New research suggests that marital status impacts cancer survival. Investigators report that among those individuals treated for lung cancer (with stage 3, non-small cell lung cancer) with chemotherapy and radiation, married patients were much more likely to be alive after 10-years (33%) compared with those who were not married (10%). Married women had the best survival rates (46%), while unmarried men had the worst survival rates (3%).
The lead author, Elizabeth Nichols, M.D. (University of Maryland Greenebaum Cancer Center) suggests that social support is likely the primary factor. “…our findings suggest the importance of social support in managing and treating our lung cancer patients. Patients may need help with day-to-day activities, getting to treatment and making sure they receive proper follow-up care.” “We believe that better supportive care and support mechanisms for cancer patients can have a greater impact on increasing survival than many new cancer therapy techniques. Not only do we need to continue to focus on finding new drugs and cancer therapies, but also on ways to better support our cancer patients.”
Previous Studies Offer Mixed Results:
- A Surveillance Epidemiology and End Results (SEER) study, of over 25,000 lung cancer patients: found that the risk for death was significantly higher among those who were single (18% higher), separated (16% higher), divorced (13% higher) or widowed (8% higher) compared to those who were married.
- The Norwegian Cancer Registry study, of approximately 20,000 lung cancer patients: reported similar results to those in the SEER study. These investigators observed that the risk for death was significantly higher among those who were single (female lung cancer patients: 13% higher, male lung cancer patients: 23% higher), divorced/separated (female: 17% higher, male: 17% higher), and widowed (female: 19% higher, male: 12% higher).
- The Mayo Clinic Lung Cancer Cohort study, of nearly 6,000 lung cancer patients: did not find any significant survival differences among those who were married, single, divorced, and widowed at the time of cancer diagnosis, even after adjusting for age, gender, and tumor stage.
What is the theory for the “marriage effect”?
Previous studies have found that aggressive cancer treatments are more likely to be given to those patients who are married. Although the precise reasons for this are not entirely clear, it has been suggested that this may be due to better support mechanisms and financial resources that enable them to get more aggressive treatments.
Unfortunately, none of these studies were designed to determine the impact of the quality of the patients’ social support network, nor did they evaluate other important relationships (i.e. civil unions, friendships, etc.).
If a personal relationship is toxic or not supportive, it is hard to imagine there would be a positive effect on cancer survival. Recent studies have demonstrated the increased risk for depression for those with unsupportive partners.
Whether marriage (or any other kind of relationship not evaluated in these studies) offers any survival benefits, most reports find that spiritual (not necessarily religious practice) and social support are stronger among married patients than those who are single, which may influence the type of cancer treatments they receive. (Check out my post on the importance of spirituality in cancer care.)
Regardless of the marital status, there are numerous other support resources that can be essential (family, friends, support groups, religious and spiritual support, mental health counseling, etc.)
I think it’s crucial for the cancer care team to keep in mind the social support of our patients when working with them, as this may be one of the most important factors enabling them to receive and tolerate aggressive treatments.