Author(s): Nehal Bakshi, Abhilasha Khatri
Mentor(s): Melissa Watt, Stephen Kimani
Institution U of U
Background: Social support is associated with improved outcomes among patients with cancer. In low-resource countries, where cancer care is under-developed and inaccessible, stigma around cancer can hamper social support. This study seeks to describe patterns of social support across the cancer care continuum in a population of cancer patients in Malawi. Methods: This mixed-methods study enrolled patients receiving oncology care at Kamuzu Central Hospital in Lilongwe, Malawi. Between June and October 2021, 29 adult cancer survivors completed in-depth interviews exploring quality of life, including social support, across the cancer care continuum. Between January and April 2024, 100 separate individuals participated in a survey that included a structured assessment of domains of social support (emotional, informational, and instrumental; each with a range 0-16), using the Patient-Reported Outcomes Measurement Information System (PROMIS). Qualitative themes were identified using document memos and thematic coding in NVivo (Ver 14). Social support survey data were described in three categories: low (0-4), medium (5-8), and high (9-16). Results: In the qualitative data, social support emerged as an important facilitator across the cancer care continuum, from diagnosis to retention and completion of treatment. In the diagnosis and linkage-to-care phases, informational support was helpful to patients as they dealt with unexplained symptoms and navigated a new system of care. During the treatment phase, instrumental support helped patients attend appointments and manage side-effects of treatment, while emotional support was motivational and facilitated adherence to treatment. Peer support emerged as a key form of social support that contributed to patient well-being. In the survey data, informational support was the least common form of social support. 24%, 26%, and 50% of participants had low, medium, and high levels of informational support. For emotional support, 20%, 23%, and 57% of participants had low, medium, and high levels. For instrumental support, 12%, 12%, and 76% of participants had low, medium, and high levels. While majority of survivors reported instrumental support (88%), informational social support was the least reported with 24% participants endorsing lowest levels. Across all domains, 46% of survivors had high levels while 10% had low levels of social support. Interpretation: Among cancer patients in Malawi, multi-domain social support is a key driver of cancer outcomes. While half of cancer survivors had high social support in all domains, one in ten cancer survivors had no social support. There is need for targeted interventions to improve social support for cancer survivors in Malawi. Funding: NIH 5P30CA042014-33S5