Widowed, divorced and unmarried patients might also simply not have another person noticing changing lesions on their skin over time, Dr Sharon said. They are also less likely to have “the important support that would allow them to pursue more aggressive treatment, she added.

“It’s interesting to note that widowed patients were older than any of the other marital status groups, with a median age of 82 compared to 64 among married patients, 54 among never married, and 62 among divorced,” Dr Gomez said.


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The study authors adjusted their statistical model for patient age but other age-related variables like comorbidities might modulate the association, Dr Gomez cautioned.

Social isolation, the converse of social support, might be such a factor, she suggested.

“Research increasingly shows social isolation to be an important risk factor for mortality,” Dr Gomez explained. “Widowed patients may be particularly vulnerable as they may have been used to a lifetime of living with a partner, compounded with advancing age where other health issues begin to set in.”

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For the time being, explanations for the associations between marital status and diagnostic decision-making remain hypothetical.

“I am not aware of research to understand the mechanisms, but given the consistency of findings, this research is clearly needed,” Dr Gomez said.

References

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  2. Aizer AA, Chen MH, McCarthy EP, et al. Marital status and survival in patients with cancer. J Clin Oncol. 2013;31:3869-3876. doi:10.1200/JCO.2013.49.6489
  3. Inverso G, Mahal BA, Aizer AA, et al. Marital status and head and neck cancer outcomes. Cancer. 2015;1273-1278. doi:10.1002/cncr.29171
  4. McLaughlin JM, Fisher JL, Paskett ED. Marital status and stage at diagnosis of cutaneous melanoma: results from the Surveillance Epidemiology and End Results (SEER) program, 1973-2006. Cancer. 2011;117:1984-1993. doi:10.1002/cncr.25726
  5. Guner N, Kulikova Y, Llull J. Marriage and health: selection, protection, and assortative mating. Eur Econ Rev. 2018;104:138-166. doi:10.1016/j.euroecorev.2018.02.005
  6. Gomez SL, Hurley S, Canchola AJ, et al. Effects of marital status and economic resources on survival after cancer: a population-based study. Cancer. 2016;122:1618-1625. doi:10.1002/cncr.29885