Is Marital Status Associated With Bladder Cancer Outcome?

An existing body of literature shows that marital status and related social support are connected with disease outcomes.

A new study found that marital status is significantly associated with outcomes in patients with bladder cancer, and this was true across disease stage. This adds to an existing body of literature showing that marital status and related social support are connected with disease outcomes.

“Marital status is commonly used as a marker of social support. Those patients who are married may enjoy increased financial resources, can experience social support, may have high quality of life, tend to have a healthier lifestyle, and receive better treatment than those who are unmarried,” wrote study authors led by Junjie Yu, MD, of Yangzhou University in China. Better outcomes have been seen in a number of malignancies for married patients, including urothelial carcinoma, but little data previously existed on this association according to stage and grade at diagnosis.

The new study used data on 133,846 urothelial carcinoma patients from the Surveillance, Epidemiology, and End Results (SEER) database; all patients were diagnosed between 1988 and 2009. Of those, 101,411 patients were men; 66.6% of the cohort were married, 15.6% were widowed, 9.9% were never married, and 7.8% were divorced/separated. The results of the analysis were published in July in Medicine.

The 5-year urothelial carcinoma cause-specific survival (CSS) rate among married patients was 85.7%; single patients had a 5-year CSS rate of 81.4%, divorced/separated patients had a rate of 79.7%, and widowed patients had a rate of 72.7%. On a multivariate analysis, these differences were all significant; for widowed patients compared with married patients, the hazard ratio was 1.674 (95% CI, 1.621–1.729), while for divorced/separated patients it was 1.253 (95% CI, 1.200–1.307) and for single patients it was 1.282 (95% CI, 1.232–1.335; P < .001 for all).

Marital status was an independent factor for CSS across each disease stage. Further, widowed patients had the lowest survival rate in a comparison across pathologic grades, with married patients again having the best outcomes.

“To improve postoperative survival, close social and family care may improve the survival outcomes for unmarried patients, especially for those who were widowed,” the authors concluded.

Leslie Hinyard, PhD, of Saint Louis University, has studied the effects of marital status on outcomes in other malignancies. She said this particular result is not surprising, given that being married has now been associated with better health outcomes in a variety of realms. “What is important to remember … is that marital status is really serving as a proxy for some other underlying mechanism,” she told Cancer Network. “It may be that social support is really what is important and marital status is serving as an indicator of social support. Alternatively, it could be a selection bias in that healthier patients are more likely to be married or that providers interact differently with married patients vs unmarried patients.” She said that studies using aggregate data like that from SEER should be considered hypothesis generating and a starting point for future studies.