Being married is associated with better cancer outcomes. In fact, for some cancers, the survival benefit associated with marriage is larger than the published survival benefit of chemotherapy, report the authors of a study that looked at the medical records of more than 700,000 cancer patients.
After adjustment for demographic characteristics, tumor and nodal stage, and the use of definitive therapy, married patients were significantly less likely to die from cancer than patients who had never married or were separated, divorced, or widowed (adjusted hazard ratio [HR], 0.80; P < .001). This association remained significant for all of the cancer types evaluated in the study (P < .05).
The study was published online September 23 in the Journal of Clinical Oncology.
Not only was being married associated with better cancer outcomes, married patients also tended to have their cancers diagnosed at an earlier stage.
"Our data suggest that marriage can have a significant health impact for patients with cancer. This was consistent for every cancer that we reviewed," said first author Ayal Aizer, MD, MHS, chief resident of the Harvard Radiation Oncology Program, in Boston, in a statement. "We suspect that social support from spouses is what's driving the striking improvement in survival. Spouses often accompany patients on their visits and make sure they understand the recommendations and complete all their treatments."
Effect of Marriage on Cardiac Events
There is more evidence of the benefit of marriage on overall health.
In a study published online September 3 in the American Heart Journal, married patients fared better than single patients after coronary angioplasty. Even after adjustment for confounders, such as smoking, family history, and high cholesterol, unmarried patients were almost twice as likely to die or experience a major cardiovascular event in the year after the procedure than married patients (13.3% vs 8.2%; P < .001).
Power of Human Attachment
"Our humanity is relational at its essence," writes David W. Kissane, MD, head of psychiatry at Monash University in Melbourne, Australia, in an editorial accompanying the study by Dr. Aizer's team.
"We are tribal people, drawn into connection with one another to share what is most meaningful and fulfilling in life," he explains. Medicine needs to follow with a parallel paradigm; healing needs to be both person- and family-centered.
The study by Dr. Aizer's team reminds us "of the power of human attachment in showing the contribution of marital status to survival," he says. It shows "why medicine ought not to be governed by money but by humanistic, culturally sensitive, and comprehensive care."
"Our response must be to develop targeted supportive programs to attend to those most in need — a paradigmatic change in the focus of healing care that truly accompanies the biologic and scientific pursuits of medicine," Dr. Kissane adds.
Less Metastatic Disease
In their study, Dr. Aizer and colleagues used the Surveillance, Epidemiology and End Results Program to identify patients who were diagnosed from 2004 to 2008 with lung, colorectal, breast, pancreatic, prostate, liver/intrahepatic bile duct, head/neck, ovarian, or esophageal cancer, or non-Hodgkin's lymphoma. They conducted a retrospective analysis of 734,889 people with clinical and follow-up information available.
They found that married patients were less likely to present with metastatic disease than unmarried patients (odds ratio [OR] 0.83; P < .001). This association remained significant when each cancer was evaluated individually (adjusted OR range for each cancer, 0.52 - 0.93; P < .05 for all cases).
Married patients were also less likely than unmarried patients to present with metastatic disease (adjusted OR, 0.83; P < .001), were more likely to receive definitive therapy (adjusted OR, 1.53; P < .001), and were less likely to die from cancer (adjusted HR, 0.80; P < .001).
The benefit associated with marriage was greater in men than in women for all of the outcome measures (P < .001 in all cases). For prostate, breast, colorectal, esophageal, and head/neck cancers, the survival benefit associated with marriage was larger than the published survival benefit of chemotherapy.
Patients in all unmarried subgroups — never married, separated, divorced, widowed — were more likely than married patients to present with metastatic disease, be undertreated, and die of their cancer (P < .001 for all associations).
"We don't just see our study as an affirmation of marriage; rather, it should send a message to anyone who has a friend or a loved one with cancer. By being there for that person and helping them navigate their appointments and make it through all their treatments, you can make a real difference to that person's outcome," said the study's senior author, Paul Nguyen, MD, a radiation oncologist at the Dana-Farber Cancer Center and Brigham and Women's Hospital in Boston.
"As oncologists, we need to be aware of our patients' available social supports and encourage them to seek and accept support from friends and family during this potentially difficult time," Dr. Nguyen said in a statement.
The study was funded in part by the Heritage Medical Research Institute/Prostate Cancer Foundation Young Investigator Award, a JCRT Foundation Grant, Fitz's Cancer Warriors, David and Cynthia Chapin, and a grant from an anonymous family foundation. Dr. Nguyen reports a consulting role with Ferring Pharmaceuticals. Dr. Kissane has disclosed no relevant financial relationships.
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου