In addition to Aizer and Nguyen, the study's other authors are Ming-Hui Chen, MD, of the University of Connecticut, Storrs; Mallika Mendu, MD, and Sophia Koo, MD, of Brigham and Women's; Ellen McCarthy, PhD, Powell Graham and Tyler Wilhite, of Harvard Medical School; Toni Choueiri, MD, and Neil Martin, MD, Dana-Farber and Brigham and Women's; Jim Hu MD MPH, of the University of California, Los Angeles; and Karen Hoffman MD MPH MHSc, of MD Anderson Cancer Center, Houston.
The study was funded in part by Heritage Medical Research Institute/Prostate Cancer Foundation Young Investigator Award, JCRT Foundation Grant, Fitz's Cancer Warriors, David and Cynthia Chapin, and a grant from an anonymous family foundation.
*ABSTRACT: Marital Status and Survival in Patients With Cancer, ©American Society of Clinical Oncology
Purpose To examine the impact of marital status on stage at diagnosis, use of definitive therapy, and cancer-specific mortality among each of the 10 leading causes of cancer-related death in the United States.
Methods We used the Surveillance, Epidemiology and End Results program to identify 1,260,898 patients diagnosed in 2004 through 2008 with lung, colorectal, breast, pancreatic, prostate, liver/intrahepatic bile duct, non-Hodgkin lymphoma, head/neck, ovarian, or esophageal cancer. We used multivariable logistic and Cox regression to analyze the 734,889 patients who had clinical and follow-up information available.
Results Married patients were less likely to present with metastatic disease (adjusted odds ratio [OR], 0.83; 95% CI, 0.82 to 0.84; P < .001), more likely to receive definitive therapy (adjusted OR, 1.53; 95% CI, 1.51 to 1.56; P < .001), and less likely to die as a result of their cancer after adjusting for demographics, stage, and treatment (adjusted hazard ratio, 0.80; 95% CI, 0.79 to 0.81; P < .001) than unmarried patients. These associations remained significant when each individual cancer was analyzed (P < .05 for all end points for each malignancy). The benefit associated with marriage was greater in males than females for all outcome measures analyzed (P < .001 in all cases). For prostate, breast, colorectal, esophageal, and head/neck cancers, the survival benefit associated with marriage was larger than the published survival benefit of chemotherapy.
Conclusion Even after adjusting for known confounders, unmarried patients are at significantly higher risk of presentation with metastatic cancer, undertreatment, and death resulting from their cancer. This study highlights the potentially significant impact that social support can have on cancer detection, treatment, and survival.
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