale for measuring loneliness in large surveys: results from two population-based studies. Research on Aging. 2004;26(6):655-672.

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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Laura Pole, MSN, RN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, MSN, RN, OCNS Senior Clinical Consultant

Nancy Hepp, MS

Lead Researcher
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher and writer for CancerChoices and also served as the first program manager. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher

Last update: February 10, 2024

Last full literature review: November 2021

CancerChoices provides information about integrative in cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

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