Table 2.

Summary of studies on cancer patients: influencing factors of social isolation among cancer patients.

Qualitative Studies
Authors, Year, Country [Citation Number]	Aims	Informants	Instrument Used	Key Findings and Classifications of Influencing Factors
Dong, 2022, China [48]	To describe social isolation-related psychological experiences of cancer patients in order to provide practicable references for developing relevant nursing support programs.	20 cancer patients	Semi-structured interview	Health status: physical health status: cancer patients suffered social isolation because of their impaired physical health; psychological health status: cancer patients suffered social isolation because of their poor psychological status. Social support and social interaction: cancer patients suffered social isolation because of their insufficient social support.
Ettridge, 2018, Australia [49]	To provide in-depth insight into men’s experiences of prostate cancer, specifically perceived stigma and self-blame, social isolation, unmet needs, and help-seeking behavior.	20 men diagnosed with prostate cancer	Semi-structured interview	Health status: physical health status: many participants experienced feelings of loneliness due to physical consequences of treatment and side effects. Social support and social interaction: many participants experienced feelings of loneliness due to a lack of readily available support/social contact, reluctance to talk to others, and perceived withdrawal from others.
Rosedale et al., 2009, USA [50]	To describe the experience of loneliness for women more than a year following breast cancer treatment.	13 women, 1–18 years following breast cancer treatment.	Open-ended interviews	Health status: psychological health status: feeling alone in the awareness of mortality; coping: wi thholding truth or projecting images that they perceived as inauthentic contributed to the loneliness.
Quantitative Studies
Authors, Year, Country [Citation Number]	Aims	Samples	Instrument Used	Key Findings and Classifications of Influencing Factors
Adams et al., 2017, USA [51]	To develop and validate the cancer loneliness scale and cancer-related negative social expectation scale.	186 cancer patients	The 20-item UCLA Loneliness Scale-Version 3 (UCLA-V3); the emotional support, depressive and anxiety symptoms, and physical quality of life subscales (4 items each) from PROMIS measures; The mental health and physical health subscales (4 items each) from the 10-item Global Health measure; a 3-item scale adapted from the Social Network Index	Health status: physical health status: physical quality of life was negatively correlated with loneliness (p < 0.01); psychological health status: anxiety and depression were positively correlated with loneliness (p < 0.01), and mental quality of life was negatively correlated with loneliness (p < 0.01). Social support and social interaction: emotional support and the number of relatives and friends with whom participants had regular contact were negatively correlated with loneliness (p < 0.01).
Adams et al., 2018, USA [52]	To examine whether cancer-related loneliness mediated the relationships between social constraints and symptoms in patients with various cancers.	182 cancer patients	7-item Cancer Loneliness Scale; 5-item version of the Social Constraints Scale; Patient-Reported Outcomes Measurement Information System (PROMIS) measures	Social support and social interaction: social constraint on cancer-related disclosure was positively correlated with loneliness (p < 0.001).
Çamlıca and Koç, 2022, Turkey [53]	To determine the relationships between the perceived loneliness and social support levels of Turkish oncology patients, as well as their quality of life and symptom management.	370 cancer patients	10-item UCLA loneliness scale (version 3); 12-item Multi-Dimensional Scale of Perceived Social Support (MSPSS); 27-item FACT-G Quality of Life Scale (Version 4); The Edmonton Symptom Assessment Scale	Demographic characteristics: gender: male patients had higher loneliness; marital status: married patients had lower loneliness; education level was negatively correlated with loneliness (all p < 0.05). Health status: physical health status: A positive significant relationship between loneliness and fatigue (r = 0.296, p < 0.01), pain (r = 0.193, p < 0.01), sleeplessness (r = 0.199, p < 0.01), nausea (r = 0.243, p < 0.01), loss of appetite (r = 0.244, p < 0.01), and shortness of breath (r = 0.220, p < 0.01) was found; psychological health status: a positive significant relationship between loneliness and sadness (r = 0.246, p < 0.05), worry (r = 0.250, p < 0.01), and feeling unwell (r = 0.376, p < 0.01) was found. Social support and social interaction: social support was negatively correlated with loneliness (r = −0.754, p < 0.01).
Chen et al., 2022, China [54]	To investigate the status quo and influencing factors of loneliness in hospitalized cancer patients.	313 hospitalized cancer patients	20-item UCLA Loneliness Scale-Version 3 (UCLA-V3); 12-item Perceived Social Support Scale (PSSS); 30-item European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30)	Demographic characteristics: gender: female patients had higher loneliness (β = 1.74, p < 0.001). Having cancer: the informed situation was positively correlated with loneliness (β = 2.20, p < 0.001). Health status: physical health status: nausea and vomiting were positively correlated with loneliness (β = 0.03, p < 0.001); psychological health status: emotional function was negatively correlated with loneliness (β = −0.10, p < 0.001); social health status: role function was negatively correlated with loneliness (β = −0.06, p < 0.001). Social support and social interaction: social support was negatively correlated with loneliness (β = −0.27, p < 0.001).
Choi and Henneghan, 2022, USA [55]	To compare the severity of psychosocial outcomes (loneliness, perceived stress, depressive symptoms, anxiety, fatigue, and daytime sleepiness) between younger (aged less than 50 years) and older (aged 50 years or older) BCS who completed chemotherapy 6 months to 10 years prior and identify predictors of loneliness for younger BCS.	90 breast cancer patients	20-item UCLA Loneliness Scale-Version 3 (UCLA-V3); 8-item Patient-Reported Outcomes Measurement Information System Emotional Distress–Anxiety, –Depression, and–Fatigue Short Forms; 8-item Epworth Sleepiness Scale; 8-item Epworth Sleepiness Scale; 10-item Perceived Stress Scale	Demographic characteristics: age was negatively correlated with loneliness (p < 0.001); not having children was positively correlated with loneliness (β = −0.443, p = 0.001). Having cancer: a longer time since the completion of chemotherapy was positively correlated with loneliness (β = 0.328, p = 0.012).
Duan Mu et al., 2022, China [56]	To investigate the current status of social isolation and its influencing factors in 242 elderly patients with colostomy for colorectal cancer in Zhengzhou city.	242 elderly patients with colostomy of colorectal cancer	15-item General Alienation Scale (GAS); 25-item impact on participation and autonomy questionnaire (IPA); 17-item Social Relationship Quality Scale (SRQS); 10-item modified Barthel Index (MBI)	Demographic characteristics: gender: female patients had higher feelings of isolation (β = 2.631, p = 0.040); education level was negatively correlated with subjective social isolation (β = −3.284, p = 0.003). Having cancer: postoperative time (β = −3.726, p = 0.005) and daily living ability (β = −0.280, p < 0.001) were negatively correlated with subjective social isolation. Social support and social interaction: social participation (β = 2.804, p < 0.001) and social relationship quality (β = −0.682, p < 0.001) were negatively correlated with subjective social isolation.
Hao et al., 2023, China [57]	To understand the status quo of social isolation in ovarian cancer patients accepting postoperative chemotherapy and analyze its influencing factors.	194 ovarian cancer patients accepting postoperative chemotherapy	14-item Type D Personality Scale-14 (DS14); 12-item Perceived Social Support Scale (PSSS); 15-item General Alienation Scale (GAS)	Demographic characteristics: personality: type D personality was a risk factor for subjective social isolation (β = 0.185, p = 0.005); marital status: married patients experienced lower subjective social isolation (β = 0.358, p < 0.001); age was positively correlated with subjective social isolation (β = 0.305, p < 0.001). Having cancer: disease stage: patients with late-stage disease had high levels of subjective social isolation (β = 0.166, p = 0.003).
He et al., 2023, China [10]	To investigate the social isolation subtypes of patients with breast cancer (BC) and explore its influencing factors.	303 women with breast cancer	20-item Chinese version of the Loneliness Scale (C-LS); 6-item Chinese version of the Social Anxiety Scale (C-SAS); 14-item Chinese version of the Social Avoidance and Distress Scale (C-SADS); 5-item Family APGER Index; 15-item Chinese version of the Self-Transcendence Scale (C-STS)	Demographic characteristics: monthly family income was negatively correlated with social isolation (p < 0.001). Having cancer: patients accepting surgery or chemotherapy were more likely to suffer from social isolation (p < 0.001). Health status: psychological health status: levels of self-transcendence were negatively correlated with social isolation (p < 0.001). Social support and social interaction: family function was negatively correlated with social isolation (p < 0.001).
Hill and Frost. 2022, USA [58]	To examine variables that might be associated with elevated loneliness and play a role in the loneliness–psychological distress relationship among women with ovarian cancer.	125 women with ovarian cancer	20-item UCLA Loneliness Scale-Version 3 (UCLA-V3); the depressive and anxiety symptoms subscales (7 items each) from the Depression Anxiety Stress Scales (DASS-21); 10-item The Self-Perceived Burden Scale (SPBS); The Social Network Index (SNI); Two subscales of the COPE	Health status: psychological health status: self-perceived burden was positively correlated with loneliness (p < 0.001). Social support and social interaction: the level of social network diversity was negatively correlated with loneliness (p < 0.001).
Hyland et al., 2019, USA [59]	To investigate the relationship between loneliness, depressive symptoms, quality of life, and social cognitive variables (e.g., stigma, social constraint, cancer-related negative social expectations) and explore loneliness as a mediator of the relationship between social cognitive variables and depressive symptoms and quality of life in lung cancer patients beginning treatment.	105 lung cancer patients	20-item UCLA Loneliness Scale-Version 3 (UCLA-V3); 21-item Cataldo Lung Cancer Stigma Scale-Shortened Version (CLCSS-SV); 15-item Social Constraint Scale-Cancer Version (SCS-CV); 5-item Cancer-related Negative Social Expectation Scale (CNSES); 37-item Functional Assessment of Cancer Therapy-Lung (FACT-L); 20-item Center for Epidemiological Studies Depression Scale (CES-D)	Demographic characteristics: marital status: being unmarried was associated with greater loneliness (p < 0.05); smoking status: current smokers reported greater loneliness than non-current smokers (p < 0.05). Health status: physical health status: performance status was negatively correlated with loneliness (p < 0.05); psychological health status: stigma and negative social expectation were positively correlated with loneliness (all p < 0.001). Social support and social interaction: social constraint was positively correlated with loneliness (p < 0.001).
Kavalalı Erdoğan and Koç, 2021, Turkey [60]	To determine the relationships among loneliness, death perception, and spiritual well-being in adult oncology patients.	347 cancer patients	10-item UCLA Loneliness Scale(version 3); 15-item Personal Meanings of Death Scale; 12-item Functional Assessment of Chronic Illness Therapy–Spiritual Well-being Scale (FACIT-Sp)	Health status: psychological health status: spiritual well-being was negatively correlated with loneliness (r = −0.217, p < 0.01).
Kömürcü et al., 2014, Turkey [61]	To determine the impact of illness on marriage and the level of loneliness for women diagnosed with gynecologic cancer.	95 women with gynecologic cancer	20-item UCLA loneliness scale	Demographic characteristics: age was negatively correlated with loneliness (p = 0.006). Having cancer: cycle of chemotherapy was positively correlated with loneliness (p = 0.049). Social support and social interaction: patients who perceived isolation from their spouse had higher loneliness than the other patients (p = 0.007).
Kosugi et al., 2021, Japan [62]	To investigate the association between loneliness and the frequency of using online peer support groups among cancer patients with minor children.	334 cancer patients with minor children	20-item UCLA loneliness scale (version 3); 6-item Lubben Social Network Scale (LSNS-6); 6-item K6 scale	Health status: psychological health status: distress was positively correlated with loneliness (OR = 1.16, 95% CI 0.73–0.83). Social support and social interaction: so cial networks and frequent use of online peer support groups were negatively correlated with loneliness (OR = 0.78, 95% CI 1.09–1.23).
Liang et al., 2022, China [63]	To investigate the status and influencing factors of social isolation in cervical cancer survivors and provide a reference for implementing targeted intervention measures.	363 cervical cancer patients	15-item General Alienation Scale (GAS); 24-item Social Impact Scale (SIS); 10-item Social Support Rating Scale (SSRS)	Demographic characteristics: monthly family income was negatively correlated with subjective social isolation (β = −2.371, p < 0.001). Having cancer: time since last treatment was negatively correlated with subjective social isolation (β = −2.538, p < 0.001). Health status: psychological health status: stigma was positively correlated with subjective social isolation (β = 0.120, p < 0.001). Social support and social interaction: soc ial support was negatively correlated with subjective social isolation (β = −0.284, p < 0.001).
Lin et al., 2024, China [64]	To identify the factors associated with loneliness among patients with cancer in China.	205 cancer patients	7-item Cancer Loneliness Scale (CLS); 10-item Social Support Rating Scale (SSRS); 14-item Hospital Anxiety and Depression Scale (HADS); 5-item Cancer-Related Negative Social Expectations Scale (C-rNSES)	Health status: psychological health status: depression (β = 0.262, p = 0.001) and negative social expectation (β = 0.327, p < 0.001) were positively correlated with loneliness. Social support and social interaction: social support was negatively correlated with loneliness (β = −0.294, p < 0.001).
Liu et al., 2021, China [22]	To explore the correlations among social isolation and symptoms of anxiety and depression among patients with breast cancer in China and further verify the mediating role of social support in social isolation and symptoms of depression or anxiety.	389 female inpatients diagnosed with breast cancer	14-item Hospital Anxiety and Depression Scale; 10-item Social Support Rating Scale; 6-item social isolation scale with reference from the simplified version of Lubben’s Social Network	Health status: psychological health status: anxiety (r = 0.369, p < 0.01) and depression (r = 0.466, p < 0.01) were positively correlated with objective social isolation. Social support and social interaction: social support was negatively correlated with objective social isolation (r = −0.223, p < 0.01).
Liu et al., 2021, China [65]	To investigate the status of social isolation among lung cancer survivors and analyze its influencing factors.	228 lung cancer survivors	15-item General Alienation Scale (GAS); 10-item Self-Esteem Scale (SES); 12-item Perceived Social Support Scale (PSSS)	Demographic characteristics: education level was negatively correlated with subjective social isolation (β = −2.296, p < 0.001). Having cancer: time after cure was negatively correlated with subjective social isolation (β = −3.204, p < 0.001). Health status: psychological health status: self-esteem was negatively correlated with subjective social isolation (β = −0.432, p < 0.001). Social support and social interaction: perceived social support was negatively correlated with subjective social isolation (β = −0.217, p < 0.001).
Miaskowski et al., 2021, USA [66]	To determine the prevalence of loneliness in a sample of oncology patients; evaluate differences in demographic, clinical, and symptom characteristics between lonely and nonlonely patients; and determine which demographic, clinical, and symptom characteristics were associated with membership of the lonely group.	606 cancer patients	20-item UCLA Loneliness Scale-Version 3 (UCLA-V3); 6-item Social Isolation Scale (SIS); Center for Epidemiological Studies–Depression scale (CES- D); Spielberger State-Trait Anxiety Inventories (STAI-S, STAI-T); General Sleep Disturbance Scale (GSDS); Lee Fatigue Scale (LFS); Attentional Function Index; Brief Pain Inventory	Demographic characteristics: marital status: married patients had lower loneliness (OR = 2.94, 95% CI 1.69–5.00). Health status: psychological health status: anxiety (OR = 3.17, 95% CI 1.86–5.39) and depression (OR = 3.24, 95% CI 1.85–5.67) were positively correlated with loneliness. Social support and social interaction: obje ctive social isolation was positively correlated with loneliness (OR = 0.66, 95% CI 0.60–0.72).
Wang et al., 2020, China [67]	To study the status quo and influencing factors of social isolation among breast cancer survivors and provide a reference for future nursing interventions for this group.	228 breast cancer patients	20-item UCLA Loneliness Scale; 28-item Social Avoidance Scale (GAS); 6-item Social Anxiety Scale (SAS); 20-item modified Medical Coping Modes Questionnaire (MCMQ)	Demographic characteristics: age and education level were negatively correlated with social isolation; marital status: married patients experienced lower social isolation; occupation status: patients who were unemployed or on sick leave had higher scores for social isolation compared to working and retired cancer survivors (all p < 0.05). Having cancer: operation mode: patients who underwent radical mastectomy had higher social isolation scores than those who underwent breast-conserving therapy; postoperative time was negatively correlated with social isolation (all p < 0.05). Coping: avoidance and yield coping were positively correlated with social isolation (all p < 0.05).
Wang et al., 2021, China [68]	To investigate the clinical characteristics of loneliness in patients from the oncology department.	344 cancer patients	20-item UCLA Loneliness Scale-Version 3 (UCLA-V3)	Demographic characteristics: gen der: female patients had higher loneliness (p < 0.001); residence: rural patients had higher loneliness than country and urban patients (p = 0.005); education level was negatively correlated with loneliness (p = 0.006); medical insurance: patients who bought new rural medical insurance felt more loneliness than those who bought resident medical insurance, employee medical insurance, and business insurance (p = 0.001). Having cancer: treatment stage: patients accepting chemotherapy had higher loneliness (p < 0.001); awareness of diagnosis: informed patients had more loneliness than ignorant patients (p = 0.001).
Wang et al., 2022, China [69]	To study the status and influencing factors of social isolation among colorectal cancer patients with an ostomy and provide a reference for helping these patients return to society.	277 colorectal cancer patients	15-item General Alienation Scale (GAS); 24-item Social Impact Scale (SIS)	Demographic characteristics: primary caregiver: patients whose primary caregiver was their parent reported the highest levels of subjective social isolation, followed by spouses and then children (p = 0.013). Having cancer: type of ostomy: subjective social isolation scores were higher in patients with temporary enterostomy than in patients with permanent enterostomy (β = 5.382, p < 0.001); the number of hospitalizations: patients who were hospitalized more often had higher subjective social isolation scores than those who were hospitalized less often (β = 4.465, p < 0.001). Health status: psychological health status: stigma was positively correlated with subjective social isolation (β = 0.843, p < 0.001).
White et al., 2023, USA [70]	To assess the impact of the COVID-19 pandemic on depression, anxiety, and loneliness between those with and without a history of cancer.	16,231 individuals with a history of cancer and 88,409 without a history of cancer	3-Item Loneliness Scale; the Generalized Anxiety Disorder 2-item (GAD-2); the Patient Health Questionnaire-2 item (PHQ-2)	Demographic characteristics: age was negatively correlated with loneliness (p < 0.05); gender and comorbidity: female patients and patients with comorbidity burden were more likely to suffer from loneliness (p < 0.05); race and smoking status: non-Hispanic White participants and smokers experienced a higher degree of loneliness compared to non-Hispanic Black and non-Hispanic Asian patients and never-smokers, respectively (all p < 0.05). Psychological factors: psychological health status: anxiety and depression were positively correlated with loneliness (p < 0.05).
Xia et al., 2023, China [71]	To assess the loneliness, spiritual well-being, and death perception, as well as their risk factors in urological cancer patients.	324 urological (including renal, bladder, and prostate) cancer patients and 100 healthy controls	20-item UCLA Loneliness Scale-Version 3 (UCLA-V3); 12-item Functional assessment of chronic illness therapy–spiritual well-being (FACIT-Sp); 32-item Death attitude profile-revised (DAP-R)	Demographic characteristics: marital status: married patients had lower loneliness (t = −2.331, p = 0.020). Having cancer: bladder cancer (vs prostate and renal cancer) patients had higher scores of loneliness (t = −3.058, p = 0.002); systemic treatment was independently correlated with a higher UCLA-LS score than surgery treatment, local treatment, and other treatments (t = −3.579, p < 0.001).
Zhang et al., 2022, China [72]	To explore the mediating effect of social isolation on the fear of cancer recurrence and sleep quality in convalescent breast cancer patients.	338 breast cancer patients	15-item General Alienation Scale (GAS); 12-item Fear of Progression Questionnaire-short Form (FoP-Q-SF); 18-item Pittsburgh Sleep Quality Index (PSQI)	Health status: physical health status: the total scores of subjective social isolation were positively correlated with the total scores of sleep quality (r = 0.432, p < 0.01); psychological health status: fear of cancer recurrence was positively correlated with subjective social isolation (r = 0.485, p < 0.01).
Combined Quantitative and Qualitative Studies
Authors, Year, Country [Citation Number]	Aims	Samples	Instrument Used	Key Findings and Classifications of Influencing Factors
Clifton et.al, 2022, USA [73]	To assess loneliness, social isolation, and social support in older adults with cancer during the pandemic.	100 older adults with cancer	UCLA Loneliness Scale long form and UCLA Three Item Loneliness Scale; PROMIS Bank Emotional Support Short Form 4a—Version 2; PROMIS Bank Social Isolation Short Form 8a—Version 2; MOS Social Support Survey; Open-ended qualitative interviews	Demographic characteristics: gender and marital status: female patients and married patients had lower loneliness; family income was negatively correlated with loneliness; residence: higher rates of loneliness were associated with individuals living alone or with an individual other than a spouse (all p < 0.05). Social support and social interaction: emotional support was negatively correlated with loneliness (r = −0.40, p < 0.05).