Correlation of Social Network With Patient Reported Distress and Survival in Patients Undergoing Radiation Therapy

Abstract

Social network and connectivity is an important facet of a patient’s ability to successfully complete radiation therapy (RT). Social influence factors, such as marital status, living status and family dynamics of oncologic patients undergoing daily radiation therapy have been previously poorly characterized. In the present study, we examine the relation of several measures of social connectedness on both overall distress and survival in patients undergoing radiation therapy. 518 patients undergoing radiation therapy between March 2012 and May 2016 were included in the study. Patients were provided a patient reported distress questionnaire before the start of RT which assessed overall distress level from 0 (lowest) to 10(highest). Demographic information was collected by chart review. Specific social influence endpoints were reviewed, including marital status, living status (alone or with others), level of concern regarding a loved one relying on the patient for their care and level of concern regarding having enough help at home. These measures were categorized as either “not at all”, “a little bit”, “somewhat”, “quite a bit”, or “very much”. Patient distress level and overall survival significance was determined with statistical analysis including Fischer’s exact test and/or Wilcoxon rank sum test for each social influence variable. Of the cohort of patients, median age was 66 years and majority of patients were female (56%). Overall distress within the cohort was 35.3% of patients for low, 33.8 % for moderate and 30.9% for high distress. When evaluating marital status, 74.7% were married, 8.3% single and 6.8% were divorced. Marital status did not correlate with significant distress level or show a correlation with survival. In terms of living status, 447 patients (87.3%) lived with others and 65 patients (12.7%) lived alone. Living status showed no significance in terms of level of distress or survival as well. On examining family and home dynamics, patients who where “at least somewhat concerned” showed significant high levels of distress with “Level of concern regarding a loved one relying on the patient for their care” (48.3%) and “Level of concern regarding enough help at home” (60%) (p<0.001). Both social factors did not show significance in survival. Family and home dynamics were a source of significant distress for patients undergoing radiation therapy. Marital and living status showed no significance in causing distress. All four social influence factors showed no correlation with survival. Reliance and responsibility of care for the patient and family is a significant social stressor, which is not always adequately addressed in the clinic. Patients undergoing significant strain at home can benefit from social services referred by the physician. Our results show that social issues in regards to home care should be focused on in the clinic in order to reduce distress for patients undergoing daily treatment.