Ayal A. Aizer, Ming-Hui Chen, Ellen P. McCarthy, Mallika L. Mendu, Sophia Koo, Tyler J. Wilhite,,Powell L. Graham, Toni K. Choueiri, Karen E. Hoffman, Neil E. Martin, Jim C. Hu, and Paul L. Nguyen
Journal of Clinical Oncology, Sept. 2013
Unmarried patients diagnosed with cancer are at a substantially higher risk of having advanced disease, of being undertreated and of dying of their disease. The features of marriage that contribute to a protective effect were explored in this study.
Using the Surveillance, Epidemiology and End Results (SEER) database, more than 700,000 patients with one of the ten leading causes of cancer related deaths were identified. The association of marital status on stage at diagnosis revealed that married patients had a much greater chance of having cancer found while it was localized, as opposed to metastatic or advanced. This finding was more striking for men with prostate cancer and women with breast cancer, but it was also seen in all other cancers studied.
For those with localized disease, married people were more likely to undergo curative therapy than unmarried. Death related to the cancer was more common among unmarried people whether or not they underwent curative therapy. The impact of marriage was greater for men than for women.
These findings highlight the importance of marriage particularly social support on cancer detection, treatment and survival. Married people may have better access to healthcare and encouragement from their spouse to seek medical attention and to undergo curative therapy. Married patients are more likely to adhere to prescribed therapies, leading to an improvement in survival. Patients who are married display less distress, depression, and anxiety than their unmarried counterparts after a diagnosis of cancer, as a partner can share the emotional burden and provide appropriate social support. Studies have suggested that unmarried patients are more likely to smoke and/or use alcohol, factors which may contribute to the poorer outcomes.
To evaluate whether unmarried people are innately different than married people, the data was reanalyzed identifying single people as never married, separated, divorced or widowed. As compared to married patients, all causes of singlehood fared worse. The data also found that living with someone other than a spouse (eg, a roommate or child) does not provide the same protective effects on cancer outcome as a marriage.
This study identifies a population that may be at risk of poorer outcomes, a risk which may be ameliorated to some extent by support services. Physicians caring for unmarried patients should be aware of the delay in diagnosis and encourage patients to pursue evaluation and therapy. Single people with cancer should be screened for depression and risky habits that may impact their survival.
These findings raise the possibility that investments in targeted social support interventions aimed at unmarried patients could significantly improve the likelihood of achieving a cure or prolonging survival. Given that patients who lack emotional support mechanisms do poorly after diagnosis with numerous healthrelated conditions,the importance of adequate support cannot be understated.
The study is available here.