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Cited by 95Global Cancer Incidence and ScreeningHealth disparities and outcomesCancer survivorship and care

Assessment of Modifiable Factors for the Association of Marital Status With Cancer-Specific Survival

Open access
Chen, Zi-Hang, Yang, Kai-Bin, Zhang, Yuan-zhe, Wu, Chen-Fei, Wen, Dan-Wan, Lv, Jia-Wei, Zhu, Guang-Li, Du, Xiao-Jing +7 more·2021·JAMA Network Open
DOI 10.1001/jamanetworkopen.2021.11813PMC PMC8164101
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Abstract

Importance: Married patients with cancer have better cancer-specific survival than unmarried patients. Increasing the early diagnosis and definitive treatment of cancer among unmarried patients may reduce the survival gap. Objectives: To evaluate the extent to which marriage is associated with cancer-specific survival, stage at diagnosis, and treatment among patients with 9 common solid cancers and to recommend methods for reducing the survival gap. Design, Setting, and Participants: This retrospective, population-based cohort study included patients older than 18 years who were diagnosed with 1 of 9 common cancers between January 1, 2007, and December 31, 2016. Patient data were retrieved from the Surveillance, Epidemiology, and End Results Program. Statistical analyses were performed from August 1 to October 1, 2020. Exposures: Marital status, classified as married and unmarried (including single, separated, divorced, widowed, and unmarried patients or domestic partners). Main Outcomes and Measures: The primary outcome was the time ratio (TR) of cancer-specific survival (married vs unmarried). Mediation analyses were conducted to determine the extent to which the association of marriage with cancer-specific survival was mediated by stage at diagnosis and treatment. Results: This study included 1 733 906 patients (894 379 [51.6%] women; 1 067 726 [61.6%] married; mean [SD] age, 63.76 [12.60] years). Multivariate analyses found that those who were married were associated with better cancer-specific survival than unmarried patients (TR, 1.36; 95% CI, 1.35-1.37). Early diagnosis in breast cancer, colorectal cancer, endometrial cancer, and melanoma mediated the association between marital status and cancer-specific survival (breast cancer: proportion mediated [PM], 11.4%; 95% CI, 11.2%-11.6%; colorectal cancer: PM, 10.9%; 95% CI, 10.7%-11.2%; endometrial cancer: PM, 12.9%; 95% CI, 12.5%-13.3%; melanoma: PM, 12.0%; 95% CI, 11.7-12.4%). Surgery mediated the association between marital status and cancer-specific survival in lung (PM, 52.2%; 95% CI, 51.9%-52.4%), pancreatic (PM, 28.9%; 95% CI, 28.6%-29.3%), and prostate (PM, 39.3%; 95% CI, 39.0%-39.6%) cancers. Chemotherapy mediated the association of marital status with cancer-specific survival in lung (PM, 37.7%; 95% CI, 37.6%-37.9%) and pancreatic (PM, 28.6%; 95% CI, 28.4%-28.9%) cancers. Improved cancer-specific survival associated with marriage was greater among men than women (men: TR, 1.27; 95% CI, 1.25-1.28; women: TR, 1.20; 95% CI, 1.19-1.21). The contribution of receiving an early diagnosis and treatment with surgery or chemotherapy to the association between marital status and cancer-specific survival was greater among men than women (early diagnosis: PM, 21.7% [95% CI, 21.5%-21.9%] vs PM, 20.3% [95% CI, 20.2%-20.4%]; surgery: PM, 26.6% [95% CI, 26.4%-26.7%] vs PM, 11.1% [95% CI, 11.0%-11.2%]; chemotherapy: PM, 6.8% [95% CI, 6.7%-6.8%] vs PM, 5.1% [95% CI, 5.0%-5.2%]). Conclusions and Relevance: In this study, survival disparities associated with marital status were attributable to early diagnosis in breast, colorectal, and endometrial cancers as well as melanoma and to treatment-related variables in lung, pancreatic, and prostate cancers. The findings also suggest that marriage may play a greater protective role in the cancer-specific survival of men than of women.

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  • There is evidence of long-term health benefits of being in a committed partnership.

    “Although the loss of a relationship can be devastating, there is evidence of long-term health benefits of being in a committed partnership [76,77].”

    From The Neurobiology of Love and Pair Bonding from Human and Animal Perspectives (2023) · cites this paper as [76]

    The Conclusions report lower cancer mortality among married patients with nine common cancers than among unmarried patients. This supports a specific survival benefit associated with marriage, but not the broader claim of long-term health benefits from committed partnerships generally. The Introduction also includes domestic partnerships in its unmarried category. (LLM, conf=0.88)

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  • Married individuals, compared to unmarried individuals, are less likely to die following cancer diagnosis and heart failure.

    “For example, married individuals, compared to unmarried individuals, are less likely to die following cancer diagnosis and heart failure, likely due, in part, to more involved care provided by a partner [76,175].”

    From The Neurobiology of Love and Pair Bonding from Human and Animal Perspectives (2023) · cites this paper as [76]

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Authors
Chen, Z.-H., Yang, K.-B., Zhang, Y.-Z., Wu, C.-F., Wen, D.-W., Lv, J.-W., Zhu, G.-L., Du, X.-J., Chen, L., Zhou, G.-Q., Liu, Q., Sun, Y., Ma, J., Xu, C., & Lin, L.
Affiliations
  • Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People’s Republic of China
  • Sun Yat-sen University (CN)
  • Sun Yat-sen University Cancer Center (CN)
Corresponding author
Xu, Cheng
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2021-05-28
Volume
4
Issue
5
Pages
e2111813
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2021.11813
PMC
PMC8164101
OpenAlex
W3164517559
Cited by
95
References
42
Citations by year
2026: 14 · 2025: 29 · 2024: 12 · 2023: 22 · 2022: 16 · 2021: 2
FWCI
4.74
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
National Natural Science Foundation of China (81902762))
Topics
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
  • Social Sciences › Health › Health disparities and outcomes
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
Keywords
marital status, cancer-specific survival, survival gap, stage at diagnosis, early diagnosis, cancer therapy, mediation analysis, solid tumors, breast cancer, colorectal cancer, endometrial cancer, melanoma, lung cancer, prostate cancer, survival disparities, social determinants of health, SEER cohort, United States adults
MeSH terms
Aged, Female, Humans, Male, Middle Aged, Prostatic Neoplasms, Retrospective Studies, Risk Factors, United States, Cohort Studies, Survival Rate, Multivariate Analysis, Marital Status, Spouses

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