Sharing Love and Support
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Also known by these names:
- Social support
- Support network
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Love heals. That is the simplest way to put it. Friends help us heal. Kindness heals. Kindness, they say, is love with its work boots on. The experience of being surrounded by love, family and friends who care about you, and the kindness of strangers—including doctors and other healers who care for you—is for many an awesomely powerful experience.
Key Points
- The National Cancer Institute defines social support as “a network of family, friends, neighbors, and community members that is available in times of need to give psychological, physical, and financial help.”
- Social support can be categorized into three major types: emotional, instrumental and informational support.
- BCCT’s interest in sharing love and support is affirmed by studies that have found that strong social ties and social integration are linked to better resistance to illness, lower mortality, lower risk of recurrence, and improved survival.
- Sharing love and support is most likely beneficial across a wide range of cancers, even though research to date may focus on only a few cancer types.
- Sharing love and support, like several other lifestyle-related therapies, generally involves very little risk, may improve quality of life and possibly improve cancer outcomes, and many practitioners are comfortable recommending this for patients.
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There is a whole literature on why social support matters. We could say social support is the neutral language with which researchers describe love, friendship and the kindness of strangers. People with stronger social support are healthier all their lives and do better when they get sick. So finding and receiving love and kindness matters. While it is easy for some, others find it difficult to find and even difficult to receive.
Michael Lerner
Introduction
Love heals. That is the simplest way to put it. Friends help us heal. Kindness heals.
Some of the BCCT staff have worked on hundreds of week-long residential retreats for people with cancer. These retreats have made strikingly clear that being in community and support with fellow wounded healers, as well as going home and revving up social support systems, contributes to long-term, life-changing benefits.
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This ancient gift of life, of being together and caring for each other in community, is called “social support” in the healthcare world. The National Cancer Institute's Dictionary of Cancer Terms defines social support as “a network of family, friends, neighbors, and community members that is available in times of need to give psychological, physical, and financial help.”
BCCT considers sharing love and support to be one of the key lifestyle factors that makes a difference in the lives of most people with cancer and those who care for them. We believe that a fully integrated cancer care plan must include social support.
Mounting evidence shows that sharing love and support benefits cancer patients as described below. Sharing love and support is most likely beneficial across a wide range of cancers, even though research to date may focus on only a few cancer types. Sharing love and support, like several other lifestyle-related therapies, generally involves very little risk, may improve quality of life and possibly improve cancer outcomes. Many practitioners are comfortable recommending this for patients.
Types of Social Support
Don’t Forget Our Caregivers
Caregivers for those with cancer also need social and professional support in caring for their loved ones.
See our Caring for Caregivers page for more information about caring for yourself and finding support.
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Social support can be categorized into three major types:
- Emotional: what people do that make us feel loved and cared for, that increases our sense of self-worth; this includes actions such as talking over a problem, or providing encouragement/positive feedback
- Instrumental: various types of practical help that others may provide, such as help with childcare/housekeeping, or providing transportation or money
- Informational: the help that others may offer through providing information
Building Your Social Support Network
BCCT has collected ideas from several sources for making good use of your social support resources and building your social support network.
Expand list
- Make a list of all the people in your life who can help support you, either emotionally or practically (such as driving you to treatments). Identify the specific kinds of support they can give you. Think about family, friends, neighbors, members of a church or community organization you belong to, workmates, acquaintances you made in a class. Think outside the box to other connections you have to people who would “get” what you’re going through. Maybe there are friends and relatives whom you don’t usually have contact with, but who would like to come back into your life to help you. This is your A-team. Remember, your A-team doesn’t have to be large.
- If you don’t have a strong support system with family and friends, consider joining a support group that has members who are going through similar experiences/challenges as you, such as a cancer-specific support group, a “young adult with cancer” group, a metastatic cancer group, and so on. Keith Block suggests that support groups seem to be most helpful during treatment or after treatment, but not right after diagnosis.
- Consider joining a group like a book club, or taking a class or volunteering.
- Meet with a professional who can provide emotional and practical support, such as an oncology social worker, a cancer navigator or a counselor who works with people with cancer.
- When you don’t feel well enough to organize your support, ask someone to organize and enlist help for you. For instance, this person might be in charge of contacting people who would prepare meals for you.
- Look into attending a retreat for people with cancer. Some can be specific to age groups or types of cancer.
- Important sources of social support reported by children and adolescents with cancer include relationships with immediate family members, aerobic classes, age-appropriate support groups, online networks, survivor day picnics, family retreats and facilitation of storytelling.
- See “More Information” below for resources that can help you both give and receive the most benefit with your support team.
Clinical Practice Guidelines
The SIO clinical practice guidelines give a Grade 1A rating to support groups and supportive/expressive therapy as part of a multidisciplinary approach to reduce anxiety, mood disturbance, chronic pain and improve quality of life. This is the strongest level of recommendation, meaning that in a review of quality evidence, the benefits outweigh the risks and the therapy can be applied to most patients in most circumstances without reservation.
Treating the Cancer
Working against cancer growth or spread, improving survival, or working with other treatments or therapies to improve their anticancer action
Sharing love and support (especially emotional support) has a strong positive influence on disease outcomes:
- Lack of social support seems to increase risks of having a major disease such as cancer, heart attack or stroke.
- Having good social support seems to improve chances of survival after heart attack, stroke and possibly even cancer.
- Social isolation is associated with all-cause mortality, with the level of greater risk varying in the US according to race and gender. With greater social isolation, both men and women of African-American descent show greater increased mortality than their peers of European-American descent. Cancer mortality was greater among women of European-American descent compared to their male counterparts, although this difference was not seen between women and men of African-American descent.
Stress, Cancer and Social Support
Stress hormones can exert tremendous influence on the tumor microenvironment (see our Managing Stress page). Mediating the stress response with love and support is an important part of an integrative cancer care plan. “The effect of social support on life expectancy appears to be as strong as the effects of obesity, cigarette smoking, hypertension, or level of physical activity.”
We emphasize that love and support can likely benefit most people with cancer and their caregivers, even though studies have been done in only a limited number of cancers.
Many outstanding integrative oncology care clinicians, including several of BCCT’s advisors, stress the importance of social support and include it in their integrative care protocols and plans
Cancer in General
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- The Society for Integrative Oncology (SIO) review of studies supporting the Society’s clinical practice guidelines found that people with cancer who have a higher degree of social involvement (more friends and relatives) and greater participation in religious and other community groups have a better quality of life and tend to live longer.
- Emotional support (primarily from small, dense networks of mostly family members) was related to better quality of life in people with cancer.
- Social support may foster post-traumatic growth and decrease post-traumatic stress symptoms in adults with cancer. Optimism, positive reappraisal and religious coping were also linked to higher levels of post-traumatic growth in this population.
- Emotional support from family members has been linked with better physical and emotional adjustment to cancer.
Advanced Cancer
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- People with advanced cancer who perceived they had high levels of social support reported better quality of life.
Breast Cancer
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Breast cancer has been the subject of most of the studies on social support and cancer:
- Several early landmark studies paved the way for understanding the importance of social support in improving quality of life, and in some cases extending life in women with metastatic breast cancer:
- In 1989, a randomized trial by Spiegel and others investigated supportive-expressive group therapy in women with advanced breast cancer. In the supportive environment of this therapist-led group, participants were encouraged to express their feelings and concerns about their illness and how it affected their lives. The 10-year survival analysis found that those who participated in this therapy lived an average of 18 months longer than women in the control group.
- In 2001, Goodwin et al. attempted to replicate Spiegel’s landmark study. Adding Expressive-Supportive Therapy to standard care didn’t influence survival. However, it seemed particularly to help the more distressed women in the group in improving quality of life. Results of additional studies of psychosocial interventions in cancer patients have been inconsistent.
- Larger social networks were associated with better breast cancer-specific and overall survival.
- Psychosocial interventions, including using social support, have been found to alleviate the impacts of stress and promote good coping. In randomized clinical trials in breast cancer, these interventions have been linked to improved neuroendocrine (both neural and endocrine in structure or function) and immune function, decreased rates of recurrence and improved survival.
- A 2017 review looked at psychosocial interventions for metastatic breast cancer survivors. Supportive-Expressive Therapy (SET)—a type of group therapy that promotes social support among the group members and encourages them to express emotions and fears related to their disease, focusing on facing and grieving losses—was found effective for preventing depression, reducing symptoms of hopelessness and trauma and improving social functioning. SET was one of the first psychological strategies to affect survival in advanced breast cancer.
- Couples-based interventions can be effective for those with breast cancer and their caregivers by helping improve quality of life, psychological distress, relationship function, and physical symptoms.
- Higher levels of social support is one of the factors shown to improve adherence to adjuvant endocrine therapy (AET) for breast cancer.
- In breast cancer survivors, online communities and groups seemed to improve well-being, possibly through helping women expand and engage in wider social networks, connect with peers with cancer and gain information about cancer.
- Several predictors of distress in breast cancer survivors, including lower social support, can be modified. Lifestyle and support programs that help women develop and use positive coping strategies are linked to reducing distress symptoms.
- Social support seems to influence the extent to which women with breast cancer see their prognosis as good or bad. Women who received social support, mostly through their families, were more optimistic.
- Looking at social ties and survival after breast cancer diagnosis, scientists found evidence for these outcomes:
- Women who were socially isolated had a greater chance of dying after a diagnosis of breast cancer, probably because they lacked access to care, especially caregiving from friends, relatives and adult children.
- Interestingly, being married didn’t seem to reduce the risk of death. This suggests that among women, the most important sources of social support may not be the women’s spouses but, rather, others in their social network.
Caregivers of People with Cancer
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- Studies of targeted interventions for both patients and caregivers, including self-care and interpersonal connections of caregivers and symptom management of patients, were effective in improving caregivers’ quality of life and relieving their depression.
Child and Adolescent Cancer Survivors
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- Targeted social support along with clinical intervention and education facilitated post-traumatic growth in child and adolescent cancer survivors.
Colorectal Cancer
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- One year after surgery, persons with colorectal cancer who had more social support were more able to function independently, had greater improvements in health-related quality of life and had less anxiety and depression than those with less social support.
- Men in Japan with low social support had higher incidence of and mortality from colorectal cancer.
Ovarian Cancer
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- In a study looking at long-term survival in women with ovarian cancer, social support reflecting connection to others (social attachment) was linked to improved survival.
- Vascular endothelial growth factor (VEGF), measured in a blood test, is released by tumors to create a blood supply and help the tumor grow. In a study of pre-operative patients with ovarian cancer, those with higher levels of social well-being before surgery had lower VEGF levels.
Prostate Cancer
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- Men with localized prostate cancer with higher levels of social support had better emotional well-being two years later than others. Those who used adaptive coping techniques, such as seeking emotional and instrumental support, had less depression and anxiety and better overall quality of life.
- Men with early-stage prostate cancer who participated in the Ornish Lifestyle Medicine Program, which includes social support and support groups, had a decrease in Prostate-specific antigen (PSA)—a marker of potential cancer activity—after one year in the program, whereas men with early stage prostate cancer in the control group saw a 6 percent increase in PSA. Prostate cancer cell growth was inhibited almost eight times as much in the experimental group compared to the control group.
Testicular Cancer
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- Anxiety and fear of recurrence are common in testicular cancer survivors, and inadequate coping resources including lack of social support is associated with poorer outcomes.
Managing Side Effects and Promoting Wellness
Sharing love and support (especially emotional support) has a strong positive influence on psychological and physical well-being:
Positive social support seems to enhance resilience to stress.
- Those who enjoy good social support have lower risk of depression or psychological distress.
- Emotional support has been linked to preserving physical and cognitive functioning in seniors.
- In the lab and in the community, positive social support seems to enhance resilience to stress. It may also protect against developing psychological problems related to trauma, as well as reduce the functional problems related to post-traumatic stress disorder (PTSD).
Integrative Plans, Protocols and Medical Systems
Many outstanding integrative oncology care clinicians, including several of BCCT’s advisors, stress the importance of social support and include it in their integrative care protocols and plans:
- In Abrams & Weil's book, Integrative Oncology, social support and psychoeducational groups are described in chapter 13 as components of an integrative oncology care approach.
- Keith Block’s integrative cancer treatment plan teaches patients to individualize their mind and spirit care plan, including mobilizing social support.
- Alschuler & Gazella list social support as one of the five guidelines for cancer patients to find love, laughter and joy. “Seek out social support. Don’t underestimate the dangers of isolation.”
- The late renowned integrative oncologist Jeremy Geffen described “Seven Levels of Healing” with “Connection with Others” near the top of the list.
- Gary Deng, MD, medical director of the Integrative Medicine Service at Memorial Sloan Kettering Cancer Center, includes “Relationships” as one of the “6 Pillars for Good Health.”
- The innovative cardiologist Dean Ornish adapted his Lifestyle Medicine program for reversing heart disease for men with prostate cancer. A critical facet of that program is what Ornish calls “love and support.” Ornish says the heart of healing is “connection”, which includes increasing love and intimacy in our lives, group support, improving communication skills and fluent listening.
Social support is included in these specific plans, protocols and approaches:
Non-cancer Uses of Social Support
Sharing love and support is considered an important component of care in reducing the risk of and managing many chronic diseases. A prime example is Dr. Ornish’s Program for Reversing Heart Disease.
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Love and support most commonly come from family members, friends and other loved ones. However, expanding social support networks to include connections in groups, community and church organizations and workmates is not uncommon. Many cancer centers and communities offer support groups for people with cancer. Many online and virtual social support programs are available for people with cancer; some are listed below.
Written by Laura Pole, RN, MSN, OCNS, with review by Nancy Hepp, MS; most recent update on September 13, 2018.
- Sri Swami Satchidananda. A Revolution in Healthcare. Viewed March 28, 2018.
- Research: Psychosocial Notebook. Support & Social Conflict: Section One—Social Support. University of California, San Francisco. April 2008. Viewed January 7, 2018.
- Block KI. Life Over Cancer: The Block Center Program for Integrative Cancer Care. New York: Bantam Dell. 2009.
- Alschuler LN, Gazella KA. The Definitive Guide to Thriving after Cancer. Berkeley, California: Ten Speed Press. 2013.
- Turner JK, Hutchinson A, Wilson C. Correlates of post-traumatic growth following childhood and adolescent cancer: a systematic review and meta-analysis. Psychooncology. 2017 Nov 2.
- Deng GE, Frenkel M et al. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. 2009 Summer;7(3):85-120.
- Wei D, Liu XY, Chen YY, Zhou X, Hu HP. Effectiveness of physical, psychological, social, and spiritual intervention in breast cancer survivors: an integrative review. Asia-Pacific Journal of Oncology Nursing. 2016 Jul-Sep;3(3):226-232; Alcaraz KI, Eddens KS et al. Social isolation and mortality in US Black and White men and women.American Journal of Epidemiology. 2018 Oct 16.
- Ozbay F, Johnson DC, Dimoulas E, Morgan CA, Charney D, Southwick S. Social support and resilience to stress: from neurobiology to clinical practice. Psychiatry (Edgmont). 2007;4(5):35-40.
- Deng GE, Frenkel M et al. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. 2009 Summer;7(3):85-120.
- Courtens AM, Stevens FC, Crebolder HF, Philipsen H. Longitudinal study on quality of life and social support in cancer patients. Cancer Nursing. 1996 Jun;19(3):162-9.
- Shand LK, Cowlishaw S, Brooker JE, Burney S, Ricciardelli LA. Correlates of post-traumatic stress symptoms and growth in cancer patients: a systematic review and meta-analysis. Psychooncology. 2015 Jun;24(6):624-34.
- Wei D, Liu XY, Chen YY, Zhou X, Hu HP. Effectiveness of physical, psychological, social, and spiritual intervention in breast cancer survivors: an integrative review. Asia-Pacific Journal of Oncology Nursing. 2016 Jul-Sep;3(3):226-232.
- Applebaum AJ, Stein EM et al. Optimism, social support, and mental health outcomes in patients with advanced cancer. Psycho-oncology. 2014;23(3):299-306.
- Spiegel D, Bloom JR, Yalom I. Group support for patients with metastatic cancer: a randomized outcome study. Archives of General Psychiatry. 981;38:527-533.
- Goodwin PJ, Leszcz M et al. The effect of group psychosocial support on survival in metastatic breast cancer. New England Journal of Medicine. 2001 Dec 13;345(24):1719-26.
- Kroenke CH, Michael YL et al. Postdiagnosis social networks and breast cancer mortality in the After Breast Cancer Pooling Project. Cancer. 2017 Apr 1;123(7):1228-1237.
- Gudenkauf LM, Ehlers SL. Psychosocial interventions in breast cancer survivorship care. Breast. 2017 Nov 20;38:1-6.
- Gudenkauf LM, Ehlers SL. Psychosocial interventions in breast cancer survivorship care. Breast. 2017 Nov 20;38:1-6.
- Brandao T, Schulz MS, Matos PM. Psychological intervention with couples coping with breast cancer: a systematic review. Psychology and Health. 2014;29(5): 491e516.
- 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. Journal of Consulting and Clinical Psychology. 2017 Dec 21.
- Falisi AL, Wiseman KP et al. Social media for breast cancer survivors: a literature review. Journal of Cancer Survivorship. 2017 Dec;11(6):808-821.
- Syrowatka A, Motulsky A et al. Predictors of distress in female breast cancer survivors: a systematic review. Breast Cancer Research and Treatment. 2017;165(2):229-245.
- Wei D, Liu XY, Chen YY, Zhou X, Hu HP. Effectiveness of physical, psychological, social, and spiritual intervention in breast cancer survivors: an integrative review. Asia-Pacific Journal of Oncology Nursing. 2016 Jul-Sep;3(3):226-232.
- Kroenke CH, Kubzansky LD, Schernhammer ES, Holmes MD, Kawachi I. Social networks, social support, and survival after breast cancer diagnosis. Journal of Clinical Oncology. 2006 Mar 1;24(7):1105-11.
- Fu F, Zhao H, Tong F, Chi I. A systematic review of psychosocial interventions to cancer caregivers. Frontiers in Psychology. 2017;8:834.
- Turner JK, Hutchinson A, Wilson C. Correlates of post-traumatic growth following childhood and adolescent cancer: a systematic review and meta-analysis. Psychooncology. 2017 Nov 2.
- Gonzalez-Saenz de Tejada M, Bilbao A et al. Association between social support, functional status, and change in health-related quality of life and changes in anxiety and depression in colorectal cancer patients. Psychooncology. 2017 Sep;26(9):1263-1269.
- Ikeda A, Kawachi I et al. Social support and cancer incidence and mortality: the JPHC study cohort II. Cancer Causes & Control. 2013;24:847–60.
- Lutgendorf SK, De Geest K et al. Social influences on clinical outcomes of patients with ovarian cancer. Journal of Clinical Oncology. 2012 Aug 10;30(23):2885-90.
- Lutgendorf SK, Johnsen EL et al. Vascular endothelial growth factor and social support in patients with ovarian carcinoma. Cancer. 2002 Aug 15;95(4):808-15.
- Zhou ES, Penedo FJ et al. Longitudinal effects of social support and adaptive coping on the emotional well-being of survivors of localized prostate cancer. The Journal of Supportive Oncology. 2010;8(5):196-201.
- Ornish D, Weidner G et al. Intensive lifestyle changes may affect the progression of prostate cancer. Journal of Urology. 2005 Sep;174(3):1065-9.
- Smith AB, Rutherford C et al. A systematic review of quantitative observational studies investigating psychological distress in testicular cancer survivors. Psychooncology. 2017 Nov 23.
- Wei D, Liu XY, Chen YY, Zhou X, Hu HP. Effectiveness of physical, psychological, social, and spiritual intervention in breast cancer survivors: an integrative review. Asia-Pacific Journal of Oncology Nursing. 2016 Jul-Sep;3(3):226-232.
- Seeman T. Support & Social Conflict: Section One—Social Support. MacArthur Research Network on SES and Health. April 2008. Viewed January 18, 2018.
- Ozbay F, Johnson DC et al. Social support and resilience to stress: from neurobiology to clinical practice. Psychiatry (Edgmont). 2007;4(5):35-40.
- Abrams DI, Weil AT. Integrative Oncology. 2nd Edition. New York, NY: Oxford University Press. 2014.
- Block KI. Life Over Cancer. New York: Bantam Dell. 2009.
- Alschuler LN, Gazella KA. The Definitive Guide to Thriving after Cancer. Berkeley, California: Ten Speed Press. 2013.
- Geffen J. The Journey Through Cancer: An Oncologist's Seven-Level Program for Healing and Transforming the Whole Person. New York, New York: Three Rivers Press. 2006.
- Ornish Lifestyle Medicine. Love and Support. Viewed January 7, 2018.
- Abrams DI, Weil AT. Integrative Oncology. 2nd Edition. New York, NY: Oxford University Press. 2014.
- Alschuler LN, Gazella KA. The Definitive Guide to Thriving after Cancer. Berkeley, California: Ten Speed Press. 2013.
- Block KI. Life Over Cancer. New York: Bantam Dell. 2009.
- Cohen L, Jefferies A. Anticancer Living. New York: Viking. 2018.
- Geffen J. The Journey Through Cancer: An Oncologist's Seven-Level Program for Healing and Transforming the Whole Person. New York, New York: Three Rivers Press. 2006.
- McKinney N. Naturopathic Oncology, 3rd Edition. Victoria, BC, Canada: Liaison Press. 2016.
- Ornish Living. Prostate Cancer Was My Doorway into Vibrant Health and an Expansive and Happy Life. Ornish Lifestyle Medicine. Viewed January 7, 2018.
View All References
More Information
Know of other helpful resources and information sources about sharing love and support? If so, please use the Comments section below to describe these resources and how we can find them.
Web resources and online support services
Resources for young adults with cancer
Social support resources for caregivers
Books
- Halpern S. The Etiquette of an Illness. New York, New York. Bloomsbury. 2004. This book is for people who are ill and want to engage with their loved ones effectively. It is also for those who feel awkward and unsure about responding to a friend, colleague, or relative who is suffering.
Videos
Research review articles
Clinical trials
- A number of clinical trials of social support and cancer are recruiting, in progress or recently completed. To learn more about these trials, visit clinicaltrials.gov.
More from Our Resources Database
- Commonweal: Healing Circles
- Michael Lerner: Choices In Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer
- Jeremy R. Geffen, MD, FACP: The Journey through Cancer: An Oncologist's Seven-Level Program for Healing and Transforming the Whole Person
- CancerCare: My Cancer Circle
- Cancer Support Community
- Norman Cousins: Head First: The Biology of Hope and the Healing Power of the Human Spirit
- Glenn Sabin with Dawn Lemanne, MD, MPH: N of 1
- Dr. Leslie Schover: Will2Love
- Jeremy R. Geffen, MD, FACP: The Seven Levels of Healing®: Celebrating Life and Spirit on the Journey through Cancer
- Lorenzo Cohen and Alison Jefferies: Anticancer Living: Transform Your Life and Health with the Mix of Six
- Keith I. Block, MD: Life over Cancer: The Block Center Program for Integrative Cancer Treatment
- Lise Alschuler, ND, FABNO, and Karolyn Gazella: The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing
- American Society of Clinical Oncology: Cancer.Net
- Commonweal: Commonweal Cancer Help Program
- The Lord Symington Foundation with Healing Circles and The New School at Commonweal: Dean Ornish, MD: Symington 2017
- The New School at Commonweal: Dwight McKee, MD: 40 Years Practicing Integrative Cancer Medicine, Part 1
- The New School at Commonweal: Dwight McKee, MD: 40 Years Practicing Integrative Cancer Medicine, Part 2
- Wayne Jonas, MD: Your Healing Journey: A Patient’s Guide to Integrative Breast Cancer Care
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