Marital status: a gender‐independent risk factor for poorer survival after radical cystectomy

Abstract

3 0 1What ' s known on the subject? and What does the study add? Married individuals have lower morbidity and mortality rates for all major causes of death. Cancer-specifi c survival is better in married patients with testis cancer, prostate cancer, breast cancer, cervical cancer, as well as head and neck cancers.We have found the effect of marital status on outcomes after radical cystectomy to be variable, depending on gender and the outcome addressed. Being married is predictive of lower all-cause mortality for both men and women relative to their separated, divorced or widowed (SDW) or never-married counterparts. It is also predictive of lower bladder-cancer-specifi c mortality relative to SDW individuals. Marriage also exerts a protective effect on men regarding non-organ-confi ned disease, with those never having married having signifi cantly higher rates. OBJECTIVES• To examine the effect of marital status (MS) on the rate of non-organ-confi ned disease (NOCD) at radical cystectomy (RC) • To assess the effect of MS on the rate of bladder-cancer-specifi c mortality (BCSM) and all-cause mortality (ACM) after RC for urothelial carcinoma of the urinary bladder (UCUB). MATERIALS AND METHODS• A total of 14 859 patients, who underwent RC for UCUB, were captured within the Surveillance, Epidemiology, and End Results database, between 1988 and 2006.• Logistic regression analysis was used to assess the rate of NOCD (T 3-4 /N I-3 /M 0 ) at RC and Cox regression analyses were used to assess BCSM and ACM.• Analyses were stratifi ed according to gender; covariates included socio-economic status, tumour stage, age, race, tumour grade and year of surgery. RESULTS• Never-married males had a higher rate of NOCD at RC (odds ratio = 1.22, P = 0.004), an effect not found in nevermarried females.• Separated, divorced or widowed (SDW) males (hazard ratio [ HR ] = 1.18, P = 0.005) and females (HR = 1.16, P = 0.002) had higher rates of BCSM than their married counterparts.• SDW and never-married males had higher rates of ACM than their married counterparts (HR = 1.22, P < 0.001 and HR = 1.26, P < 0.001, respectively).• SDW and never-married females also had higher rates of ACM than married females (HR = 1.24, P < 0.001 and HR = 1.22, P = 0.01, respectively). CONCLUSIONS• For both men and women, being SDW conveyed an increased risk of BCSM after RC.• SDW and never marrying had a deleterious effect on ACM.• Unfavourable stage at RC was also seen more commonly in never-married males.

Effects of marital status and economic resources on survival after cancer: A population‐based study

“…The stronger survival benefit of marriage among men confirms prior research 1,2,23,24 and may provide important clues into underlying mechanisms. Men and women appear to benefit differentially from marriage, 25–28 with women benefitting more financially and men benefitting more socially.…”

Survival advantage of marriage in uterine cancer patients contrasts poor outcome for widows: A Surveillance, Epidemiology and End Results study

“…The consistent protective effect of marriage seen on uterine cancer survival after adjustment is on par with marriage benefits proposed in numerous other studies [1][2][3][4][5]. More importantly this study identifies widows as having an elevated risk of death from uterine cancer and the poor outcome of widows accounted for most of the survival advantage ascribed to marriage.…”

“…The observation that married patients had a uterine cancer survival advantage relative to those who were not married is consistent with the survival benefit of marriage reported in other cancer sites [1][2][3][4][5]. Multivariate Cox modeling and Kaplan-Meier method were used to extend the prior studies by comparing uterine cancer survival in singles vs. married women vs. widows vs. others.…”

“…Marital status is associated with a survival advantage among patients with a variety of cancers [1][2][3][4][5]. A recent study demonstrated that marriage conferred a survival advantage in the ten most lethal cancers in the United States as married patients were less likely to present with metastatic disease, more likely to receive definitive treatment, and less likely to die as a result of their cancer [2].…”

Marital status and survival in patients with gastric cancer

“…Marriage may have a protective effect on prognosis of cancer patients. Studies indicated that unmarried patients were at higher risk of presentation with metastatic cancer, undertreatment, and shorter survival in various cancer types 3, 4, 5, 6, 7, 8, 9, 10, 11, 12. Mixed 13, 14, 15, 16 or no significant 17, 18, 19 associations between marital status and cancer survival were reported as well.…”