Married Individuals Less Likely to Be Diagnosed With Advanced Cancer

A large study shows a difference in the cancer outcomes of married and unmarried individuals, finding that those who are married are less likely to be diagnosed with metastatic disease and to die of their cancer compared with those who are unmarried.

A large study shows a difference in the cancer risk and outcomes for married and unmarried individuals. An analysis of the 10 cancers that account for the most deaths shows that individuals who are married are less likely to be diagnosed with metastatic disease and to die of their cancer compared with those who are unmarried. The result was true for each cancer studied, including prostate, breast, lung, and colorectal cancers.

The benefit of marriage was higher for men compared with women. The results are published in the Journal of Clinical Oncology.

“We didn’t expect the beneficial effect of marriage to be as consistent or as large as we found in this study,” said Ayal A. Aizer, MD, a clinical fellow in radiation oncology at the Brigham and Women's Hospital in Boston, and first author of the study. “Among all 10 cancers we examined, patients who were married were more likely to present with localized cancer, receive more appropriate therapies, and live longer.”

While the National Cancer Institute has a significant investment in developing new cancer therapies, the researchers wanted to determine if improved social support could similarly affect cancer outcomes, said Aizer, who noted that social support is a relatively inexpensive intervention. “We used marital status as a surrogate marker for social support.”

Aizer, along with Paul L. Nguyen, MD, assistant professor in the department of radiation oncology at Harvard Medical School in Boston, and colleagues, used information from 734,889 patients in the Surveillance, Epidemiology and End Results (SEER) database.

Patients who were married were less likely to die of their cancer (hazard ratio [HR] = 0.80; P < .001), after adjusting for tumor stage, nodal stage, and therapy type. The association was statistically significant for all cancers analyzed.

After adjusting for demographics such as age, income level, education, tumor stage, and geographical location, the analysis showed that married patients were less likely to be diagnosed with metastatic cancer (odds ratio = 0.83; P < .001) compared with unmarried patients, regardless of the cancer analyzed.

Those who were married were more likely to receive surgery or radiotherapy compared with those who were not married (odds ratio = 1.53; P < .001). This was true for any of the cancers analyzed.

It may be that people who get married and stay married tend to have an overall healthy lifestyle and be less likely to engage in risky behaviors, such as excessive smoking or drinking. But, Aizer says that he believes the support by marriage itself, rather than other characteristics associated with married patients, is responsible for their 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 undertreated, and to die of their disease.

“Given that widowed patients were once married, and lost their spouse for reasons outside of their control, this speaks to the point that the support provided by marriage is the mediator of the effect seen in our study,” said Aizer.

Men appeared to benefit more from the effect of marriage, on stage of disease at diagnosis, the use of therapy, and even death from cancer compared with women (P < .001 for each factor).

Limitations of the study included a lack of information on chemotherapy treatment for each patient in the database; the chance that the study results may not extend to other cancers not yet evaluated; and the fact that some of the patients who were not married may have had a long-term partner that was not indicated in the SEER records.

Previous results assessing the impact of marriage on cancer survival have been conflicting. The current study is the first to show a consistent, positive effect for all cancer types tested, according to the researchers.

The authors are currently analyzing the effect of other social factors that could be associated with poor outcomes for cancer patients.

Aizer says that based on these results, physicians should ask patients about potential support that can be provided by a spouse, family members, and friends. As 51% of Americans are married, making sure a spouse or partner provides appropriate support and care can boost outcomes and quality of life for patients. “For those who don’t [have spouses], clinicians should consider involving social workers, mental health professionals, and/or other clinicians to improve the support that such patients receive,” said Aizer.

Even if social support does not ultimately lead to better clinical outcomes in all cases, such support can at least improve the quality of life for all patients.

As David W. Kissane, MD, of Monash University in Victoria, Australia, states in his editorial to the study, “Our humanity is relational at its essence-we are tribal people, drawn into connection with one another to share what is most meaningful and fulfilling in life. Our medicine needs to follow a parallel paradigm: healing care that is both person- and family-centered in its expression.”