Skip to main content

Advertisement

SpringerLink
Log in

Impact of marital status and race on outcomes of patients enrolled in Radiation Therapy Oncology Group prostate cancer trials

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Introduction

Previous studies by our group and others have demonstrated the importance of sociodemographic factors in cancer-related outcomes. The identification of these factors has led to novel approaches to the care of the high-risk cancer patient, specifically in the adoption of clinical interventions that convey similar benefits as favorable sociodemographic characteristics. This study examined the importance of marital status and race as prognostic indicators in men with prostate cancer.

Methods

This report is a meta-analysis of 3,570 patients with prostate cancer treated in three prospective RTOG clinical trials. The Kaplan–Meier method was used to estimate the survival rate and the cumulative incidence method was used to analyze biochemical failure rate. Hazard ratios were calculated for all covariates using either the Cox or Fine and Gray’s proportional hazards model or logistic regression model with associated 95% confidence intervals and p values.

Results

Hazard ratio (HR) for overall survival (OS) for single status compared to married status was 1.36 (95% CI, 1.2 to 1.53). OS HR for non-White compared to White patients was 1.05 (CI 0.92 to 1.21). In contrast, the disease-free survival (DFS) HR and biochemical failure (BF) HR were both not significantly different neither between single and married patients nor between White patients and non-White patients. Median time to death for married men was 5.68 years and for single men was 4.73 years. Median time for DFS for married men was 7.25 years and for single men was 6.56 years. Median time for BF for married men was 7.81 years and for single men was 7.05 years.

Conclusions

Race was not associated with statistically significant differences in this analysis. Congruent with our previous work in other cancer sites, marital status predicted improved prostate cancer outcomes including overall survival.

Implications for cancer survivors

Prostate cancer is the most common visceral cancer in men in the USA. The stratification of prostate cancer risk is currently modeled solely on pathologic prognostic factors including PSA and Gleason Score. Independent of these pathologic prognostic factors, our paper describes the central sociodemographic factor of being single as a negative prognostic indicator. Single men are at high risk of poorer outcomes after prostate cancer treatment. Intriguingly, in our group of patients, race was not a significant prognostic factor. The findings in this paper add to the body of work that describes important sociodemographic prognostic factors that are currently underappreciated in patients with cancer. Future steps will include the validation of these findings in prospective studies, and the incorporation of clinical strategies that identify and compensate for sociodemographic factors that predict for poorer cancer outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Jemal A, Siegel R, Xu J, Ward E (2010) Cancer statistics, 2010. CA Cancer J Clin 60(5):277–300

    Article  PubMed  Google Scholar 

  2. Godley PA, Schenck AP, Amamoo MA, Schoenbach VJ, Peacock S, Manning M et al (2003) Racial differences in mortality among Medicare recipients after treatment for localized prostate cancer. J Natl Cancer Inst 95(22):1702–1710

    Article  PubMed  Google Scholar 

  3. Harvei S, Kravdal O (1997) The importance of marital and socioeconomic status in incidence and survival of prostate cancer. An analysis of complete Norwegian birth cohorts. Prev Med 26(5 Pt 1):623–632

    Article  PubMed  CAS  Google Scholar 

  4. Wrigley H, Roderick P, George S, Smith J, Mullee M, Goddard J (2003) Inequalities in survival from colorectal cancer: a comparison of the impact of deprivation, treatment, and host factors on observed and cause specific survival. J Epidemiol Commun Health 57(4):301–309

    Article  CAS  Google Scholar 

  5. Wudel LJ Jr, Chapman WC, Shyr Y, Davidson M, Jeyakumar A, Rogers SO Jr et al (2002) Disparate outcomes in patients with colorectal cancer: effect of race on long-term survival. Arch Surg 137(5):550–554, discussion 4–6

    Article  PubMed  Google Scholar 

  6. Johansen C, Schou G, Soll-Johanning H, Mellemgaard A, Lynge E (1996) Influence of marital status on survival from colon and rectal cancer in Denmark. Br J Cancer 74(6):985–988

    Article  PubMed  CAS  Google Scholar 

  7. Lund R, Due P, Modvig J, Holstein BE, Damsgaard MT, Andersen PK (2002) Cohabitation and marital status as predictors of mortality—an eight year follow-up study. Soc Sci Med 55(4):673–679

    Article  PubMed  Google Scholar 

  8. Vercelli M, Lillini R, Capocaccia R, Micheli A, Coebergh JW, Quinn M et al (2006) Cancer survival in the elderly: effects of socio-economic factors and health care system features (ELDCARE project). Eur J Cancer 42(2):234–242

    Article  PubMed  Google Scholar 

  9. Cox D (1972) Regression models and life tables. J Roy Stat Soc 34:187–220

    Google Scholar 

  10. Coyne JC, Rohrbaugh MJ, Shoham V, Sonnega JS, Nicklas JM, Cranford JA (2001) Prognostic importance of marital quality for survival of congestive heart failure. Am J Cardiol 88(5):526–529

    Article  PubMed  CAS  Google Scholar 

  11. Konski AA, Pajak TF, Movsas B, Coyne J, Harris J, Gwede C et al (2006) Disadvantage of men living alone participating in Radiation Therapy Oncology Group head and neck trials. J Clin Oncol 24(25):4177–4183

    Article  PubMed  Google Scholar 

  12. Yates BC (1995) The relationships among social support and short- and long-term recovery outcomes in men with coronary heart disease. Res Nurs Health 18(3):193–203

    Article  PubMed  CAS  Google Scholar 

  13. Trief PM, Wade MJ, Britton KD, Weinstock RS (2002) A prospective analysis of marital relationship factors and quality of life in diabetes. Diabetes Care 25(7):1154–1158

    Article  PubMed  Google Scholar 

  14. Kaplan E, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481

    Google Scholar 

  15. Cohen JH, Schoenbach VJ, Kaufman JS, Talcott JA, Schenck AP, Peacock S et al (2006) Racial differences in clinical progression among Medicare recipients after treatment for localized prostate cancer (United States). Cancer Causes Control 17(6):803–811, Research Support, N.I.H., Extramural Research Support, U.S. Gov't, Non-P.H.S

    Article  PubMed  Google Scholar 

  16. Scafato E, Galluzzo L, Gandin C, Ghirini S, Baldereschi M, Capurso A et al (2008) Marital and cohabitation status as predictors of mortality: a 10-year follow-up of an Italian elderly cohort. Soc Sci Med 67(9):1456–1464

    Article  PubMed  Google Scholar 

  17. Dupre ME, Beck AN, Meadows SO (2009) Marital trajectories and mortality among US adults. Am J Epidemiol 170:546–555

    Article  PubMed  Google Scholar 

  18. Ebrahim S, Wannamethee G, McCallum A, Walker M, Shaper AG (1995) Marital status, change in marital status, and mortality in middle-aged British men. Am J Epidemiol 142(8):834–842

    PubMed  CAS  Google Scholar 

  19. Ikeda A, Iso H, Toyoshima H, Fujino Y, Mizoue T, Yoshimura T et al (2007) Marital status and mortality among Japanese men and women: the Japan Collaborative Cohort Study. BMC Public Health 7:73

    Article  PubMed  Google Scholar 

  20. Barnett E, Reader S, Ward BG, Casper ML (2006) Social and demographic predictors of no transport prior to premature cardiac death: United States 1999–2000. BMC Cardiovasc Disord 6:45

    Article  PubMed  Google Scholar 

  21. Patel MK, Patel DA, Lu M, Elshaikh MA, Munkarah A, Movsas B (2010) Impact of marital status on survival among women with invasive cervical cancer: analysis of population-based surveillance, epidemiology, and end results data. J Low Genit Tract Dis 14(4):329–338, Research Support, N.I.H., Extramural

    Article  PubMed  Google Scholar 

  22. Abern MR, Dude AM, Coogan CL (2010) Marital status independently predicts testis cancer survival—an analysis of the SEER database. Urol Oncol [Epub ahead of print]

  23. Moul JW, Douglas TH, McCarthy WF, McLeod DG (1996) Black race is an adverse prognostic factor for prostate cancer recurrence following radical prostatectomy in an equal access health care setting. J Urol 155(5):1667–1673, Clinical Trial Research Support, U.S. Gov't, Non-P.H.S

    Article  PubMed  CAS  Google Scholar 

  24. Sohayda CJ, Kupelian PA, Altsman KA, Klein EA (1999) Race as an independent predictor of outcome after treatment for localized prostate cancer. J Urol 162(4):1331–1336

    Article  PubMed  CAS  Google Scholar 

  25. Peters N, Armstrong K (2005) Racial differences in prostate cancer treatment outcomes: a systematic review. Cancer Nurs 28(2):108–118, Review

    Article  PubMed  Google Scholar 

  26. Sridhar G, Masho SW, Adera T, Ramakrishnan V, Roberts JD (2010) Do African American men have lower survival from prostate cancer compared with White men? A meta-analysis. Am J Mens Health 4(3):189–206 [Meta-Analysis Review]

    Article  PubMed  Google Scholar 

  27. Roach M 3rd, Lu J, Pilepich MV, Asbell SO, Mohiuddin M, Grignon D (2003) Race and survival of men treated for prostate cancer on radiation therapy oncology group phase III randomized trials. J Urol 169(1):245–250 [Research Support, U.S. Gov't, P.H.S.]

    Article  PubMed  Google Scholar 

  28. Fowler JE Jr, Terrell F (1996) Survival in Blacks and Whites after treatment for localized prostate cancer. J Urol 156(1):133–136 [Comparative Study]

    Article  PubMed  Google Scholar 

  29. Optenberg SA, Thompson IM, Friedrichs P, Wojcik B, Stein CR, Kramer B (1995) Race, treatment, and long-term survival from prostate cancer in an equal-access medical care delivery system. JAMA 274(20):1599–1605

    Article  PubMed  CAS  Google Scholar 

  30. Carpenter WR, Howard DL, Taylor YJ, Ross LE, Wobker SE, Godley PA (2010) Racial differences in PSA screening interval and stage at diagnosis. Cancer Causes Control 21(7):1071–1080 [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S.]

    Article  PubMed  Google Scholar 

  31. Chamberlain RM, Winter KA, Vijayakumar S, Porter AT, Roach M 3rd, Streeter O et al (1998) Sociodemographic analysis of patients in radiation therapy oncology group clinical trials. Int J Radiat Oncol Biol Phys 40(1):9–15 [Comparative Study Research Support, U.S. Gov't, P.H.S.]

    Article  PubMed  CAS  Google Scholar 

  32. Sprehn GC, Chambers JE, Saykin AJ, Konski A, Johnstone PA (2009) Decreased cancer survival in individuals separated at time of diagnosis: critical period for cancer pathophysiology? Cancer 115(21):5108–5116 [Research Support, N.I.H., Extramural]

    Article  PubMed  Google Scholar 

  33. Chou KL (2010) Moderating effect of apolipoprotein genotype on loneliness leading to depressive symptoms in Chinese older adults. Am J Geriatr Psychiatry 18(4):313–322

    Article  PubMed  Google Scholar 

  34. Hermes GL, Delgado B, Tretiakova M, Cavigelli SA, Krausz T, Conzen SD et al (2009) Social isolation dysregulates endocrine and behavioral stress while increasing malignant burden of spontaneous mammary tumors. Proc Natl Acad Sci USA 106(52):22393–22398

    Article  PubMed  CAS  Google Scholar 

  35. Shrock D, Palmer RF, Taylor B (1999) Effects of a psychosocial intervention on survival among patients with stage I breast and prostate cancer: a matched case–control study. Altern Ther Health Med 5(3):49–55

    PubMed  CAS  Google Scholar 

Download references

Conflicts of interest statement

The authors indicated no potential conflicts of interest.

Author information

Authors and Affiliations

  1. University of Pennsylvania, Philadelphia, PA, USA

    Kevin Lee Du, Charlene Bryan & Deborah Watkins Bruner

  2. Radiation Therapy Oncology Group, Philadelphia, PA, USA

    Kyounghwa Bae & Yan Yan

  3. Henry Ford Health System, Detroit, MI, USA

    Benjamin Movsas

  4. Department of Radiation Oncology, Hospital of the University of Pennsylvania, 2 Donner, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Kevin Lee Du

Authors
  1. Kevin Lee Du
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kyounghwa Bae
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Benjamin Movsas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yan Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Charlene Bryan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Deborah Watkins Bruner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kevin Lee Du.

Additional information

Charlene Bryan is deceased.

Supported by RTOG U10 CA21661 and CCOP U10 CA37422 grants from the NCI, as well as Pennsylvania Commonwealth Universal Research Enhancement (CURE) Program ME-02-149. This paper's contents are the sole responsibility of the authors and do not necessarily represent the official views of the NCI.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Du, K.L., Bae, K., Movsas, B. et al. Impact of marital status and race on outcomes of patients enrolled in Radiation Therapy Oncology Group prostate cancer trials. Support Care Cancer 20, 1317–1325 (2012). https://doi.org/10.1007/s00520-011-1219-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-011-1219-4

Keywords

Search

Navigation