Marriage's Cancer Survival Benefit Is Independent of Income, Study Finds

Scarlett Lin Gomez

Scarlett Lin Gomez

Being married may help extend survival among patients with cancer, and the benefit is largely unaffected by economic resources like health insurance, a finding the researchers note reinforces the importance of clinicians querying whether their unmarried patients have someone within their social network available to help them physically and emotionally.

The study, published in the journal Cancer, found that death rates were 27% higher for unmarried men and 19% for unmarried women, compared with their married counterparts.¹

“While other studies have found similar protective effects associated with being married, ours is the first in a large population-based setting to assess the extent to which economic resources explain these protective effects,” said lead author Scarlett Lin Gomez of the Cancer Prevention Institute of California in a statement.

“Our study provides evidence for social support as a key driver.”

Lower cancer-specific mortality among married patients has been previously documented in a 2013 analysis of Surveillance, Epidemiology, and End Results (SEER) data published in the Journal of Clinical Oncology.² This analysis was conducted in a similar way—and involved a nearly equal number of patients—to the Cancer study, but adjusted for age, sex, race, urban versus rural residence, education, and median household income.

The Cancer study set out to evaluate the mortality differences between married and unmarried individuals, adjusting for health insurance status and neighborhood socioeconomic status—two factors that have not been well studied.

In the analysis reported here, 783,167 individuals in the California Cancer Registry were selected who had been diagnosed with cancer between 2000 and 2009. Patients diagnosed with first primary, invasive disease of one of the 10 most common sites of cancer-related death for each gender were analyzed and followed through 2012.

Risk of mortality was 27% and 19% higher for unmarried men and women, respectively, compared with their married counterparts. When adjusted for insurance status and neighborhood socioeconomic status, mortality risk associated with being unmarried was “only marginally” reduced, according to study authors—down to 22% percent for men and 15% for women.

Further, mortality risk differed slightly between married women and women with specific types of unmarried statuses: 15% for never married, 16% for separated, 16% for divorced, and 15% for widowed. Among men, mortality risk differences were greater: 26% for never married, 17% for separated, 23% for divorced, and 18% for widowed.

The association of marital status and mortality varied slightly between specific types of cancer, with some showing a more pronounced effect. Researchers observed the greatest differences between unmarried women with uterine cancer (20%), non-Hodgkin lymphoma (NHL; 21%) and breast cancer (20%), compared to their unmarried counterparts with those diseases. Among men, the greatest differences were seen in individuals with NHL (36%) and prostate cancer (33%), compared with their married counterparts.

The cause of this reduction in cancer mortality is thought to be twofold. The social benefits of marriage “include spousal or children support/encouragement for health-seeking behaviors, such as adherence to recommended health screening and treatment, and health-promoting behaviors, such as more exercise and better diet,” according to study authors. The “material” benefits of marriage, however, include greater income, employment, and better health insurance.

Reduction in risk of cancer mortality varies between genders, according to study authors.

“Men and women appear to benefit differentially from marriage, with women benefiting more financially and men benefiting more socially.”

Though this study provides answers as to the degree of the effect of marital status on a cancer diagnosis, more research must be done to fully understand why the association exists in the first place—and ultimately improve survival.

“Future research that focuses on social support and other socially mediated factors associated with marriage may provide an important avenue to inform interventions that improve cancer survival.”

References

• Gomez SL, Hurley S, Canchola AJ, et al. Effects of Marital Status and Economic Resources on Survival After Cancer: A Population-Based Study [published online before print April 11, 2018]. Cancer.
• Aizer AA, Chen MH, McCarthy EP, et al. Marital status and survival in patients with cancer. J Clin Oncol. 2013;31(31):3869-3876.