Can your marital status affect your cancer risk and outcomes?
A recent large study examined the impact of marital status on stage at cancer diagnosis, use of definitive therapy, and cancer specific mortality among each of the ten leading causes of cancer-related deaths in the US.
Data from the Surveillance Epidemiology and End Results (SEER) program was reviewed for over 734,000 patients diagnosed in 2004 through 2008 with lung, colorectal, breast, pancreatic, prostate, liver, non-Hodgkin lymphoma, head-neck, ovarian, or esophageal cancer.
Among all cancers examined, patients who were married were more likely to have a better prognosis, along with a better quality of life:
- Married patients were less likely to present with metastatic disease.
- More likely to receive definitive therapy.
- Less likely to die as a result of their cancer after adjusting for demographics, stage and treatment.
- The benefit associated with marriage was greater for males than females.
After adjusting for demographics such as age, income level, education, tumor stage, and geographical location, the analysis showed that married people were less likely to be diagnosed with metastatic cancer. Furthermore, those who were married were more likely to receive surgery or radiotherapy compared with those who were not married.
According to researchers, marital status was used as a surrogate marker for social support. Support by the marriage itself rather than characteristics associated with married patients, is responsible for better outcomes compared with unmarried counterparts. Providing support for this hypothesis is the result that those who were widowed, separated or divorced were as likely as those who were never married to present with metastatic cancer, to be under-treated and to die of their disease.
Should the clinician recognize a patient's single status as a warning sign for possible lack of social support? Communication skills are important as one would want to explore the social supports available for our cancer patients.
From a personal perspective, I can certainly attest to the value of a partner. Through my initial diagnosis and the shocking side effects from treatment, my husband has been my strength. He is always there to find a bright spot in an otherwise difficult situation. This support has helped me get through the worry of what I call "scanxiety".
The take-home message from this study emphasizes the need to ask patients about support that can be provided by a spouse, family members, or friends. For those patients without apparent support, efforts should be made to involve social workers, mental health professionals and other clinicians to improve the quality of life for our patients.
Do you find that your cancer patients who are married or who have a partner have a better outcome overall?