Marital Status Can Affect Cancer Survival

Roxanne Nelson

August 26, 2009

August 26, 2009 — Marital status might have an impact on cancer survival, according to a new study published online August 24 in Cancer. Married patients had the highest survival rates, and those who were undergoing a marital separation at the time of diagnosis had the lowest rates. After married patients, the next highest survival rates, in descending order, were in those who were widowed, divorced, and never married at the time of diagnosis.

The researchers found that at the upper end of the spectrum, married patients had 5-year survival rates of 63.3% and 10-year survival rates of 57.5%. Conversely, patients who were separated had the poorest survival; 5- and 10-year survival rates for separated patients were 45.4% and 36.8%, respectively.

"Patients who are going through a separation at the time of diagnosis may be a particularly vulnerable population for whom intervention could be prioritized," said lead author Gwen Sprehn, PhD, from the Indiana University School of Medicine in Indianapolis, in a statement. "Identification of relationship-related stress at time of diagnosis could lead to early interventions that might favorably [affect] survival."

The researchers note that personal relationships have persistently played a significant role in physical health, in that good relationships are beneficial and poor relationships can adversely affect health. Previous studies have also shown that married cancer patients have better survival than unmarried patients; it has been speculated that married patients have better support networks, which could lead to improved treatment compliance.

However, disruption of a close relationship and abrasive relationships can negatively affect the immune system, the authors explain. Pituitary and adrenal hormones can also be altered by discordant or hostile relationships.

Poorest Outcomes in Separated Patients

Previous studies have focused on whether patients were married or unmarried, so less information is available concerning the specific subtype of unmarried status at time of diagnosis (divorced, widowed, separated, and single). The researchers hypothesized that the specific subtype of marital status at time of cancer diagnosis would have a differential impact on survival, with separation having the poorest outcome.

Dr. Sprehn and colleagues used data from the Surveillance, Epidemiology, and End Results (SEER) database, and the records of 3.79 million patients were included in their analysis. They specifically analyzed 5- and 10-year relative survival, defined as "observed survival divided by observed survival of an age-matched, race-matched, and gender-matched population without disease, for all cancer patients by marital status, with specific subset analyses as indicated."

5- and 10-Year Survival Stratified by Marital Status

Status 5-Year Survival (%) 10-Year Survival (%)
Married 63.3 57.5
Never married 57.3 51.7
Divorced 52.4 45.6
Widowed 47.2 40.9
Separated 45.4 36.8

Stress Could Be Primary Culprit

The researchers speculate that the survival benefit observed in married patients could be due to a number of interrelated factors. One is the special characteristics of the married population, such as greater financial stability and support. Some studies have also shown that married patients often receive more aggressive treatment for their cancer.

They also note that separation is a unique marital status that carries with it a degree of uncertainty. The stress of separation can compromise the immune system, and they point out that stress has been shown to "cause an increase in proinflammatory cytokines, adhesion molecules, and acute-phase reactants, leading to central nervous system changes, with sequelae including depression, fatigue, impaired sleep, and cognitive dysfunction."

The role of stress and cancer is likely "bidirectional," they write; patients under stress can have a compromised immune system, and a cancer diagnosis and marital separation are both major causes of stress.

"Ideally, future research will study marital status in more detail over time and address individual differences in genetic profile and biomarkers related to stress, immune, and cancer pathways in order to determine mechanisms that might underlie this possible critical period for cancer pathogenesis," said Dr. Sprehn.

The study was supported in part by a grant from the Office of Cancer Survivorship of the National Cancer Institute.

Cancer. Published online August 24, 2009. Abstract

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