Examining the Life-Saving Effects of Marriage
A large study connects marriage to improved outcomes for patients with cancer.
There are two things I credit my mother's 7-month survival after a diagnosis of double-hit lymphoma—the excellent care she received from her oncology team and the fact that my father never left her side.
He sat with her each day, took detailed notes, asked follow-up questions, and served as her advocate.
At the point of diagnosis, her health care team tentatively treated this aggressive disease and were uncertain if she would survive the first chemotherapy treatment.
But she did, and several months later she entered a rehabilitation facility between chemotherapy treatments in an effort to regain her strength. From expecting only days to gaining months, my mother's oncologist credited my father's continuous presence for my mother's longevity. Ultimately, she succumbed to the disease, but those months bought our family the precious gift of time.
When patients are married at the point of a cancer diagnosis, they tend to live longer than unmarried patients, according to a recent article published in the Journal of Clinical Oncology. New results from a large study of the National Cancer Institute's Surveillance, Epidemiology and End Results database show that married patients are often diagnosed with an earlier stage of cancer and seek appropriate treatment for their specific disease more than unmarried patients.
This study—the first of its kind—demonstrated a noteworthy benefit of marriage on survival in lung, colorectal, breast, pancreatic, prostate, liver/bile duct, non-Hodgkin lymphoma, head and neck, ovarian, and esophageal cancer; diseases that result in more than 15,000 deaths in the United States annually.1
Researchers at Harvard Medical School looked at clinical and demographic data from the SEER registry of 734,889 patients diagnosed between 2004 and 2008 and assessed the association between marital status and stage at diagnosis, type of therapy received, and survival. The results show that married patients were less likely to present with metastatic disease (adjusted odds ratio [OR], 0.83; 95% CI: 0.82 to 0.84; P < 0.001), more likely to receive definitive therapy (adjusted OR, 1.53; 95% CI: 1.51 to 1.56; P < 0.001), and less likely to die of cancer than unmarried patients. These results accounted for patient demographics, stage of disease at diagnosis, and treatment (adjusted hazard ratio, 0.80; 95% CI: 0.79 to 0.81; P < 0.001)1, discounting other factors such as household income as the reason for observed improved outcomes among married patients.
Unmarried Patients Need Stronger Social Support
This study highlights the fact that unmarried patients, including those who are widowed, need additional social support because there is a relationship between marital status and adherence to medical recommendations.1 A married partner may nudge a spouse to seek treatment for symptoms that lead to early diagnosis, and encourage the patient to undergo treatment and follow-up care, according to the study.
“As doctors, we should assess what level of social support our unmarried patients have—who's helping them shoulder the burden of this diagnosis, who's going to take them to doctors' appointments, and make sure they're coping with the mental, emotional, and physical stresses of cancer. If they don't have enough support, we need to engage the help of family, friends, social workers, mental health professionals, faith-based organizations, and cancer support groups to get patients the support that they need,” said lead study author Ayal Aizer, MD, MHS, a chief resident in radiation oncology at Harvard Medical School in Boston, MA.
The point of diagnosis can be overwhelming for patients, so it's important for the medical team to share information about patient resources; explain what an oncology social worker does; and tell patients about types of support groups, such as the ones listed on the CancerCare.org site, which include online, phone, as well as face-to-face groups. All of these support mechanisms may help patients adhere to recommended treatments, and perhaps help unmarried patients experience better outcomes.
- Aizer AA, Chen MH, McCarthy EP, et al. Marital Status and Survival in Patients with Cancer. J Clin Oncol. Epub ahead of print. Sep 23, 2013. DOI: 10.1200/JCO.2013.49.6489
- DiMatteo MR, Lepper HS, Croghan TW: Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 160:2101-2107, 2000.