Ayal A. Aizer, Ming-Hui Chen, Ellen P. McCarthy, Mallika L. Mendu, Sophia Koo, Tyler J. Wilhite,,Powell L. Graham, Toni K. Choueiri, Karen E. Hoffman, Neil E. Martin, Jim C. Hu, and Paul L. Nguyen

Journal of Clinical Oncology, Sept. 2013

Unmarried patients diagnosed with cancer are at a substantially higher risk of having advanced disease, of being undertreated and of dying of their disease. The features of marriage that contribute to a protective effect were explored in this study.

Using the Surveillance, Epidemiology and End Results (SEER) database, more than 700,000 patients with one of the ten leading causes of cancer related deaths were identified. The association of marital status on stage at diagnosis revealed that married patients had a much greater chance of having cancer found while it was localized, as opposed to metastatic or advanced. This finding was more striking for men with prostate cancer and women with breast cancer, but it was also seen in all other cancers studied.

For those with localized disease, married people were more likely to undergo curative therapy than unmarried. Death related to the cancer was more common among unmarried people­ whether or not they underwent curative therapy. The impact of marriage was greater for men than for women.

These findings highlight the importance of marriage­ particularly social support­ on cancer detection, treatment and survival. Married people may have better access to healthcare and encouragement from their spouse to seek medical attention and to undergo curative therapy. Married patients are more likely to adhere to prescribed therapies, leading to an improvement in survival. Patients who are married display less distress, depression, and anxiety than their unmarried counterparts after a diagnosis of cancer, as a partner can share the emotional burden and provide appropriate social support. Studies have suggested that unmarried patients are more likely to smoke and/or use alcohol, factors which may contribute to the poorer outcomes.