The study bolsters the case that marriage is associated with improved cancer survival, and why. Earlier diagnosis means a better chance of effective treatment and long-term survival.2-6
“The findings are entirely expected and consistent with the growing volume of literature supporting a positive effect of being married across a range of cancer outcomes — from detection to diagnosis, to treatment, and survival,” commented Scarlett Lin Gomez, PhD, an epidemiology professor at the University of California, San Francisco School of Medicine. “Melanoma is a cancer where detection at earlier stages and appropriate treatment management can greatly improve the chances of survival. The findings from this study […] have implications for clinical and public health measures if we can understand the process by which being married confers these advantages.”
Dr Gomez’s own study of data from the California Cancer Registry found that unmarried patients, particularly men, have increased risk of cancer mortality.6 Economic resources played a role in that effect across racial and ethnic groups, Dr Gomez noted.
“At least where it comes to cancer survival, some part of the survival advantage among married compared to unmarried patients may be due to greater economic resources including having health insurance and higher household income,” Dr Gomez explained. “However, even after accounting for these economic factors, marital status still remains a significant factor, suggesting that mechanisms such as social and logistical support from a spouse or from children, may be relevant.”
“From a clinical standpoint, understanding the availability of social and logistical support among patients is important in helping to ensure that all patients have the opportunity to experience optimal outcomes,” Dr Gomez added. “Certainly, from a public health standpoint, ensuring adequate access to appropriate care, particularly among low socioeconomic status populations, continues to be critical.”
In the new study, urban or rural residence correlated with marital status but in multivariate analysis, residence did not predict T stage at diagnosis. The authors therefore removed that variable from their multivariate model. “The association between marital status and T stage remained statistically significant irrespective of inclusion of this variable in the multivariable model,” Dr Sharon noted.
The new study’s findings about widowed patients were particularly troubling.
“This is an important finding from this research, as they found that widowed patients were 70% more likely than married patients to be diagnosed with higher T stage ― which is a much higher rate than the never married and divorced groups ― and they were much less likely to undergo sentinel node biopsy,” Dr Gomez said.
“We suspect that depression may at least partly explain the association,” Dr Sharon said. “We initially thought that age might have played a role in widowed patients’ decision to undergo SLNB, as this procedure is generally not recommended to older patients. But widowed patients remained less likely to undergo SLNB even after including age in the multivariable model.”