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Marriage associated with better cancer outcomes

Wednesday September 25, 2013
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Patients with cancer who were married at diagnosis live markedly longer compared with unmarried patients, according to new results from a large retrospective study.

Researchers also found married patients are more likely to be diagnosed earlier and much more likely to receive appropriate therapy. This study is the first to show a consistent and significant benefit of marriage on survival for each of the 10 leading causes of cancer-related death in the U.S. ─ lung, colorectal, breast, pancreatic, prostate, liver/bile duct, non-Hodgkin lymphoma, head and neck, ovarian and esophageal cancer.

“Marriage probably improves outcomes among patients with cancer through increased social support,” lead study author Ayal Aizer, MD, MHS, a chief resident in radiation oncology at Harvard Medical School in Boston, said in a news release. “Our results suggest that patients who are not married should reach out to friends, cancer support or faith-based groups and their doctors to obtain adequate social support.”

Past studies have shown social support — including help with decision-making, instruction regarding coping strategies and management of depression and anxiety — extends survival after a cancer diagnosis. For married patients, spouses typically are their primary sources of social support.

The study, published Sept. 23 on the website of the Journal of Clinical Oncology, assessed clinical and demographic data from the National Cancer Institute’s Surveillance, Epidemiology and End Results registry for 734,889 patients diagnosed between 2004 and 2008. For each form of cancer, researchers assessed the association between marital status and stage at diagnosis, receipt of appropriate therapy and cancer-specific survival.

Overall, patients who were married were 17% less likely to have metastatic disease when first diagnosed with cancer compared with unmarried patients, the analysis found. Married patients with nonmetastatic disease were 53% more likely to receive therapy indicated for their disease than unmarried patients. The researchers also found at any given time a married patient was 20% more likely to be alive than an unmarried patient.

Longer follow-up is needed to determine how much longer married patients live on average, the authors wrote. But after controlling for cancer stage at diagnosis, married patients on average were more likely to live longer.

To ensure the benefits were because of marriage and not another associated factor such as household income, researchers accounted for differences in baseline characteristics between married vs. unmarried patients. They also adjusted for other factors such as age, gender, education level and urban or rural residence.

For patients with prostate, breast, colorectal, esophageal and head and neck cancers, marriage was associated with a larger survival increase than standard chemotherapy regimens based on published clinical trial/meta-analysis results.

“This finding suggests that there may be ways to improve cancer outcomes in addition to anti-cancer therapy,” senior study author Paul Nguyen, MD, an assistant professor of radiation oncology at the Dana-Farber/Brigham and Women’s Cancer Center in Boston, said in the release. “Improving social support for our patients may be equally important as providing effective therapy, and it is less costly to develop and implement.”

According to Nguyen, individual physicians, nurses, hospitals, health insurance companies and other healthcare entities need to focus more on providing support for unmarried patients and making sure their needs are met.

A prospective, randomized clinical trial is needed to confirm these results, the authors wrote, and more research should be done to identify the social support services most helpful for unmarried patients with cancer.

Study abstract: http://jco.ascopubs.org/content/early/2013/09/18/JCO.2013.49.6489.abstract


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