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Abstract
Background: Prostate cancer is more common in men with African ancestry, with African American men having the highest incidence among all racial and ethnic groups in the US. As prostate cancer survival rates are high, it is important to understand factors that can improve quality of life (QoL), reduce cancer recurrence risk, and manage comorbidities. Social connection and support are associated with declines in cancer mortality and improved QoL in cancer survivors. Several distinct but overlapping pathways may explain the relationship between social connection and health. For example, studies report a biological relationship between social connection and markers of chronic stress, such as allostatic load. Allostatic load theory describes the impact of accumulated “wear and tear” on the body and offers an opportunity to quantify the physiological dysregulation that occurs with chronic stress exposure. In the cancer literature, studies have primarily targeted the associations between allostatic load and mortality, and less is known about the relationships between allostatic load and other cancer related factors, such as tumor progression or QoL. Evidence suggests the consequences of stress are not inevitable, as several factors appear to moderate the impact, including social support, exercise, and mindfulness activities. Other research addresses how social networks influence behavioral norms and attitudes around health, arguing that participating in social networks opens people to others’ influence to practice positive health behaviors. However, little is known about the social connections and support of African American prostate cancer survivors (AAPCS) and how these relate to QoL, allostatic load, or lifestyle change. This study used a mixed methods approach to examine the relationships between QoL, allostatic load, and social connection in AAPCS enrolled in Men Moving Forward (MMF), a randomized, lifestyle intervention trial for AAPCS.
Methods: Participants completed Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires for physical function, anxiety, depression, fatigue, sleep disturbance, social function, and pain intensity. Summative T-scores for physical and mental health were constructed from these PROMIS domains using established protocols. A 15-item allostatic load (AL) index was generated for participants. AL index criterion were chosen based on existing literature and study availability and included: DHEA, IL-6, CRP, HDL, triglycerides, total cholesterol, HbA1c, glucose, albumin, body mass index (BMI), waist circumference, systolic blood pressure, resting heart rate and medication use. The Cohen Social Network Index solicited information on three aspects of social networks across twelve relationship domains: network size (number of ties with regular contact), diversity (number of different roles with regular contact), and embeddedness (number of domains in which one has 4 or more regular contacts). Social support was measured using PROMIS domains for informational support, emotional support, and companionship. Linear regression and correlation analyses were used to explore the association between social connection, QoL, and allostatic load. Semi-structured interviews were also conducted to gain additional context on social connections and health and health behavior.
Results: Allostatic load was associated with physical but not mental QoL. No associations were found between allostatic load and any dimensions of social connection, however, associations between social connection and both mental and physical QoL were identified. Qualitative interviews revealed that survivors participating in the study had a robust network of friends and family that supported health and positive health behaviors through the provision of knowledge, sharing of perspectives rooted in experience, encouragement, and engaging in shared health behaviors.
Conclusions: This study offers novel data on social connections (networks and support) and allostatic load in AAPCS and is among the first to explore how these constructs intersect with QoL. Our findings document associations between allostatic load and perceived stress on QoL, suggesting a damaging impact of stress on survivorship in AAPCS. Positive associations between aspects of social connection and QoL were also found, suggesting a protective benefit of social relationships. Future work in larger samples is needed to further understand these associations and the mechanisms that underpin them.
