1. Effects of Social Support Availability & Social Network Size on Quality of Life
Tekla Evans, MPH, PMP
Behavioral Research Center
American Cancer Society
Project Manager
ACS: NHO in Atlanta, GA
April 19, 2007

2. Cancer Facts & Figures
Approximately 10.5 million Americans alive today have been diagnosed with cancer
African Americans have the highest incidence and death rate of any racial and ethnic group for all cancers combined
Colorectal cancer is the third leading cause of cancer incidence and death
2nd bullet: Among people diagnosed with cancer
3rd bullet: Among cancer types…
American Cancer Society (2007) Cancer Facts & Figures

3. 2007 Estimated US Cancer Cases*
Men 766,860
Women 678,060
Prostate 29%
Lung & bronchus 15%
Colon & rectum 10%
Urinary bladder 7%
Non-Hodgkin 4% lymphoma
Melanoma of skin 4%
Kidney 4%
Leukemia 3%
Oral cavity 3%
Pancreas 2%
All Other Sites 19%
26% Breast
15% Lung & bronchus
11% Colon & rectum
6% Uterine corpus
4% Non-Hodgkin lymphoma
4% Melanoma of skin
4% Thyroid
3% Ovary
3% Kidney
3% Leukemia
21% All Other Sites
This information represents the number of new cancer cases anticipated in the US this year.
It is estimated that about 1.4 million new cases of cancer will be diagnosed in 2007.
As you can see, cancer of the colon and rectum will be the 3rd most frequently diagnosed cancer in men and women as it historically has been for some time.
*Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.
Source: American Cancer Society, 2007.

4. Cancer Survival*(%) by Site and Race,1996-2002
African %
Difference
Site
White
American
All Sites
Breast (female)
Colon
Esophagus
Leukemia
Non-Hodgkin lymphoma
Oral cavity
Prostate
Rectum
Urinary bladder
Uterine cervix
Uterine corpus
The 5-year relative survival rate from cancer is 68% for whites and 57% for African Americans (taking normal life expectancy into consideration).
For many sites, survival rates in African Americans are 10% to more than 20% lower than in whites.
This is due, in part, to African Americans being less likely to receive a cancer diagnosis at an early, localized stage, when treatment can improve chances of survival. Additional factors that contribute to the survival differential include unequal access to medical care and tumor characteristics.
Again, as you can see, 12% fewer African Americans survive from colon cancer than whites and 7% fewer African Americans survive rectal cancer than whites.
*5-year relative survival rates based on cancer patients diagnosed from 1996 to 2002 and followed through 2003.
Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control and
Population Sciences, National Cancer Institute, 2006.

5. Social Support Findings
Only 16% of total personal assistance provided to adults with disabilities paid*
Greater reliance on family associated with being age ≥ 80, black, and living with others**
Younger and lower income women indicated they received less help than needed**
Research findings on social support indicate that…
Paints a picture of usage of and need for a social support network
* LaPlante, MP, Harrington, C, Kang, T (2002). Estimating Paid and Unpaid Hours of Personal Assistance Services in Activities of Daily Living Provided to Adults Living at Home. Health Services Research, 37 (2)
** Kasper, JD, Shore, A, Penninx, BW (2000). Caregiving arrangements of older disabled women, caregiving preferences, and views on adequacy of care. Aging-Clinical & Experimental Research,12 (2)

6. Source & Perception of Social Support
Thrasher et al. study:
850 African Americans surveyed on source of and perceived levels of social support and self-efficacy around and engagement in health behaviors
Hypotheses based on Optimal Matching Theory
Summary of Findings:
Informational & Instrumental Support ~ Healthy Diet & Colorectal Cancer Screening
Emotional Support ~ Colorectal Cancer Screening & (among women) Physical Activity
Source (for given activities)
Optimal Matching Theory:
Importance of social support depends on controllability of behavior
Different social support network members often provide support across health behaviors
~ means associated with
Thrasher, JF, Campbell, MK, Oates, V (2004). Behavior-Specific Social Support for Healthy Behaviors Among African American Church Members: Applying Optimal Matching Theory. Health Education & Behavior, 31 (2)

7. Rationale for Study Overall Findings:
Colorectal cancer is the 3rd leading cause of cancer incidence and death
African Americans bear greatest burden of this disease
Relevant social support has been shown to have a significant stress-buffering effect
Just to give you an overall summary of findings which support the rationale for our study…

8. Rationale for Study Gaps in Research:
Characteristics of social support largely unexplored
Little research on relationship between ethnicity, cancer, and social support and how this relationship affects quality of life

9. Study Aim
To determine whether availability of and size of social support network influenced quality of life of African American colorectal cancer patients (compared to non-African American colorectal cancer patients).

10. Method
Participants:
Patients diagnosed colorectal cancer within 2 months of recruitment
English-speaking
18 years of age or older
From five community hospitals in metro Atlanta area

11. Method Procedure: Participants completed surveys
at 2 - months post-diagnosis (T1)
at 6- months post-diagnosis (T2)
Total n (completed T1 and T2 surveys) = 72

12. Measures Predictor Variables: Outcome Variables: Covariates:
Availability of social support
(ISEL: Cohen et al., 1985)
Number of people in social network
Ethnicity
Outcome Variables:
Mental Functioning at T2
Physical Functioning at T2
(MOS-SF 12: Ware, Kosinski, & Keller, 1996)
Covariates:
Stage of Cancer
Mental and Physical Functioning at T1
Interpersonal Support Evaluation List (ISEL): functional indicators of social support: (perceived) belonging, appraisal, tangible support → higher score correlated with significant stress-buffering effect
Number of people in social network (number of people who the patient indicates has provided support for them since their cancer diagnosis)
Quality of Life indicators – Mental & Physical Functioning (MOS-SF 12: Ware, Kosinski, & Keller, 1996)

13. Demographic Characteristics
n = 72
Ethnicity: African American
non–African American
35 (46.5%)
37 (51.4%)
Education: ≤ HS
Some college
College graduate
Graduate degree
21 (29.2%)
23 (31.9%)
17 (23.6%)
11 (15.3%)
Income: ≤ 19K
20K – 39K
40K – 74K
> 75K
prefer not answer
11 (15.7%)
19 (27.1%)
21 (30.0%)
12 (17.1%)
7 (10.0%)
Age:
59.7 (36 – 88)
Gender: Male
Female
48 (66.7%)
24 (33.3%)
Education: 2/3 had some college or higher
Income: even spread
Age: middle-aged
Gender: 2/3 male
There were no statistically significant differences between African Americans and non-African Americans, except for income. African Americans generally had a lower income than non-African Americans (p=.013)

14. Medical Characteristics
Cancer Stage
Study
2.8% I
21.1% II
24.0%
III
42.2% IV
9.9%
Cancer Stage
SEER
Localized
39%
Regional
37%
Distant
19%
In our sample, CRC patients are diagnosed earlier compared to SEER data but overall diagnosis stage is comparable
Sample is representative of the national dataset
Study: 47.9% of new diagnoses are Stage 0, 1, 2
Cite Morris et al. study: Analysis of African Americans & Caucasians aged ≥ 65 using Medicare & SEER data, (14% of US population)
Summary of Findings:
5-year survival rate among rectal cancer patients: 27% higher for Caucasians, partially explained by number of medical conditions and stage at diagnosis
African Americans more likely to be diagnosed in emergency situation and less likely to receive adjuvant chemotherapy or radiotherapy
Colorectal Cancer Staging only

15. Study Variables - Descriptives
n = 72
Mean (SD)
Range
Social Support Network Size
median: 3
0 - 14
Social Support Availability
3.26 (0.45)
0 - 4
Mental Functioning at T1
50.19 (9.29)
Mental Functioning at T2
50.70 (8.65)
Physical Functioning at T1
40.16 (11.29)
Physical Functioning at T2
41.31 (9.91)

16. Results
No significant difference in availability of social support network availability between African American and non – African American colorectal cancer patients

17. Results
Nor was there any significant difference in social support network size between African American and non – African American colorectal cancer patients

18. Results
No statistically significant differences between mental and physical functioning between African Americans and non-African Americans at T1 or T2
T2 physical functioning significantly predicted only by T1 physical functioning and cancer colorectal stage
T2 mental functioning significantly predicted only by T1 mental functioning.

19. Results Hierarchical Linear Regression
Greater social support network size related to better physical functioning for African American patients (β=.21; p < .05) but not for non – African American patients at a level of marginal signficance.
†p < .07

20. Summary of Findings
No significant difference in availability and social support network size between African American and non – African American colorectal cancer patients
Greater social support network size was related to better physical functioning for African American patients (β=.384; p = .065) but not for non – African American patients
T2 physical functioning significantly predicted only by T1 physical functioning and cancer colorectal stage (β=.489, -.268; ps < .01)
T2 mental functioning significantly predicted by T1 mental functioning only (β=.540; p < .001) .

21. Limitations Small Sample Size Limited generalizability
Colorectal Cancer only
Not a national study
African American vs. Non-African American patients
Small sample size: The study does have a small sample size, but this is a pilot study conducted to determine whether it is feasible to replicate it on a larger scale
Limited generalizability: This study should be replicated in rural communities, using other cancer sites, with other ethnicities

22. Implications
Findings suggest that availability of social support has different impact on physical quality of life among colorectal cancer patients
African American patients should be encouraged to maximize social support as a means of improving physical functioning
Ways to boost social support for African Americans: church, etc

23. Next Steps Similar studies should be conducted that include:
more cancer sites
a larger sample
a national sample
a more ethnically diverse sample
Community-based programs should be developed to assist African American colorectal cancer patients in maximizing the beneficial effect of social support
Community organizations already rooted in African American communities (e.g. churches) should be targeted as vehicles to boost social support systems

24. Acknowledgments Youngmee Kim, PhD Rachel Spillers
Family Studies Interns
Di He
Linda Nguyen
Kunal Sharma
Adriane Vega
Marra Katz
American Cancer Society & Behavioral Research Center staff

25. Thank you