Abstract
BACKGROUND: To date, the social participation of breast cancer survivors has mainly been studied in terms of their return to work, while long-term studies on participation in social activities are rare. Against this backdrop, we analyze the influence of socioeconomic and sociodemographic factors on breast cancer survivors' social activities on average five years following first surgery. Furthermore, we identify social subgroups that are most affected by low levels of social activities, taking long-term breast cancer-related complaints into account. METHODS: The study population is based on a multicenter longitudinal study on return to work after breast cancer. We used data of a third follow-up study with n = 372 breast cancer survivors, corresponding to a response rate of 81.9% with regard to the first sample. Participation in social activities comprises the dimensions of 'sociocultural participation', 'social participation in institutions' and 'social participation in the private sphere'. Logistic regression analyses and CHAID decision tree analyses were applied to analyze the influence of socioeconomic factors (school education, income and occupational position), sociodemographic factors (age, marital status, labor force participation and migration status) and the number of cancer-related complaints on social participation. RESULTS: Five years after the primary surgery, younger survivors (≤ 61 years) with a high number of breast cancer-related complaints showed the greatest limitations in 'social participation in the private sphere'. Marital status, labor force participation and migration status were of less importance in all the dimensions of social participation considered. By contrast, all socioeconomic factors proved to be significantly associated with sociocultural participation. In particular, women with a low household income with more than two breast cancer-related complaints were identified as a vulnerable group in terms of low sociocultural participation. CONCLUSIONS: We found evidence of social inequalities in participation in social activities among breast cancer survivors. Our results indicate that a comprehensive assessment of social participation and early intervention are required to prevent long-term limitations in social activities, especially in socially disadvantaged breast cancer survivors.