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Social relationships and their associations with affective symptoms of women with breast cancer: A scoping review

  • Yesol Yang ,

    Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Supervision, Validation, Writing – original draft, Writing – review & editing

    Affiliation Ohio State University Comprehensive Cancer Center-James, Columbus, Ohio, United States of America

  • Yufen Lin,

    Roles Data curation, Formal analysis, Investigation, Methodology, Writing – review & editing

    Affiliation Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States of America

  • Grace Oforiwa Sikapokoo,

    Roles Data curation, Methodology, Writing – review & editing

    Affiliation School of Communication Studies, Ohio University, Athens, Ohio, United States of America

  • Se Hee Min,

    Roles Data curation, Writing – review & editing

    Affiliation School of Nursing, Duke University, Durham, North Carolina, United States of America

  • Nicole Caviness-Ashe,

    Roles Data curation, Writing – review & editing

    Affiliation School of Nursing, Duke University, Durham, North Carolina, United States of America

  • Jing Zhang,

    Roles Data curation, Writing – review & editing

    Affiliation College of Nursing, Ohio State University, Columbus, Ohio, United States of America

  • Leila Ledbetter,

    Roles Data curation, Formal analysis, Investigation, Methodology, Writing – review & editing

    Affiliation Duke University Medical Center Library, Durham, North Carolina, United States of America

  • Timiya S. Nolan

    Roles Conceptualization, Investigation, Validation, Writing – review & editing

    Affiliation College of Nursing, Ohio State University, Columbus, Ohio, United States of America



Problems in affective and cognitive functioning are among the most common concurrent symptoms that breast cancer patients report. Social relationships may provide some explanations of the clinical variability in affective-cognitive symptoms. Evidence suggests that social relationships (functional and structural aspects) can be associated with patients’ affective-cognitive symptoms; however, such an association has not been well studied in the context of breast cancer.


The purpose of this scoping review was to address the following question: What social relationships are associated with affective-cognitive symptoms of women with breast cancer?


This scoping review used the framework proposed by Arksey and O’Malley and PRISMA-Sc. Studies published by February 2022 were searched using four databases: MEDLINE (PubMed), Embase (Elsevier), PsycINFO (EBSCOhost), and Web of Science (Clarivate). All retrieved citations were independently screened and eligibility for inclusion was determined by study team members. Extracted data included research aims, design, sample, type and measures of social relationships (functional and structural), and the association between social relationships and affective-cognitive symptoms


A total of 70 studies were included. Affective symptoms were positively associated with social support, family functioning, quality of relationships, social networks, and social integration, whereas the negative association was found with social constraints.


Our findings suggest positive social relationships may mitigate affective symptoms of women with breast cancer. Thus, health care providers need to educate patients about the importance of building solid social relationships and encourage them to participate in a supportive network of friends and family members.


With advances in medical treatments, breast cancer mortality rates have steadily declined in recent years, resulting in an increase in 5-year survival rates [1]. According to the report from American Cancer Society in 2017, the overall survival rates have increased from 68% to 89% for White women and from 55% to 81% for Black women [2]. Resultantly, cancer is no longer viewed as an incurable acute disease. Instead, it follows the trajectories of chronic diseases that is characterized by periods of remission and exacerbation of symptoms [3]. Women with breast cancer often experience symptoms that co-occur (i.e., symptom clusters) during the disease trajectory [3]. For example, patients experience affective and cognitive problems (symptoms) concurrently. The co-occurrence of these symptoms is called a psychoneurological symptom cluster [4]. Further, these two symptoms within a psychoneurological cluster are strongly related to each other [4, 5].

Problems in affective and cognitive functioning are among the most common concurrent symptoms that breast cancer patients report [4, 5]. Affective symptoms include any mood disturbances that occur throughout the illness trajectory of cancer (e.g., depression, stress, anxiety, and fear), and such symptoms confers the risk of development of problems in memory, concentration, processing speed, and language (i.e., cognitive symptoms) [4, 5]. Severe affective-cognitive symptoms may result in poor adherence of cancer treatments [6] and lower levels of functioning status and quality of life [7]. For this reason, it is critical to identify who may be at risk for affective as well as cognitive symptoms.

Factors that contribute to affective-cognitive (i.e., psychoneurological) symptoms were identified as stress, hypothalamic-pituitary-adrenocortical axis dysfunction, cytokine dysregulation, telomere shortening, or DNA damage [4]; however, these factors do not sufficiently explain the variability in these symptoms. For example, some patients have reported persistent and high levels of mood disturbance and cognitive impairment for several years or more following cancer treatment [8]. This finding suggests a need to investigate other potential factors that can explain their clinical variabilities.

Social relationships may provide some explanations of the clinical variability in affective-cognitive symptoms. Social relationships refer to the connections between individuals that they perceive to have personal meaning [9]. These relationships can be characterized as aspects, structural and functional. The structural aspect reflects the size, scope, and connectedness of social relations (e.g., social integration, social network), while the functional aspect covers the interpersonal interaction within the structure of the social relations (e.g., social support, family cohesion) [9]. Although the exact underlying mechanism of the association between social relationships and affective-cognitive symptoms remains unknown, several studies have examined this association. Recent systematic reviews have reported that the older populations showed a greater decline in their cognition when their social relationship was functionally and structurally poor [10, 11]. Other studies have found that patients who had greater social support and cohesive relationships with their family members showed fewer depressive symptoms [12, 13]. Specifically, breast cancer survivors demonstrated higher levels of depressive symptoms over the trajectory of their illness when they received lower levels of social support [14].

Taken together, greater social relationships (both functional and structural aspects) appear to be associated with fewer affective-cognitive symptoms in breast cancer patients. However, there is no comprehensive understanding on whether or which social relationships characteristics relate to BC patients’ affective-cognitive symptoms. Therefore, the understanding of social relationship characteristics associated with affective-cognitive symptom in breast cancer patients may be important to as a basis for development of prevention and interventions to manage those symptoms.


The purpose of this scoping review was to map the literature that has investigated both aspects of social relationships (functional and structural) and their links to affective-cognitive symptoms in breast cancer patients. This review paper addresses the following question: What social relationships are associated with affective-cognitive symptoms of women with breast cancer? This will lay the foundation for studies that explicate the mechanism of affective-cognitive symptoms in breast cancer patients. This understanding will also allow clinicians to identify patients more precisely at risk for affective-cognitive symptoms associated with social relationships and will contribute to the development of strategies to prevent and manage these symptoms.

Materials and methods

We reported the findings using the five methodological stages of scoping review developed by Arksey and O’Malley [15]. This review was conducted based on the following stages: 1) identifying the research question, 2) identifying relevant studies, 3) selecting studies, 4) charting the data, and 5) collating, summarizing, and reporting the results. A scoping review approaches was used because it helps clarify key concept related to outcomes as well as identify the types of available evidence [16]. We reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) [17].

Stage 1. Identifying research questions

We applied the PCO model to develop our research question [15]: “What social relationships (“C”, concept) are associated with affective-cognitive symptoms (“O”, outcome) of women with breast cancer (“P”, population)?” We limited our study population of women with breast cancer aged 18 years and above because of different trajectories and manifestations of cognitive symptoms that children with cancer show compared with adults [18]. Table 1 describes eligibility criteria for the studies that were included in this scoping review.

Stage 2. Identifying relevant studies

We developed relevant search terms in collaboration with a librarian included a mix of keywords and database specific subject headings representing women, breast cancer, affective symptoms and social relationships. The search was translated and conducted by a medical research librarian on February 15, 2022 using four databases: MEDLINE (PubMed), Embase (Elsevier), PsycINFO (EBSCOhost), and Web of Science (Clarivate). Editorials, letters, and comments were excluded, as were animal-only studies and studies involving pediatric populations. Reproducible search strategies for all databases can be found in S1 Table. We reviewed the results for existing review articles and determined that no review articles currently exist on our topic.

Stage 3. Study selection

The search identified a total of 5,386 references that were imported into Covidence, a systematic review screening tool (Covidence systematic review software, Veritas Health Innovation, Melbourne, Australia. Available at Duplicate citations (n = 1,504) were automatically identified and removed by Covidence. The software ensures that two reviewers independently screened a total of 3,882 references by title and abstract. Studies were excluded if they did not clearly meet inclusion criteria, and of those, 3,723 references were deemed irrelevant and excluded. Upon the completion of screening titles and abstracts, any disagreements were resolved by discussion. One hundred fifty-nine citations were identified for full text assessment. At the full text review stage, articles were independently read by two different members of team (YY, YL, GS). During the full-text review, each study was reviewed independently to determine the final sample. Full-text studies that did not meet the inclusion criteria were excluded, and the reasons for exclusion were noted. Disagreement between the team members were resolved through discussion. Seventy articles were confirmed to be included in the final set for data extraction.

Stage 4. Charting the data

Our team developed a data extraction tool and determined which data should be extracted from studies to answer the research question. Two team members (YY, GS) independently piloted data abstraction from the first fifteen included studies using the data charting form. Then, they discussed the process and their results to confirm whether their approaches to data extraction were consistent. Questions arising when piloting the extract data form were discussed with the other team members (YL, TN). After piloting the form, two team members (YY, GS) independently recorded the following data from selected studies on the data charting form: 1) authors, 2) country of study, 3) year of publication, 4) study design, 5) sample characteristics (sample size, age, and type of cancer treatment), 6) type of social relationships 7) affective-cognitive symptoms and measurements, and 8) key findings (the association between social relationships and affective-cognitive symptoms).

Stage 5. Collating, summarizing and reporting the results

Our team collated, summarized, and reported all data obtained in stage 4 to map the knowledge on social relationships associated with affective-cognitive symptoms of adult women with breast cancer. The studies in the final sample were tabulated based on social relationships (e.g., functional or structural aspect of social relations). A table for the final sample was created and included the information on authors, years of publication, country of study, study population, type of social relationships, measures of affective-cognitive symptoms, and the association between social relationships and affective-cognitive symptoms. Verification of data accuracy was impudently conducted by six research team members (YY, YL, GS, SM, NC, JZ).


Study characteristics

Table 2 includes sixty-five studies that met the inclusion criteria. Fig 1 presents study selection by flowchart as per PRISMA guidelines. The reviewed studies were conducted in 22 countries with majority conducted in the US (n = 30) and Canada (n = 4). Of 70 studies, 36 were cross-sectional, 4 were randomized controlled trials (RCTs), 9 were longitudinal, and 21 were a secondary analysis from a cross-sectional, longitudinal, or multiple-institutional cohort study. Two studies included this review used the same dataset [19, 20]. The sample size of dyadic studies (included both patients and their spouses/partners/family caregivers) ranging from 92 to 470, and the sample size of the remaining 60 non-dyadic studies ranged from 25 to 2235 patients. The mean age of patients who participated in this study ranged from 36.7 to 66.7 years old. Also, participants in the published studies from the US were White, followed by Black (African American), Latina or Asian. Of the included studies, three dealt with patients living with metastatic/advanced breast cancer. Additionally, cancer treatments that patients received were varied including chemotherapy, surgery, hormone, radiation, and targeted therapy.

Fig 1. PRISMA-ScR flow diagram for the study selection process.

Association between social relationships and affective symptoms

In this review, social relationships were classified as functional and structural aspects of social relations. Of the included 70 studies, 64 focused on functional aspects of social relationships, and the remaining 6 reported on structural aspects of social relationships. Interestingly, none of the included 70 studies examined the association between social relationships and cognitive symptoms of breast cancer patients; thus, in this paper, we focused only on the affective symptoms of breast cancer patients and their association with patients’ social relationships (Table 3).

Table 3. Characteristics of studies regarding social relationships associated with the patient’s affective symptoms.

Functional aspects of social relationships

Social support, satisfaction of social support, quality of the relationship, social constraints, and family functioning (including family conflict and family stress) are functional social relationships included in this review.

Social support.

Fifty-three studies examined the association between social support and affective symptoms among breast cancer patients. Of those 53 studies, four did not find any associations of affective symptoms with social support [2124], whereas one showed that patients’ affective symptoms can be changed depending on the source of provided support was [21]. A reduction in patients’ depression was reported when patients received peer support from patients who are newly diagnosed with cancer rather than from patients who are undergoing active treatment [21].

Among 49 studies that reported significant association with affective symptoms, 37 investigated the association of patients’ affective symptoms with the quantity of social support that patients received. The quantity of social support refers to the amount of social support that is available to patients (e.g., frequency of meetings) [25]. Patients showed lower levels of anxiety, depression, worry, mood disturbances, and psychological/mental distress when they received a greater quantity of social support [14, 20, 24, 2650]. Furthermore, some studies reported that the quantity of social support can predict the levels of patients’ affective symptoms including their emotional well-being [5158].

In addition to the quantity of social support, seven studies reported an association between type of social support and affective symptoms. Emotional (i.e., subjective) support, defined as support that includes the provision of care, empathy, and trust, was found to be most helpful to decrease patients’ depression and anxiety.[37, 47, 56, 59, 60] In other words, as patients received stronger emotional/subjective support, their experience of affective symptoms decreased. Some longitudinal studies showed that emotional/subjective support can function as a predictor of patients’ anxiety and depression [34, 61, 62]. Additionally, improvements in affective symptoms occurred when tangible support such as material support/assistance (e.g., brochures) was provided [34, 37, 56, 59, 61].

In six studies, patients’ affective symptoms were affected by source and satisfaction of social support received. When patients received support from their family members, including a spouse or children, they reported less anxiety and depression [19, 42, 6365]. However, one study showed less depression and anxiety when support was received from friends compared to support from family [66]. In addition, higher satisfaction with support received was associated with the lower levels of patients’ anxiety and depression [32, 63, 6770]. A study reported that patients showed less affective symptoms when they were more satisfied with support from family than from friends [66]. Patients’ affective symptoms were not related to whether they were satisfied with their friend’s support but were related to the amount of support received from a friend.

Social support and/or social constraints.

Three studies have examined the association of patients’ depression with social constraints [7173]. Patients who perceived social constraints from family (including spouse/partners) or friends showed higher depressive symptoms. However, patients showed lower depression when they had decreased family/friend social constraints. Patients reported no change in depression when social constraints increased [72, 73]. Also, lower depression was reported when patients received greater social support.

Social support and family functioning.

One study found that both patients’ anxiety and depression decreased when they had greater social support and a better-functioning family [74]. Furthermore, family functioning predicted the levels of patients’ anxiety and depression [74]. In line with this finding, three other studies also found higher depression in patients when they perceived poor/ineffective family functioning. Specifically, depression greatly increased when patients experienced inappropriate responses from family [75], conflicts between its members (i.e., family conflict) [76], and stress due to the demands on the family (i.e., family stress) [77].

Quality of relationships.

Four studies investigated the quality of relationships with patients’ partners/spouses that patients perceived and assessed its association with their affective symptoms. Of those four, two of them failed to show any significant associations of affective symptoms with the quality of couple/marital relationships [78, 79]. However, one study showed that anxiety was not associated with patient’s reported relationship quality but with the partner’s reported relationship quality [79]. The other two studies showed that patients’ psychological distress and mood disturbance increased when patients reported unsatisfying relationships with their spouse/partners [80, 81]. Specifically, one study found that lower mood disturbance was reported when patients have a partner relationship with greater cohesion and expression (i.e., open communication) as well as more constructive conflicts [81]. The authors interpreted constructive conflicts as an indicator of greater engagement in the relationship with partners. In other words, constructive conflicts can occur due to greater discussion/understanding of each other’s specific needs, and this constructive conflict can help reduce patients’ mood disturbances.

Structural aspects of social relationships

Structural aspects of social relationships refers to the structure of social networks, such as the size and the linkage between members within a social network [9]. This review included social integration as the structural social relationships (Table 3).

Social integration.

In this review, one RCT that investigated the effect of psychoeducational intervention examined the association between social integration and affective symptoms of breast cancer patients [82]. Social integration did not show any associations with the presence of psychiatric illness. However, one year after psychoeducational intervention, patients showed overall less depression when they perceived adequacy of both close relationships and more distant social ties (i.e., greater social integration).

Both aspects of social relationships

Social networks.

Social networks can be assessed through whether individuals have important persons in their lives, type (e.g., friends or family) and duration of the relationship, and the frequency of contact with that persons [83]. Five studies assessed both of social networks and social support and their associations with patients’ affective symptoms. Patients showed less anxiety and depression when they had stronger social support and social network (i.e., lower social isolation) [8488]. Specifically, one longitudinal study showed that patients’ depression at both initial and follow-up appointments was improved when they had a support person [84]. Another study also reported that living alone (without having a support person) contributed to increased anxiety as well as depression levels [86, 88].


Seventy studies met the inclusion criteria and informed this review. None of the included studies examined the association of social relationships with patients’ cognitive symptoms, thus including studies that investigated the association of social relationships with affective symptoms. Of those 70 studies, four studies completely failed to show significant associations of affective symptoms with any aspects of social relationships [2224, 78]; we found that most patients who participated in those four studies were primarily treated with surgery, which could be interpreted as showing very early stage breast cancer. However, in patients with advanced cancer (metastatic disease), better social relationships are associated with lower levels of their affective symptoms [19, 20, 67, 81]. This finding suggests that patients with advanced stage cancer can benefit from social relationships in managing their affective symptoms compared with those with early stages of cancer.

This review found that the level of social support and its association with affective symptoms change throughout the cancer treatment trajectory. Patients reported a decrease in social support before and after cancer treatments [14, 61]. Specifically, a continuous decrease in emotional support was found after surgery for breast cancer, whereas informational or tangible support increased right after surgery and then dropped over time [34, 63]. Although the overall levels of social support showed a decreased trend, the magnitude of its association with affective symptoms increased over time [14, 29, 61]. These findings suggest the need to assess the level of social support and implement programs to optimize social support, especially for those at the end of cancer treatments.

We further found several factors that help explain the link between social support and affective symptoms. A study showed that women with higher social support appraised their illness as less stressful situations and, in turn, fewer mood disturbances [61]. Another study also found that patients who perceived lower level of social support tend to choose passive coping strategy (i.e., self-blame) rather than active coping (i.e., positive reframing), which in turn decrease emotional well-being [54]. In contrast, those who received higher level of social support are more likely to rely on active coping, resulting in enhancing emotional well-being [54]. Similarly, Hills and colleagues (2011) reported higher self-blame and lower social support predict greater levels of depression and anxiety [55]. In addition to the appraisal of illness and coping strategies, several other studies showed that demographic information (age, income, education, marital status), clinical information (cancer stage, type of surgery, treatment types), physical function, and coping styles have comparable effects to social support on mood disturbances [37, 77]. Further studies are needed to identify factors that explain the link between social support and affective symptoms; doing so will help develop targeted interventions.

In this review, social relationships were divided into their function and structural aspects. Functional aspects of social relationships include four variables: social support, social constraints, family functioning, and quality of relationship. Social support refers to aid provided (e.g., emotional or instrumental) through contact with one’s social networks (e.g., friends or family) [9, 49, 83], whereas social constraints are social conditions that hinder individuals’ expression of stressors due to unsupportive, misunderstood, or isolated responses from others [89]. Our findings clearly show that patients’ affective symptoms are positively associated with the quantity (e.g., time spent or availability), type (e.g., tangible aid or empathy), source (i.e., who provided support), and satisfaction from the support that they received. Additionally, greater levels of affective symptoms are associated with negative social interactions (i.e., social constraints) and poor family functioning.

Compared with three functional aspects above, findings regarding the quality of social relationships are not consistent. Some studies reported that the quality of relationships is associated with patients’ affective symptoms [80, 81], but others do not [78, 79]. Furthermore, one study showed that patients who reported greater conflicts in relationships with partners also reported lower mood disturbances [81].This inconsistency can occur due to differences in sample characteristics. For example, patients included in Giese-Davis and Hermanson (2000)’s study reported more metastatic diseases compared to those of other three studies [7880]. In addition, the study conducted by Al-Zaben and colleagues (2015) included married couples and investigated their marital quality, whereas other three studies focused on the relationship quality/satisfaction with their significant others. Future studies would benefit from ensuring consistency and specificity in defining and measuring quality of social relationships.

Similarly, structural aspects of social relationships also show an association with patients’ affective symptoms. All six included studies showed that having a support person, not living alone, and building close relationships with others are factors that lower patients’ affective symptoms. It is possible that patients with larger social networks and greater social integration may increase the odds that patients will have friends and family who survive as peer and familiar support [90]. This support can be beneficial while patients are managing symptoms from disease and/or treatment [90]. Additional research is needed to understand how structural and functional aspects of social relationships interact with biological factors (e.g., cytokines, HPA axis dysfunction) to influence patients’ affective symptoms. This understanding may help identify important concepts for models that promote social relationships in breast cancer patients that will help improve their affective symptoms.

Implication for practice

Most interventions for those with affective symptoms have primarily focused on managing their internal clinical characteristics. However, our findings reveal that positive social relationships benefit in mitigating affective symptoms of women with breast cancer. Thus, healthcare providers need to educate patients about the importance of building positive social relationships and encourage them to participate in a supportive network of friends and family members. Specifically, patients with advanced cancer (i.e., metastatic status) may find it highly beneficial to have access to support groups that are relevant to their specific needs. For example, health professionals can encourage them to participate in interventions that include components such as communication skills training or coordinating coping responses; in turn, this will help improve the quality of relationships.

Based on findings from this review paper, there is a need to capitalize on existing relationships that patients perceive as beneficial in their everyday lives like those considered as family members. Family intervention development that aims to lower affective symptoms as well as improve quality of life and well-being may be a suitable next step in improving patient outcomes. For example, family-based group tasks that improve family functioning or family conflicts can be provided to breast cancer patients and their family members as a part of the intervention for improving affective-cognitive symptoms.

Lastly, it is important in the clinical setting to assess social support and social constraints. This type of assessment may be helpful in preventing, and furthermore, mitigating their affective symptoms. Assessment tools for social relationships including social support or social constraints can be built into the medical chart to alert for clinical staff to address. Additionally, establishing a social system to support coordination of various types of social relationships from healthcare professionals may yield positive affective outcomes in breast cancer patients. While evidence supporting this association is limited, more studies on the impact of social relationships on affective symptoms of breast cancer patients are recommended.


Our study goal was to find literature that examined the association between social relationships and cognitive symptoms among breast cancer patients. The review of literature yielded that there are no published studies that study this association based on our review criteria. During the literature search, we found several studies that investigated this association in healthy older adults [10, 11]. However, no studies have been conducted in the context of breast cancer. We only included articles that explore the association between social relationships and affective symptoms of breast cancer patients. Future research that considers the effect of social relationships on cognitive symptoms in breast cancer is needed to advance our knowledge in cancer symptom science.

Approximately half of the included studies did not report confounding factors (e.g., sociodemographic) and did not adjust for these factors. This is an important limitation because the associations between social relationships and a patients’ affective symptoms could differ depending on confounding factors. Thus, it is essential to report and adjust for confounding factors using statistical methods.

Another limitation is that fewer included studies focused on assessing the association between structural aspects of social relationship and patients’ affective symptoms. To fully understand the role of structural aspects of social relationships on patient’s affective symptoms, further studies are needed that include diverse aspects of social relationships are needed.

Lastly, we found that most included studies RCTs design. To better understand the influence of social relationships on patients’ affective symptoms, studies with observational longitudinal studies are needed. Additionally, most patients included this study were White, which could impede generalizability of the study findings. Therefore, a large and heterogeneous sample is needed for future studies to be representative of all women breast cancer patients from all ethnicities.


This scoping review summarized current evidence concerning social relationships that are associated with affective symptoms of a breast cancer patient. Of the identified social relationships, social support was most identified, followed by social constraints, family functioning, quality of relationships, social networks, and social integration. Our review results support the concept of an association between social relationships and affective symptoms of breast cancer patients, although the specific nature of this association remains unclear. Understanding different aspects of social relationships and their differential effects on patients’ affective symptoms will contribute to development of interventions for best practices to support the well-being of this patient population.


  1. 1. DeSantis CE, Ma J, Gaudet MM, Newman LA, Miller KD, Goding Sauer A, et al. Breast cancer statistics, 2019. CA: A Cancer Journal for Clinicians. 2019;69(6):438–51.
  2. 2. DeSantis CE, Ma J, Goding Sauer A, Newman LA, Jemal A. Breast cancer statistics, 2017, racial disparity in mortality by state. CA Cancer J Clin. 2017;67(6):439–48. pmid:28972651
  3. 3. So WKW, Law BMH, Ng MSN, He X, Chan DNS, Chan CWH, et al. Symptom clusters experienced by breast cancer patients at various treatment stages: A systematic review. Cancer Medicine. 2021;10(8):2531–65. pmid:33749151
  4. 4. Starkweather AR, Lyon DE, Elswick RK Jr., Montpetit AJ, Conley Y, McCain NL. A Conceptual Model of Psychoneurological Symptom Cluster Variation in Women with Breast Cancer: Bringing Nursing Research to Personalized Medicine. Curr Pharmacogenomics Person Med. 2013;11(3):224–30. pmid:24497894
  5. 5. Kim E, Jahan T, Aouizerat BE, Dodd MJ, Cooper BA, Paul SM, et al. Differences in symptom clusters identified using occurrence rates versus symptom severity ratings in patients at the end of radiation therapy. Cancer nursing. 2009;32(6):429–36. pmid:19816162
  6. 6. Yussof I, Mohd Tahir NA, Hatah E, Mohamed Shah N. Factors influencing five-year adherence to adjuvant endocrine therapy in breast cancer patients: A systematic review. The Breast. 2022;62:22–35. pmid:35121501
  7. 7. Reid-Arndt SA, Yee A, Perry MC, Hsieh C. Cognitive and psychological factors associated with early posttreatment functional outcomes in breast cancer survivors. J Psychosoc Oncol. 2009;27(4):415–34. pmid:19813133
  8. 8. Ng T, Dorajoo SR, Cheung YT, Lam YC, Yeo HL, Shwe M, et al. Distinct and heterogeneous trajectories of self-perceived cognitive impairment among Asian breast cancer survivors. Psychooncology. 2018;27(4):1185–92. pmid:29315963
  9. 9. August KJ, Rook KS. Social Relationships. In: Gellman MD, Turner JR, editors. Encyclopedia of Behavioral Medicine. New York, NY: Springer New York; 2013. p. 1838–42.
  10. 10. Kuiper JS, Zuidersma M, Zuidema SU, Burgerhof JG, Stolk RP, Oude Voshaar RC, et al. Social relationships and cognitive decline: a systematic review and meta-analysis of longitudinal cohort studies. Int J Epidemiol. 2016;45(4):1169–206. pmid:27272181
  11. 11. Kelly ME, Duff H, Kelly S, McHugh Power JE, Brennan S, Lawlor BA, et al. The impact of social activities, social networks, social support and social relationships on the cognitive functioning of healthy older adults: a systematic review. Syst Rev. 2017;6(1):259. pmid:29258596
  12. 12. Cohen S. Social relationships and health. Am Psychol. 2004;59(8):676–84. pmid:15554821
  13. 13. Rivera FI, Guarnaccia PJ, Mulvaney-Day N, Lin JY, Torres M, Alegria M. Family Cohesion and its Relationship to Psychological Distress among Latino Groups. Hisp J Behav Sci. 2008;30(3):357–78. pmid:19444326
  14. 14. Hughes S, Jaremka LM, Alfano CM, Glaser R, Povoski SP, Lipari AM, et al. Social support predicts inflammation, pain, and depressive symptoms: longitudinal relationships among breast cancer survivors. Psychoneuroendocrinology. 2014;42:38–44. pmid:24636499
  15. 15. Arksey H, O’Malley L. Scoping Studies: Towards a Methodological Framework. International Journal of Social Research Methodology. 2005;8(1):19–32.
  16. 16. Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Medical Research Methodology. 2018;18(1):143. pmid:30453902
  17. 17. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and ExplanationThe PRISMA-ScR Statement. Annals of Internal Medicine. 2018;169(7):467–73. pmid:30178033
  18. 18. Vardy J, Rourke S, Tannock IF. Evaluation of cognitive function associated with chemotherapy: a review of published studies and recommendations for future research. J Clin Oncol. 2007;25(17):2455–63. pmid:17485710
  19. 19. Hasson-Ohayon I, Goldzweig G, Braun M, Galinsky D. Women with advanced breast cancer and their spouses: diversity of support and psychological distress. Psychooncology. 2010;19(11):1195–204. pmid:20029822
  20. 20. Hasson-Ohayon I, Goldzweig G, Dorfman C, Uziely B. Hope and social support utilisation among different age groups of women with breast cancer and their spouses. Psychol Health. 2014;29(11):1303–19. pmid:24874894
  21. 21. Moon T-J, Chih M-Y, Shah DV, Yoo W, Gustafson DH. Breast Cancer Survivors’ Contribution to Psychosocial Adjustment of Newly Diagnosed Breast Cancer Patients in a Computer-Mediated Social Support Group. Journalism & Mass Communication Quarterly. 2017;94(2):486–514.
  22. 22. Palesh OG, Shaffer T, Larson J, Edsall S, Chen XH, Koopman C, et al. Emotional self-efficacy, stressful life events, and satisfaction with social support in relation to mood disturbance among women living with breast cancer in rural communities. Breast J. 2006;12(2):123–9. pmid:16509836
  23. 23. Malicka I, Kozłowska A, Woźniewski M, Rymaszewska J, Szczepańska-Gieracha J. The role of social support in women’s health and recovery processes. Psychol Health Med. 2016;21(1):81–91. pmid:25668634
  24. 24. Friedman LC, Kalidas M, Elledge R, Chang J, Romero C, Husain I, et al. Optimism, social support and psychosocial functioning among women with breast cancer. Psychooncology. 2006;15(7):595–603. pmid:16287209
  25. 25. Fiorillo D, Sabatini F. Quality and quantity: the role of social interactions in self-reported individual health. Soc Sci Med. 2011;73(11):1644–52. pmid:22001229
  26. 26. Lee EH, Yae Chung B, Boog Park H, Hong Chun K. Relationships of mood disturbance and social support to symptom experience in Korean women with breast cancer. J Pain Symptom Manage. 2004;27(5):425–33. pmid:15120771
  27. 27. Talley A, Molix L, Schlegel RJ, Bettencourt A. The influence of breast cancer survivors’ perceived partner social support and need satisfaction on depressive symptoms: a longitudinal analysis. Psychol Health. 2010;25(4):433–49. pmid:20397295
  28. 28. Jones SL, Hadjistavropoulos HD, Sherry SB. Health anxiety in women with early-stage breast cancer: What is the relationship to social support? Canadian Journal of Behavioural Science / Revue canadienne des sciences du comportement. 2012;44(2):108–16.
  29. 29. Mallinckrodt B, Armer JM, Heppner PP. A threshold model of social support, adjustment, and distress after breast cancer treatment. J Couns Psychol. 2012;59(1):150–60. pmid:22229798
  30. 30. Popoola AO, Adewuya AO. Prevalence and correlates of depressive disorders in outpatients with breast cancer in Lagos, Nigeria. Psychooncology. 2012;21(6):675–9. pmid:21462281
  31. 31. Waters EA, Liu Y, Schootman M, Jeffe DB. Worry about cancer progression and low perceived social support: implications for quality of life among early-stage breast cancer patients. Ann Behav Med. 2013;45(1):57–68. pmid:22983622
  32. 32. Aguado Loi CX, Baldwin JA, McDermott RJ, McMillan S, Martinez Tyson D, Yampolskaya S, et al. Risk factors associated with increased depressive symptoms among Latinas diagnosed with breast cancer within 5 years of survivorship. Psychooncology. 2013;22(12):2779–88. pmid:24000126
  33. 33. Yi M, Kim J. Factors influencing health-promoting behaviors in Korean breast cancer survivors. Eur J Oncol Nurs. 2013;17(2):138–45. pmid:22687200
  34. 34. Boinon D, Sultan S, Charles C, Stulz A, Guillemeau C, Delaloge S, et al. Changes in psychological adjustment over the course of treatment for breast cancer: the predictive role of social sharing and social support. Psychooncology. 2014;23(3):291–8. pmid:24123390
  35. 35. Schleife H, Sachtleben C, Finck Barboza C, Singer S, Hinz A. Anxiety, depression, and quality of life in German ambulatory breast cancer patients. Breast Cancer. 2014;21(2):208–13. pmid:22661104
  36. 36. So WK, Leung DY, Ho SS, Lai ET, Sit JW, Chan CW. Associations between social support, prevalent symptoms and health-related quality of life in Chinese women undergoing treatment for breast cancer: a cross-sectional study using structural equation modelling. Eur J Oncol Nurs. 2013;17(4):442–8. pmid:23238353
  37. 37. Wang F, Liu J, Liu L, Wang F, Ma Z, Gao D, et al. The status and correlates of depression and anxiety among breast-cancer survivors in Eastern China: a population-based, cross-sectional case-control study. BMC Public Health. 2014;14:326. pmid:24708474
  38. 38. Borstelmann NA, Rosenberg SM, Ruddy KJ, Tamimi RM, Gelber S, Schapira L, et al. Partner support and anxiety in young women with breast cancer. Psychooncology. 2015;24(12):1679–85. pmid:25765893
  39. 39. Berhili S, Kadiri S, Bouziane A, Aissa A, Marnouche E, Ogandaga E, et al. Associated factors with psychological distress in Moroccan breast cancer patients: A cross-sectional study. Breast. 2017;31:26–33. pmid:27810696
  40. 40. Schellekens MPJ, Tamagawa R, Labelle LE, Speca M, Stephen J, Drysdale E, et al. Mindfulness-Based Cancer Recovery (MBCR) versus Supportive Expressive Group Therapy (SET) for distressed breast cancer survivors: evaluating mindfulness and social support as mediators. J Behav Med. 2017;40(3):414–22. pmid:27722908
  41. 41. Schmidt ME, Wiskemann J, Schneeweiss A, Potthoff K, Ulrich CM, Steindorf K. Determinants of physical, affective, and cognitive fatigue during breast cancer therapy and 12 months follow-up. Int J Cancer. 2018;142(6):1148–57. pmid:29082588
  42. 42. Su JA, Yeh DC, Chang CC, Lin TC, Lai CH, Hu PY, et al. Depression and family support in breast cancer patients. Neuropsychiatr Dis Treat. 2017;13:2389–96. pmid:28979126
  43. 43. Thompson T, Pérez M, Kreuter M, Margenthaler J, Colditz G, Jeffe DB. Perceived social support in African American breast cancer patients: Predictors and effects. Soc Sci Med. 2017;192:134–42. pmid:28965004
  44. 44. Tomita M, Takahashi M, Tagaya N, Kakuta M, Kai I, Muto T. Structural equation modeling of the relationship between posttraumatic growth and psychosocial factors in women with breast cancer. Psychooncology. 2017;26(8):1198–204. pmid:27731954
  45. 45. Bright EE, Stanton AL. Prospective investigation of social support, coping, and depressive symptoms: A model of adherence to endocrine therapy among women with breast cancer. J Consult Clin Psychol. 2018;86(3):242–53. pmid:29265835
  46. 46. Wondimagegnehu A, Abebe W, Abraha A, Teferra S. Depression and social support among breast cancer patients in Addis Ababa, Ethiopia. BMC Cancer. 2019;19(1):836. pmid:31455282
  47. 47. Janowski K, Tatala M, Jedynak T, Wałachowska K. Social support and psychosocial functioning in women after mastectomy. Palliat Support Care. 2020;18(3):314–21. pmid:31637989
  48. 48. Zamanian H, Amini-Tehrani M, Jalali Z, Daryaafzoon M, Ala S, Tabrizian S, et al. Perceived social support, coping strategies, anxiety and depression among women with breast cancer: Evaluation of a mediation model. Eur J Oncol Nurs. 2021;50:101892. pmid:33583690
  49. 49. Okati-Aliabad H, Ansari-Moghadam A, Mohammadi M, Kargar S, Shahraki-Sanavi F. The prevalence of anxiety and depression and its association with coping strategies, supportive care needs, and social support among women with breast cancer. Support Care Cancer. 2022;30(1):703–10. pmid:34365523
  50. 50. Dobretsova A, Derakshan N. Cognitive function and emotional vulnerability in metastatic breast cancer: Moderating effects of age and social support. Psychooncology. 2021;30(9):1563–71. pmid:33991121
  51. 51. Kim Y, Morrow GR. The effects of family support, anxiety, and post-treatment nausea on the development of anticipatory nausea: a latent growth model. J Pain Symptom Manage. 2007;34(3):265–76. pmid:17604591
  52. 52. Cohen M, Mabjish AA, Zidan J. Comparison of Arab breast cancer survivors and healthy controls for spousal relationship, body image, and emotional distress. Qual Life Res. 2011;20(2):191–8. pmid:20859767
  53. 53. Gorman JR, Malcarne VL, Roesch SC, Madlensky L, Pierce JP. Depressive symptoms among young breast cancer survivors: the importance of reproductive concerns. Breast Cancer Res Treat. 2010;123(2):477–85. pmid:20130979
  54. 54. Kim J, Han JY, Shaw B, McTavish F, Gustafson D. The roles of social support and coping strategies in predicting breast cancer patients’ emotional well-being: testing mediation and moderation models. J Health Psychol. 2010;15(4):543–52. pmid:20460411
  55. 55. Hill J, Holcombe C, Clark L, Boothby MR, Hincks A, Fisher J, et al. Predictors of onset of depression and anxiety in the year after diagnosis of breast cancer. Psychol Med. 2011;41(7):1429–36. pmid:20942992
  56. 56. Liu DG, Wang SS, Peng RJ, Qin T, Shi YX, Teng XY, et al. Interaction of social support and psychological stress on anxiety and depressive symptoms in breast cancer patients. Asian Pac J Cancer Prev. 2011;12(10):2523–9. pmid:22320935
  57. 57. Alfonsson S, Olsson E, Hursti T, Lundh MH, Johansson B. Socio-demographic and clinical variables associated with psychological distress 1 and 3 years after breast cancer diagnosis. Support Care Cancer. 2016;24(9):4017–23. pmid:27129841
  58. 58. Fong AJ, Scarapicchia TMF, McDonough MH, Wrosch C, Sabiston CM. Changes in social support predict emotional well-being in breast cancer survivors. Psychooncology. 2017;26(5):664–71. pmid:26818101
  59. 59. Escalera C, Santoyo-Olsson J, Stewart AL, Ortiz C, Nápoles AM. Social support as a moderator in the relationship between intrusive thoughts and anxiety among Spanish-speaking Latinas with breast cancer. Psychooncology. 2019;28(9):1819–28. pmid:31216604
  60. 60. Fisher HM, Winger JG, Miller SN, Wright AN, Plumb Vilardaga JC, Majestic C, et al. Relationship between social support, physical symptoms, and depression in women with breast cancer and pain. Support Care Cancer. 2021;29(9):5513–21. pmid:33723675
  61. 61. Von Ah D, Kang DH. Correlates of mood disturbance in women with breast cancer: patterns over time. J Adv Nurs. 2008;61(6):676–89. pmid:18302608
  62. 62. Lee MK, Park S, Lee ES, Ro J, Kang HS, Shin KH, et al. Social support and depressive mood 1 year after diagnosis of breast cancer compared with the general female population: a prospective cohort study. Support Care Cancer. 2011;19(9):1379–92. pmid:20676695
  63. 63. Neuling SJ, Winefield HR. Social support and recovery after surgery for breast cancer: frequency and correlates of supportive behaviours by family, friends and surgeon. Soc Sci Med. 1988;27(4):385–92. pmid:3175721
  64. 64. Maly RC, Umezawa Y, Leake B, Silliman RA. Mental health outcomes in older women with breast cancer: impact of perceived family support and adjustment. Psychooncology. 2005;14(7):535–45. pmid:15493064
  65. 65. Ozkaraman A, Culha I, Fadiloglu ZC, Kosgeroglu N, Gokce S, Alparslan GB. Relationships between social support and social image concerns in Turkish women with breast cancer. Asian Pac J Cancer Prev. 2015;16(5):1795–802. pmid:25773827
  66. 66. Roberts CS, Cox CE, Shannon VJ, Wells NL. A closer look at social support as a moderator of stress in breast cancer. Health Soc Work. 1994;19(3):157–64. pmid:7959397
  67. 67. Koopman C, Hermanson K, Diamond S, Angell K, Spiegel D. Social support, life stress, pain and emotional adjustment to advanced breast cancer. Psychooncology. 1998;7(2):101–11. pmid:9589508
  68. 68. Porter LS, Clayton MF, Belyea M, Mishel M, Gil KM, Germino BB. Predicting negative mood state and personal growth in African American and White long-term breast cancer survivors. Ann Behav Med. 2006;31(3):195–204. pmid:16700633
  69. 69. Gellaitry G, Peters K, Bloomfield D, Horne R. Narrowing the gap: the effects of an expressive writing intervention on perceptions of actual and ideal emotional support in women who have completed treatment for early stage breast cancer. Psychooncology. 2010;19(1):77–84. pmid:19194996
  70. 70. Boinon D, Sultan S, Charles C, Rosberger Z, Delaloge S, Dauchy S. How social sharing and social support explain distress in breast cancer after surgery: the role of alexithymia. J Psychosoc Oncol. 2012;30(5):573–92. pmid:22963184
  71. 71. Lally RM, Kupzyk K, Mills A, Gallo S, Meneses K. Effects of social constraints and web-based psychoeducation on cancer-related psychological adjustment early-after breast cancer diagnosis. Journal of Psychosocial Oncology. 2019;37(6):677–98. pmid:31631813
  72. 72. Wong CCY, Warmoth K, Ivy S, Cheung B, Lu Q. Relation of social constraints on disclosure to adjustment among Chinese American cancer survivors: A multiprocesses approach. Psychooncology. 2018;27(3):977–82. pmid:29232487
  73. 73. Schmidt JE, Andrykowski MA. The role of social and dispositional variables associated with emotional processing in adjustment to breast cancer: an internet-based study. Health Psychol. 2004;23(3):259–66. pmid:15099166
  74. 74. Lueboonthavatchai P. Prevalence and psychosocial factors of anxiety and depression in breast cancer patients. J Med Assoc Thai. 2007;90(10):2164–74. pmid:18041438
  75. 75. Mantani T, Saeki T, Inoue S, Okamura H, Daino M, Kataoka T, et al. Factors related to anxiety and depression in women with breast cancer and their husbands: role of alexithymia and family functioning. Support Care Cancer. 2007;15(7):859–68. pmid:17216201
  76. 76. Segrin C, Badger TA, Sikorskii A, Crane TE, Pace TWW. A dyadic analysis of stress processes in Latinas with breast cancer and their family caregivers. Psychooncology. 2018;27(3):838–46. pmid:29125677
  77. 77. Ashing-Giwa K, Rosales M, Lai L, Weitzel J. Depressive symptomatology among Latina breast cancer survivors. Psychooncology. 2013;22(4):845–53. pmid:22544458
  78. 78. Al-Zaben FN, Sehlo MG, Koenig HG. A cross-sectional study of anxiety and marital quality among women with breast cancer at a university clinic in western Saudi Arabia. Saudi Med J. 2015;36(10):1168–75. pmid:26446326
  79. 79. Segrin C, Badger T, Dorros SM, Meek P, Lopez AM. Interdependent anxiety and psychological distress in women with breast cancer and their partners. Psychooncology. 2007;16(7):634–43. pmid:17094160
  80. 80. Manne SL, Norton TR, Ostroff JS, Winkel G, Fox K, Grana G. Protective buffering and psychological distress among couples coping with breast cancer: The moderating role of relationship satisfaction. J Fam Psychol. 2007;21(3):380–8. pmid:17874923
  81. 81. Giese-Davis J, Hermanson K, Koopman C, Weibel D, Spiegel D. Quality of couples’ relationship and adjustment to metastatic breast cancer. J Fam Psychol. 2000;14(2):251–66. pmid:10870293
  82. 82. Simpson JS, Carlson LE, Beck CA, Patten S. Effects of a brief intervention on social support and psychiatric morbidity in breast cancer patients. Psychooncology. 2002;11(4):282–94. pmid:12203742
  83. 83. Berkman LF, Glass T, Brissette I, Seeman TE. From social integration to health: Durkheim in the new millennium. Soc Sci Med. 2000;51(6):843–57. pmid:10972429
  84. 84. Brothers BM, Andersen BL. Hopelessness as a predictor of depressive symptoms for breast cancer patients coping with recurrence. Psychooncology. 2009;18(3):267–75. pmid:18702065
  85. 85. Gagliardi C, Vespa A, Papa R, Mariotti C, Cascinu S, Rossini S. Social support networks and depression of women suffering from early-stage breast cancer: a case control study. J Psychosoc Oncol. 2009;27(2):216–29. pmid:19337930
  86. 86. Puigpinós-Riera R, Graells-Sans A, Serral G, Continente X, Bargalló X, Domènech M, et al. Anxiety and depression in women with breast cancer: Social and clinical determinants and influence of the social network and social support (DAMA cohort). Cancer Epidemiol. 2018;55:123–9. pmid:29940418
  87. 87. Wang JH, Gomez SL, Brown RL, Davis K, Allen L, Huang E, et al. Factors associated with Chinese American and White cancer survivors’ physical and psychological functioning. Health Psychol. 2019;38(5):455–65. pmid:31045429
  88. 88. Liu B, Wu X, Shi L, Li H, Wu D, Lai X, et al. Correlations of social isolation and anxiety and depression symptoms among patients with breast cancer of Heilongjiang province in China: The mediating role of social support. Nurs Open. 2021;8(4):1981–9. pmid:33939294
  89. 89. Lepore SJ, Revenson TA. Social constraints on disclosure and adjustment to cancer. Social and Personality Psychology Compass. 2007;1(1):313–33.
  90. 90. Kroenke CH, Kwan ML, Neugut AI, Ergas IJ, Wright JD, Caan BJ, et al. Social networks, social support mechanisms, and quality of life after breast cancer diagnosis. Breast Cancer Res Treat. 2013;139(2):515–27. pmid:23657404