Married Women Have Best (and Single Men, Worst) Survival Rate for NSCLC
Marriage also conferred a significant survival benefit: 26% at 5 years, compared with 0% for those who were single (P=0.0206), and is an independent predictor of outcome, said Elizabeth Nichols, MD, of the University of Maryland Medical Center, Baltimore, MD.
The study reviewed records of 168 patients with stage III NSCLC treated at the University of Maryland Greenebaum Cancer Center from January 2000 to December 2012. Median dose of radiation was 66.6 Gy (range, 59.4 to 70 Gy); concurrent chemotherapy was administered in 89% of patients, with weekly carboplatin/paclitaxel the most common regimen (90%). “After concurrent therapy, patients typically received 2 cycles of systemic or consolidative doses of chemotherapy, if carboplatin/paclitaxel was utilized,” Dr. Nichols noted.
For all patients, at a median follow-up of 1.3 years, median 3-year overall survival (OS) was 13 months and the rate was 21%; median 5-year OS was 21 months and 12%. “On multivariate analysis, age (P<0.032), marital status (P<0.003), and gender (P<0.012) were independent predictors of OS, independent of disease and treatment related variables,” she reported.
The 3-year OS rate was 33% for married patients vs 10% for single patients (P<0.001); men had inferior survival compared with women, 13% vs 35%, respectively (P=0.004). OS was 3% for single males, 25% for married males, 25% for single females, and 46% for married females (P=0.029). When stratified by race, married whites had an OS of 40%, followed by married blacks (26%); for single whites and single blacks, it was 11% (P=0.005).
The exact etiology of this inferior outcome is unclear; however, marital status may be a surrogate for better supportive care and compliance with treatment, Dr. Nichols said. “If this is the case, then (1) interventions to improve social support play a vital role for single patients, and (2) single males and blacks may have the most to gain.
“While we were not surprised by these results, they confirm the positive impact of spousal support on patient survival,” she concluded. “These findings also demonstrate the need for improved support of cancer patients and their spouses in order to continue to improve survival rates.”
The symposium is sponsored by the American Society of Clinical Oncology (ASCO), the American Society for Radiation Oncology (ASTRO), the International Association for the Study of Lung Cancer (IASLC), and The University of Chicago.