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The effect of marital status on survival in late-stage cancer patients: An analysis based on surveillance, epidemiology, and end results (SEER) data, in the United States

  • Hong LaiEmail author
  • Shenghan Lai
  • Arnon Krongrad
  • Edward Trapido
  • J. Bryan Page
  • Clyde B. McCoy
Article

Abstract

Recently findings that marital status is associated with survival in patients with late-stage prostate cancer led to an examination of the generalizability of this association for all cancers. We restricted the investigation to patients with late-stage cancer using population-based data collected from 261,070 patients with late-stage cancer at multiple sites in the United States to determine relations between marital status and survival. After controlling for age, race, and treatment, married patients with cancers of all major primary sites had significantly better survival than single, separated, divorced, or widowed patients. Although single and widowed patients had the poorest prognosis in general, single patients appeared to show the most consistently poor survival across the different types of cancers. Survival differences by marital status were more pronounced in men than in women. This observation raises the possibility that some characteristics associated with being married delay death from cancer. These findings require investigators to ask new questions about the effect of being married and its possible correlates, such as general health status, access to health care, and socioeconomic status. Known correlates of marital status, such as available social support and social isolation also merit attention in relation to these findings.

Key words

marital status cancer late stage survival SEER 

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References

  1. Berkman, L. F., & Syme, S. L. (1979). Social networks, host resistance and mortality: A nine year follow-up study of Alameda County residents. American Journal of Epidemiology, 109, 186–204.PubMedGoogle Scholar
  2. Coombs, R. H. (1991). Marital status and personal well-being: a literature review. Family Relations, 40, 97–102.CrossRefGoogle Scholar
  3. Cox, D. R. (1972). Regression models and life tables. Journal of the Royal Statistical Society, 34, 187.Google Scholar
  4. Ell, K., Nishirnoto, R., Medeansky, L., Mantell, J., & Hamovitch, M. (1992). Social relations, social support and survival among patients with cancer. Journal of Psychosomatic Research, 36, 531–541.PubMedCrossRefGoogle Scholar
  5. Fidler, I. J. (1990). Critical factors in the biology of human cancer metastasis: Twenty-eighth GHA Clowes memorial award lecture. Cancer Research, 50, 6130.PubMedGoogle Scholar
  6. Fidler, I. J., Gersten, D. M., & Hart, I. R. (1978). The biology of cancer invasion and metastasis. Advances in Cancer Research, 28, 149.PubMedCrossRefGoogle Scholar
  7. Ganz, P. A., Lee, J. J., & Siau, J. (1990). Quality of life assessment: An independent prognostic variable for survival in lung cancer. Cancer, 67, 3131–3135.CrossRefGoogle Scholar
  8. Goodwin, J. S., Hunt, W. C., Key, C. R., & Samet, J. M. (1987). The effect of marital status on stage, treatment, and survival of cancer patients. Journal of the American Medical Association, 258, 3125–3130.PubMedCrossRefGoogle Scholar
  9. Gove, W. R. (1972). The relationship between sex roles, marital status, and mental illness. Social Forces, 51, 34–44.CrossRefGoogle Scholar
  10. Hastie, T. J., & Tibshirani, R. T. (1986). Generalized additive models. Stat Sci, 1, 97–318.CrossRefGoogle Scholar
  11. Kaplan, E. L., & Meier, P. (1958). Nonparametric estimation from incomplete observations. Journal of the American Statistical Association, 53, 457.CrossRefGoogle Scholar
  12. Kaprio, J., Koskenvuo, M., & Rita, H. (1987). Mortality after bereavement: A prospective study of 96,647 widowed persons. American Journal of Public Health, 77, 283–287.PubMedCrossRefGoogle Scholar
  13. Kato, I., Tominaga, S., & Ikari, A. (1992). The role of socioeconomic factors in survival of patients with gastrointestinal cancers. Japanese Journal of Clinical Oncology, 22, 270–277.PubMedGoogle Scholar
  14. Krongrad, A., Lai, H., Burke, M. A., Goodkin, K., & Lai, S. (1996). Marriage and mortality in prostate cancer. Journal of Urolology, 156, 1696–1700.CrossRefGoogle Scholar
  15. Kvikstad, A., Vatten, L. J., & Tretli, S. (1995). Widowed and divorce in relation to overall survival among middle-age Norwegian women with cancer. British Journal of Cancer, 71, 1343–1347.PubMedGoogle Scholar
  16. Last, J. M., Abramson, J. H., Friedman, G. D., Porta, M., Spasoff, R. A., & Thuriaux, M. (1995). A dictionary of epidemiology (3rd ed.). New York: Oxford University Press.Google Scholar
  17. Murphy, M. F. G., Goldblatt, P. O., & Mant, D. (1993). Marital stability and cancer of the uterine cervix: Changing patterns in post-war Britain. International Journal of Epidemiology, 22, 385–392.PubMedCrossRefGoogle Scholar
  18. Nayeri, K., Pitaro, G., & Feldman, J. G. (1992). Marital status and stage at diagnosis in cancer. New York State Journal of Medicine, 92, 8–11.PubMedGoogle Scholar
  19. Ortmeyer, C. F. (1974). Variables in mortality, morbidity, and health care by marital status. In L. L. Erhardt & J. E. Berlin (Eds.), Mortality and morbidity in the United States (pp. 159–184). Cambridge, MA: Harvard University Press.Google Scholar
  20. Parker, S. L., Tong, T., Bolden, S., & Wingo, P. A.(1997). Cancer statistics, 1997. Ca: A Cancer Journal for Clinicians, 47, 5–27.CrossRefGoogle Scholar
  21. Reynolds, P., Boyd, P. T., Blacklow, R. S., Jackson, J. S., Greenberg, R. S., & Austin, D. F. (1994). The relationship between social ties and survival among black and white breast cancer patients. Cancer Epidemiology, Biomarkers, and Prevention, 3, 253–259.Google Scholar
  22. Ries, L. A. G., Miller, B. A., Hankey, B. F, Koary, C. L., Harras, A., & Edwards, B. K.(Eds.). (1994). SEER cancer statistics review: 1973–1991. Tables and graphs. (National Institiute of Health Publication No. 94-2789). Bethesda, MD.Google Scholar
  23. Rothman, K. J., & Greenland, S. (1998). Modern epidemiology (2nd ed.). Philadelphia: Lippincott.Google Scholar
  24. Schaefer, C., Quesenberry, C. P., & Wi, S. (1995). Mortality following conjugal bereavement and the effects of shared environment. American Journal of Epidemiology, 141, 1142–1152.PubMedGoogle Scholar
  25. Spiegel, D., Kraemer, H. C., Bloom, J. R., & Gottheil, E. (1989). Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet, 2, 888–891.PubMedCrossRefGoogle Scholar
  26. Sugarbaker, E. V. (1979). Cancer metastasis: A product of tumor-host interactions. Current Problems in Cancer, 3, 1.PubMedCrossRefGoogle Scholar
  27. Weiss, L. Principles of metastasis. (1985). Orlando, FL: Academic.Google Scholar
  28. Willis, R. A. The spread of tumors in the human body. (1972). London: Butterworth.Google Scholar
  29. Young, J. L., Percy, C. L., & Asire, A. J. (Eds.). (1981). Surveillance, epidemiology and end results: Incidence and mortality data, 1973-1977 (NIH Monograph 57). Bethesda, MD: National Cancer Institute.Google Scholar

Copyright information

© International Society of Behavioral Medicine 1999

Authors and Affiliations

  • Hong Lai
    • 1
    Email author
  • Shenghan Lai
    • 2
  • Arnon Krongrad
    • 2
  • Edward Trapido
    • 1
  • J. Bryan Page
    • 3
  • Clyde B. McCoy
    • 1
  1. 1.Department of Epidemiology and Public HealthUniversity of Miami School of Medicine, Dominion Tower, Room 1111A (D-93)Miami
  2. 2.Department of MedicineUniversity of Miami School of MedicineMiami
  3. 3.Department of Psychiatry and Behavioral SciencesUniversity of Miami School of MedicineMiami

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