Association Between Marital Status and Racial Disparities in Esophageal Cancer Care

Abstract

PURPOSE: This study was designed to examine the impact of marital status on racial disparities in esophageal cancer care. PATIENTS AND METHODS: We performed a secondary analysis of data collected from the state cancer registry maintained by the Michigan Department of Health and Human Services. We identified patients with an esophageal cancer diagnosis between January 1, 2000, and December 31, 2013. χ2 test and logistics regression were used to analyze 6,809 patients who met our eligibility criteria. Statistical significance was defined as P ≤ .05. RESULTS: Approximately 88.4% of our patients were White and 11.6% were Black. A significantly higher number of White patients were married when compared with Blacks (62.9% v 31.8%, respectively; P < .0001). There was no significant difference in cancer staging between the 2 groups ( P = .0671). Married Blacks had similar rates of esophagectomy, chemotherapy, and radiation as married Whites. Both single groups had lower rates of esophagectomy and chemotherapy than married Whites, but single Blacks were the least likely to undergo esophagectomy. Single patients were more likely to refuse treatment. CONCLUSION: Marital status differs significantly in Black and White patients with esophageal cancer and may help explain racial disparities in cancer care. Further research is needed to explore reasons for care underutilization in single patients and whether these differences translate into clinical outcomes.

Equity in adjuvant radiotherapy utilization in locally advanced head and neck cancer: A SEER‐data based study

“…The impact of partnered status on treatment patterns and outcomes has been well‐documented for many cancer sites 14,43–49 . Our results confirmed that partnered patients were more likely to undergo adjuvant RT than unpartnered patients (OR 1.470, CL 1.332, 1.623, p < 0.0001) (Table 2).…”

Gender Differences in Treatment Allocation and Survival of Advanced Gastroesophageal Cancer: A Population-Based Study

“…In the Dutch population aged 55 years and older, women are overrepresented and less often married than men ( 38 , 39 ). Being single has been associated with a higher probability of refraining from esophageal cancer treatment ( 40 , 41 ). We hypothesize that lack of spousal support may contribute to different treatment choices.…”

Influence of Caregiver Presence During Physician Office Visits on Patients Undergoing Chemoradiation Therapy for Esophageal Cancer

“…Although there is a large body of research showing that being married is correlated with esophageal cancer survival, mechanisms for this finding are still are not fully understood. 3 , 4 , 5 , 7 One reason that marriage is associated with improved cancer survival may be because married patients are less likely to refuse potentially curative radiation or surgery against the advice of their physicians. 7 , 8 It also has been proposed that esophageal cancer may be particularly demanding on social support for optimal care and that spouses may help by improving nutritional intake.…”

“… 3 , 4 , 5 , 7 One reason that marriage is associated with improved cancer survival may be because married patients are less likely to refuse potentially curative radiation or surgery against the advice of their physicians. 7 , 8 It also has been proposed that esophageal cancer may be particularly demanding on social support for optimal care and that spouses may help by improving nutritional intake. 7 This would be congruent with studies that found poor nutritional status to be associated with lower quality of life, lower tolerability of treatment, and lower overall survival in patients with gastrointestinal malignancies.…”

“… 7 , 8 It also has been proposed that esophageal cancer may be particularly demanding on social support for optimal care and that spouses may help by improving nutritional intake. 7 This would be congruent with studies that found poor nutritional status to be associated with lower quality of life, lower tolerability of treatment, and lower overall survival in patients with gastrointestinal malignancies. 9 , 10 Increased nutritional risk as calculated by a formula that included serum albumin level and the proportion of the patients’ weight at certain timepoints compared with their ideal weight was found by Cox et al to be associated with reduced survival in patients with esophageal cancer treated with chemoradiation therapy (CRT) 11 ; improvement in survival was observed after nutritional interventions that ranged from dietary advice or oral supplementation to major interventions such as enteral feeding or tube placement.…”