Social Networks & Breast Cancer Prognosis in the Chinese and US Evaluation Study

描述(申请人提供)：每年有超过200,000名妇女被诊断出患有乳腺癌，近40,000人死于乳腺癌(BC)，但治疗和肿瘤特征的差异只解释了乳腺癌死亡的一小部分。重要的是要确定这些 考虑到人口老龄化和老年女性乳腺癌发病率较高，可能有助于延长生存期的因素。社交网络被定义为围绕个人的社会关系网络。以前的文献表明，拥有较大社交网络的女性在确诊为BC后存活时间更长，但社交网络影响预后的机制以及在哪些人群中影响尚不清楚。这笔赠款的目的是研究社交网络规模、网络成员(配偶/伴侣的存在、一级亲属的数量、社区参与、宗教参与)与1)生存的主要行为风险因素(包括体力活动、饮食、吸烟和体重)以及2)乳腺癌特有死亡率和全因死亡率之间的关系。我们将考虑关系质量的修正影响，即 社会支持和社会负担)对BC结果的影响。还将审查不同的妇女人口之间的联系，这些妇女由社会经济地位、种族/民族、癌症严重程度和治疗的广泛性确定。AIMS将在中美评估(原因)队列中对10,239名乳腺癌幸存者进行汇集分析，其中包括来自癌症后生活流行病学(LACE)、女性健康饮食和生活(WHEL)和上海乳腺癌队列(SBCC)研究的女性。在评估异质性之后，将使用多元线性和Logistic回归来评估与行为因素的关联，并且将使用COX模型来评估与死亡率的关联。将通过社会人口学因素、疾病严重程度和治疗、社会支持和负担水平以及效果修改测试来检查相关性。这项拟议的研究是第一次研究生活方式因素和体重之间的关系。这是第一个关于社交网络和社交网络的综合研究 它代表了新一代的研究，以更细微的方式研究社会网络如何以及在哪些人群中影响乳腺癌的结果，包括可能的成本和负担，而不仅仅是社会关系的好处。我们预计对行为因素的影响将在一定程度上解释与死亡率的关联。我们证明了这些发现，以前用来改善心血管疾病患者生活方式因素的家庭干预措施可能会为改善BC女性患者的健康和生存提供可能的新策略。以前对不列颠哥伦比亚省幸存者的社会干预主要集中在社会情感支持上，但这些未能提高存活率。人们希望，解决文献中的差距将有助于指出潜在的途径，通过这些途径，可以扩大与网络成员的关系以促进生存，或设法减少社会关系的成本。

DESCRIPTION (provided by applicant): Each year, more than 200,000 women are diagnosed with, and nearly 40,000 die from their breast cancer (BC) but variations in treatment and tumor characteristics explain only a fraction of breast cancer deaths. It is important to determine those factors that may help prolong survival given the aging of the population and the greater incidence of breast cancer in older women. Social networks are defined as the web of social relationships that surround an individual. Previous literature demonstrates that women with larger social networks have longer survival after a BC diagnosis, but the mechanisms through which social networks influence prognosis and in what populations are unknown. The aims of this grant are to examine associations between social network size, network members (presence of a spouse/partner, number of first-degree relatives, community participation, religious participation), and 1) major behavioral risk factors for survival including physical activity, diet, smoking, and body weight, as well as 2) breast cancer-specific mortality and all-cause mortality. We will consider the modifying influence of relationship quality, (i.e., levels of social support and social burden) on BC outcomes. Associations will also be examined in different populations of women defined by socioeconomic status, race/ethnicity, cancer severity, and extensiveness of treatment. Aims will be addressed in a pooled analysis of 10,239 breast cancer survivors in the Chinese and US Evaluation (CAUSE) Cohort which includes women from the Life After Cancer Epidemiology (LACE), the Women's Healthy Eating and Living (WHEL) and the Shanghai Breast Cancer Cohort (SBCC) studies. Multiple linear and logistic regression will be used to evaluate associations with behavioral factors, and Cox models will be used to evaluate associations with mortality, after evaluating heterogeneity. Associations will be examined by sociodemographic factors, disease severity and treatment, and levels of social support and burden, testing for effect modification. The proposed study is the first to examine associations with lifestyle factors and weight. It is the first pooled study of social networks and breast cancer outcomes, the largest of its kind, and represents a new generation of studies to examine in a more nuanced way how and in what populations social networks influence BC outcomes, including the possible costs and burdens, and not just benefits of social relationships. We expect that influences on behavioral factors will in part explain associations with mortality. I we demonstrate these findings, family interventions previously employed to improve lifestyle factors in persons with cardiovascular conditions might inform possible new strategies to improve health and survival in women with BC. Previous social interventions in BC survivors have largely focused on social-emotional supports, but these have failed to improve survival. It is hoped that addressing gaps in the literature will help point to potential avenues through which relationships with network members might be augmented to promote survival, or managed to mitigate costs of social relationships.