Addressing Loneliness

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Loneliness is a very important concept for oncology nurses. A growing body of health sciences literature identifies it as a prevalent problem for patients with cancer. Findings from a recent study revealed that loneliness and depression were associated with mortality risk in patients with cancer.1   

Considering loneliness to be a health issue in patients with cancer is based on the fact that loneliness has been linked to inflammatory and immune responses that affect cancer healing, explained Dr Theeke. New research is also suggesting that older patients who are lonely may experience greater cognitive impairment.2

“A meta-analysis reported in 2014 detailed the risks for loneliness in persons with cancer. In this study, cancer patients were moderately lonely and the loneliness increased over time. This is very important and indicates a need for intervention,” said Dr Theeke.

The 2014 study was a review of the literature on the severity and risk factors for loneliness in adult patients with cancer. The meta-analysis included 15 studies and found that levels of loneliness rise with increasing time after a cancer diagnosis.3 A consistent theme that emerged in this analysis was social functioning.

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Although oncology nurses have a long list of assessments to make for each patient, Dr Theeke suggests they add loneliness to the list. A “Cancer Loneliness Scale” was recently validated in a clinical trial.4 Once patients have been assessed for loneliness, Dr Theeke explained, oncology nurses should make its prevalence known at their institution and consider developing a loneliness intervention program to include in their oncology services.

Dr Theeke calls loneliness a smoldering stressor. Some researchers have compared loneliness to cigarette smoking in terms of its harmful effects. It can exacerbate hypertension, contribute to depression, heighten anxiety, and is associated with higher rates of smoking and drug use.     


1. D’ippolito S, Ambrosini E, Shams M, Calì G, Pastorelli D. The effect of loneliness on cancer mortality. J Clin Oncol. 2017;35(15 suppl):10070.

2. Alkan A, Öztorun HS, Karci E, et al. Loneliness and cognitive dysfunction in elderly cancer patients. Ann Oncol. 2017;28(suppl_5):v507-v510.

3. Deckx L, van den Akker M, Buntinx F.  Risk factors for loneliness in patients with cancer: a systematic literature review and meta-analysis. Eur J Oncol Nurs. 2014;18(5):466-47.

4. Adams RN, Mosher CE, Rand KL, et al. The Cancer Loneliness Scale and Cancer-related Negative Social Expectations Scale: development and validation. Qual Life Res. 2017;26(7):1901-1913.