Exploring Loneliness in the Context of Cancer
: A Mixed Methods Study

  • Kathryn Cunningham

    Student thesis: Doctoral ThesisDoctor of Philosophy


    Background: Psychosocial loneliness is an unpleasant and distressing experience arising from subjective discrepancies between a person’s desired and actual social relationships. An increasingly common problem in UK society, loneliness is linked with serious adverse mental health outcomes and poses a significant risk to physical health, which several experts suggest is as great as smoking and obesity. In recent years leading cancer care organisations have raised awareness of the existence of loneliness and its potential importance in the context of cancer; however little attention has been paid in the literature or in clinical practice to understanding, identifying and alleviating loneliness.

    Aims: The project reported in this thesis aimed to: 1) clarify the conceptual and theoretical meaning of ‘loneliness’; 2) enhance understanding of loneliness in people living with and beyond cancer; and 3) develop an assessment tool for ‘cancer-related loneliness following treatment completion’.

    Methods: The project began with a theoretical concept analysis of ‘loneliness’. This was followed by a systematic scoping review of loneliness and cancer. Gaps in the knowledge base were addressed by means of an exploratory mixed methods study. Phase 1 involved collection of quantitative data concerning loneliness from 107 individuals living with and beyond cancer. Descriptive and inferential statistical analysis of the data was conducted. Phase 2 involved the undertaking of semi-structured interviews with 12 individuals living with and beyond cancer who scored highly for loneliness in phase 1. Thematic Framework Analysis was employed to analyse the interview data. The findings of the qualitative phase, together with the initial conceptual work and the findings of the literature review were employed to develop the Cancer-related Loneliness Assessment Tool. Preliminary cognitive testing of this tool was conducted.

    Findings: Loneliness results from an interaction between personal and situational factors and is better viewed as an individual process rather than as a clinical condition for which specific diagnostic symptoms and cut-offs exist. The experience of loneliness appears to transcend the boundaries of cancer diagnosis, stage of disease, tumour site and treatment modality. The results of the quantitative phase indicated that participants in the study experienced, on average, ‘moderate’ levels of loneliness. In the study sample age was an independent predictor of cases of loneliness – the odds of individuals aged <30-59 being lonely were 23 times those of individuals aged 70+. Employment status was significantly associated with loneliness scores – non-employed individuals had higher loneliness scores than did employed individuals and retired individuals. The qualitative phase identified a contextual loneliness termed ‘cancer-related loneliness following treatment completion’. Such loneliness is a result of perceived social, emotional, cultural and healthcare-related relationship deficiencies stemming from or exacerbated by cancer-related sources. Loneliness emanating from deficiencies in relationships with healthcare professionals – termed healthcare-related loneliness – has not previously been referred to in the loneliness literature. The Cancer-related Loneliness Assessment Tool operationalised ‘cancer-related loneliness following treatment completion’ and preliminary cognitive testing indicated that the items generate the information intended and that individuals have little trouble completing the assessment tool.

    Conclusions: Cancer-related loneliness following treatment completion should be addressed as part of comprehensive cancer care. Following further development, the Cancer-related Loneliness Assessment Tool could facilitate identification of loneliness in clinical practice. It could also aid with the development/adaptation and evaluation of interventions to address loneliness. Healthcare-related loneliness should be added to the existing tripartite (social, emotional and cultural) typology of loneliness, creating a quadripartite typology that encompasses all types of relationship deficits that can beget loneliness.
    Date of Award2014
    Original languageEnglish
    SupervisorElena Wells (Supervisor)


    • Loneliness
    • Psychosocial Oncology
    • Mixed Methods
    • Cancer Care

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