Social isolation was a strong predictor of mental health among cancer survivors, with key antecedents including cancer information access, inability of self-care, time since diagnosis, negative life perception, and perception of care quality, and several pathways varied significantly between rural and urban settings.
Key Findings
Results
Social isolation was a strong predictor of mental health outcomes (PHQ-4) among cancer survivors.
Data were drawn from the 2022 Health Information National Trends Survey (HINTS 6) with a subsample of cancer survivors (n = 926).
Partial Least Squares Structural Equation Modeling (PLS-SEM) was used to evaluate relationships among personal factors, psychosocial perceptions, social isolation, and mental health.
Mental health was measured using the PHQ-4 instrument.
Social isolation served as a mediator between psychosocial/personal factors and mental health outcomes.
Results
Cancer information comprehension was identified as a key antecedent of social isolation among cancer survivors.
Cancer information access and comprehension was included as a psychosocial perception construct in the model.
The relationship between cancer information comprehension and social isolation was identified as a significant pathway in the overall model.
This finding was identified using PLS-SEM across the full sample of 926 cancer survivors.
The conceptual framework drew from the Biopsychosocial Model, Stress Process Model, Transactional Model of Stress and Coping, and Andersen Behavioral Model of Health Services Use.
Results
Inability of self-care was identified as a significant antecedent of social isolation among cancer survivors.
Inability of self-care was included as a personal factor construct alongside age, BMI, and time since diagnosis.
Self-care difficulty was a significant predictor of social isolation in the overall model.
The effect of self-care difficulty on isolation and mental health was significant only in urban settings, not rural settings.
This geographic difference was identified through multigroup analysis comparing rural and urban survivors.
Results
Negative life perception was a significant antecedent of social isolation among cancer survivors.
Negative life perception was included as a psychosocial perception construct in the conceptual framework.
It was identified as one of the key antecedents of perceived social isolation in the PLS-SEM model.
The construct was evaluated across the full sample of 926 cancer survivors from the HINTS 6 dataset.
Negative life perception contributed to the pathways linking psychosocial factors to mental health via social isolation.
Results
Perceived care quality was a significant antecedent of social isolation, with its effect on isolation and mental health significant only in urban settings.
Perception of care quality was included as a psychosocial perception construct in the model.
Perceived care quality was identified as a key antecedent of social isolation in the overall sample.
Multigroup analysis revealed that the effect of care perception on isolation and mental health was significant only in urban settings.
This urban-specific finding suggests context-sensitive differences in how healthcare experiences relate to social isolation.
Results
Time since cancer diagnosis was a significant antecedent of social isolation among survivors.
Time since diagnosis was included as a personal factor construct alongside age, BMI, and inability of self-care.
It was identified as one of the key antecedents of perceived social isolation in the PLS-SEM analysis.
The finding indicates that the duration of survivorship relates to the degree of perceived social isolation experienced.
Analysis was conducted on a subsample of n = 926 cancer survivors from the 2022 HINTS 6 survey.
Results
Several pathways linking personal and psychosocial factors to social isolation and mental health differed significantly between rural and urban cancer survivors.
Multigroup analysis was used to compare rural and urban survivors within the PLS-SEM framework.
Effects of self-care difficulty and care perception on isolation and mental health were significant only in urban settings.
The study notes that rural communities were characterized as underserved, suggesting different intervention needs.
The geographic differences underscore the importance of context-sensitive interventions to reduce isolation.
Methods
The study used a multi-theoretical conceptual framework integrating four models to examine social isolation among cancer survivors.
The framework incorporated constructs from the Biopsychosocial Model, the Stress Process Model, the Transactional Model of Stress and Coping, and the Andersen Behavioral Model of Health Services Use.
Constructs included personal factors (age, BMI, time since diagnosis, inability of self-care), psychosocial perceptions (perceived care quality, cancer information comprehension, negative life perception), social isolation, and mental health (PHQ-4).
PLS-SEM was selected as the analytical method to evaluate the relationships among these constructs.
The sample consisted of n = 926 cancer survivors drawn from the 2022 HINTS 6 nationally representative survey.
What This Means
This research suggests that social isolation plays a central role in shaping the mental health of cancer survivors in the United States. Using data from nearly 1,000 cancer survivors in a 2022 national survey, the study found that feeling socially isolated was strongly linked to poorer mental health. Several factors contributed to social isolation, including difficulty understanding cancer-related information, trouble caring for oneself, a negative outlook on life, dissatisfaction with care quality, and how long it had been since the cancer diagnosis.
The study also found important differences between cancer survivors living in rural versus urban areas. For example, struggles with self-care and perceptions of poor care quality were linked to social isolation and worse mental health only among urban survivors — not rural ones. This suggests that the pathways leading to isolation may look different depending on where a person lives, and that rural communities, which are often underserved, may face distinct challenges that require different types of support.
This research suggests that addressing social isolation among cancer survivors should be a priority in survivorship care, and that interventions should be tailored to the specific contexts and needs of different communities. Improving access to understandable cancer information, supporting self-care abilities, and enhancing the quality of care experiences may all help reduce isolation and improve mental well-being for cancer survivors.
Choudhury A, Wheldon C, Elkefi S, Dixit P. (2026). Antecedents of loneliness among cancer survivors: An exploratory analysis of the Health Information National Trends Survey (HINTS) data.. PloS one. https://doi.org/10.1371/journal.pone.0323159