Importance of Social Support in Cancer Patients

Cancer affects patients’ lives and those of their families in different ways. Cancer diagnosis and treatment brings about changes in patients’ personal paths of life, in their daily activities, work, relationships, and family roles, and it is associated with a high level of patient psychological stress (Zabalegui et al., 2005). This stress emerges as anxiety and/or depression and it is mainly related to uncertainty about the diagnosis, side-effects of chemotherapy or radiotherapy treatment, lack of social or personal control, progressive physical deterioration, and thoughts of near death (Zabalegui et al., 2005). Caplan and Killelea (1976) consider social support to be significant when dealing with a crisis situation. Also, a great deal of research (Katz & Bender 1976; Taylor et al., 1986; Sarason et al., 1987; Samarel et al., 1997) reports it as an important source of emotional support that facilitates the psychological adjustment to cancer. Also, psychological interventions, such as support groups, contribute to improving adjustment of cancer patients by reinforcing effective coping mechanisms. Katz and Bender (1976) define a ‘support group’ as a structured group composed of few members who offer mutual support through interpersonal interactions. Also, according to Atchley (2000), social support consists of people we can count on to provide ongoing emotional support, affirmation, information, and assistance, especially in times of crisis. Moreover, sharing cancer experiences with other group members has positive effects, as participating in the group helps to develop effective coping strategies and improves emotional adaptation (Spiegel, 1981). Particularly due to this stress, cancer patients do have


Importance of Social Support in Cancer Patients
Yasemin Yıldırım Usta many needs.To begin with, the need for fast and accurate diagnosis and timely treatment is vital.However, attention to psychosocial needs and quality of life is equally important and it forms an essential part of modern cancer care (National Cancer Plan 2000; National Institute of Clinical Excellence 2004).On the other hand, an important aspect of psychosocial care and quality of life is social support.This may be defined as emotional, instrumental, informational, and appraisal assistance (House and Kahn, 1985) and includes both the resources that meet individual needs as well as the social relationships which these needs are met through (Jacobson, 1986).A support system includes formal and informal relationships and groups.They may provide an individual with cognitive (information, advice, and knowledge), emotional (security, love, and comfort), and material (services that help practical problems) supports required to overcome stressful experiences (Caplan, 1974).This is important for good psychological functioning during diagnosis and treatment, and many patients experience a strong need for support and reassurance (Krishnasamy, 1996).During diagnosis and treatment, interactions with staff, including doctors, clinic nurses, and specialist nurses, and the social world of cancer clinics play a valuable role in the provision of support (Dunkel-Schetter and Wortman ,1982;Costain and Hewison,1999) and frequently, patients form valuable relationships with those involved in their care (Clarke et al.,2006).definitions of social support.Some other academic theoretic definitions further suggest that the recipient should have a perception of someone caring for them and a resultant sense of well-being (Hupcey, 1998).Hupcey lists the factors required for social support as follows: (a) the act of providing a resource, (b) the recipient having a sense of being cared for or a sense of well-being, (c) the act having an implied positive outcome, (d) the existence of a relationship between the provider and the recipient, (e) support not given from or to an organization, the community, or a professional, and (f) support that does not have a negative intent or is given grudgingly (Rash, 2007).
On the other hand, structural characteristics of social support refer to the composition of a social network or sources of support while functional characteristics refer to the provision of particular resources or types of support (Stewart 1989;Komproe et al., 1997).Also, four different functions of social support have been described: emotional support, instrumental support, appraisal support, and informational support.For example, family members offer emotional support like esteem, trust, concern, and listening.Instrumental support consists of aid in kind, money, labor, and time.Peers offer appraisal support that enhances the individual's self-esteem.Finally, informational support consists of advice, suggestions for problem solving, directives, and information (Gotay and Wilson, 1998;Katapodi et al., 2002).

Impact of Social Support on Cancer
According to the World Health Organization (2002), cancer control is a public health objective that is focused on reducing the consequences of cancer by applying scientific knowledge to practice.One of the main objectives of cancer treatment is enhancement of patients' quality of life through national cancer programmes, which should establish standards for improving the patient's well-being.On the other hand, cancer treatments are not always curative; there are effective strategies for improving cancer patients' coping and quality of life, even in low resource settings (Zabalegui et al., 2005).Social support is one of these effective strategies.
In a study with 65 years or older aged newly diagnosed 799 cancer patients, Goodwin, Hunt and Samet (1991) found that patients with functional limitations were more likely to have poor social support networks than subjects without such limitations.In another study with 161 breast and gynecological cancer survivors, Lim and Zebract reported (2008) that functional social support directly influences quality of life.Filazoglu and Griva (2008) found that social support was positively associated with health-related quality of life in Turkish breast cancer patients.Similarly, Sammarco and Konecny (2008) identified a significant positive correlation between perceived social support and total quality of life in Latina breast cancer survivors.Finally, findings from the study of Kroenke et al. (2006) on the absence of friends, living children, and close relatives were significantly related to poorer survival, similar to findings by Friedmann et al.
(2005), who found women who reported more satisfaction with their social support networks had greater functional well-being; and social/ family well-being (Ozkan and Ogce, 2008).
Evidently, social support has a remarkable importance in dealing with psychological problems such as anxiety and depression, which both are common in cancer patients.For example, in a study on patients with different types of cancer, the incidence of psychological disorder one year after diagnosis was found to be 31.8%while patients with low social support scores were diagnosed with depression (Simpson et al., 2002).Yen et al. (2006) reported that depression is a significant predictor for quality of life for breast cancer patients.Therefore, social support plays a key role in dealing with the disadvantages that result from cancer and its treatment (Delbrück, 2008).
Finally, the evidence for the relationship between social support and cancer progression is sufficiently strong for breast cancer as shown by some methodologically sound studies (Nausheen et al., 2009).Bina (2009) also found that structural support indices were more frequently associated with disease progression than the indices of functional support in breast cancer.Also, low social support can lead to poor health behaviors, which may then predict an increased vulnerability toward cancer and its associated mortality (Kawahara et al.,1998;Crispo et al., 2004) and to psychosocial stress, which can influence the immune system via the endocrine system and cause angiogenesis and promotion of tumor growth (Lutgendorf et al., 2003;Steel et al., 2004).Therefore, it may be significant to identify patients who may be more at risk due to the psychosocial vulnerability resulting from low social support (Rudge et al., 2005).

Nurses' Role in Providing Social Support
Cancer patients benefit from support from healthcare professionals, including information and help with adjusting to the psychological difficulties associated with the disease.Both informational and emotional aspects of social support can have a positive influence on adaptation to cancer.Cognitive support for cancer patients includes information concerning the illness, diagnosis and prognosis, and treatment and side effects, as well as information on available services, such as support groups (Erikkson and Lauri, 2000).
Most patients want basic information on diagnosis, treatment options, and common side effects (Leydon et al., 2000) and express a need to receive accurate and timely information throughout the course of their illness (National Cancer Alliance, 1996;Degner et al., 1996).Cancer patients seek out information to understand the course and potential outcomes of their illness (Bayne et al., 1997) and information is believed to be essential to patients' perception of overall support and quality of life (Clarke et al., 2006).
On the other hand, it is an important task in providing social support belongs to the nurses.Nurses are healthcare professionals who act like a bridge between the health system and patients most of the time.For patients, they DOI:http://dx.doi.org/10.7314/APJCP.2012.13.8.3569 Importance of Social Support in Cancer Patients are usually the closest medical staff to turn to for anything they need.Therefore, nurses should know the necessary conditions in order to obtain social support, should understand whether social support is sufficient or not, and should provide counseling in cases where social support is insufficient (Ardahan, 2006).
It is important that all health care professionals as well as nurses better understand the need for social support and statement of functional status for cancer patients in attempt to improve clinical interventions and care.Therefore, nurses should assess patients' levels of social support as a factor when evaluating functional status of cancer.Questions of a patient's needs for nursing care must be resolved such as, who can provide inpatient and outpatient support, and where this can be provided (Ozkan and Ogce, 2008).

Conclusion
Research suggests that social support has an impact on physical health, well-being and adjustment to cancer of cancer patients (Hann et al., 2002;Parker et al., 2003;Ashing et al., 2004;Kartoğlu and Saraçoğlu, 2005).Perceived social support act as a barrier against high-stress for individuals, satisfy their feelings of commitment and help protect and strengthen feelings of identity (Sorias, 1992;Şahin, 1999;Kaymakçıoğlu, 2001;Aksüllü and Doğan, 2004).Having a low level of social support can negatively affect individuals' mental status (Ozbas, 2008).
In addition, evidence reveals that social support is beneficial for cancer patients and there is positive relationship between emotional support from family members and the level of physical and psychological adjustment to cancer.Furthermore, research into the relationship between the social support given during diagnosis stage and longer lifespan shows a causal relationship between social support and psychological adjustment (Eylen, 2001).Cancer diagnosis shakes the existing social support network and requires new arrangements in this network.In a study which examined which supports (depending on the person giving the support) cancer patients found useful, it was found that cancer patients believed that the emotional support given by the people they felt close was really significant.The patients in that study regarded the reassurance and emotional support given by nurses as important while they considered the informational support given by doctors as useful (Eylen, 2001).
To sum up, social support is obviously closely associated with physical adaptation, wellbeing and emotional adjustment in cancer.Furthermore, it is recommend that to introduce support services for all cancer patients, perceptions of support and satisfaction with available services should be examined.Also, adequate support including specialist nurses should occur as part of a structured care plan for all patients throughout the cancer journey.This may enable patients to form supportive relationships with specialist nurses from diagnosis and by means of the support they find they may lead a more quality life during the treatment.