Marital status and its effect on lung cancer survival

Stacey L Tannenbaum; Wei Zhao; Tulay Koru-Sengul; Feng Miao; David Lee; Margaret M Byrne

doi:10.1186/2193-1801-2-504

Marital status and its effect on lung cancer survival

Springerplus. 2013 Oct 3:2:504. doi: 10.1186/2193-1801-2-504. eCollection 2013.

Authors

Stacey L Tannenbaum¹, Wei Zhao¹, Tulay Koru-Sengul², Feng Miao¹, David Lee², Margaret M Byrne³

Affiliations

¹ Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL 33136 USA.
² Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL 33136 USA ; Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL USA.
³ Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL 33136 USA ; Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL USA ; Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL USA.

Abstract

Purpose: The purpose of this study was to determine if marital status, including specific types of single status categories, is associated with length of survival in lung cancer patients.

Methods: Data from the 1996-2007 Florida Cancer Data System were linked with Agency for Health Care Administration data and U.S. Census data. Patients with both small cell and non-small cell lung cancer were identified (n = 161,228). Marital status was characterized by married, widowed, separated/divorced, and never married. We compared median survival time and 1, 3, and 5-year post diagnosis survival rates.

Results: Overall, 54.6% were married, 19.1% were widowed, 13.5% were separated/divorced, and 12.7% had never married. Median survival in months was longest for married (9.9) and widowed (7.7) patients, and shortest for never married (4.9) and separated/divorced (4.1) patients. Five-year survival rates were 14.2% for married, 10.7% for widowed, 8.9% for separated/divorced, and 8.4% for never married. In univariate Cox regression, marital status was a significant predictor of better survival for married (HR = 0.70; p < 0.001) and widowed (HR = 0.81; p < 0.001) patients compared with never married patients, but worse for separated/divorced patients (HR = 1.03; p = 0.003). Multivariate models demonstrated sustained survival benefits for married (HR = 0.86; p < 0.001) and widowed (HR = 0.88; p < 0.001) patients, and detriments for separated/divorced patients (HR = 1.05; p < 0.001) after adjusting for extensive confounders including demographics; tumor stage, grade, and morphology; comorbidities; treatment; and smoking status.

Conclusions: Our study demonstrated that married or widowed lung cancer patients have better survival compared to patients who were never married or separated/divorced. Research to understand the mechanism of this effect, and how the beneficial effect can be extended to those who have never married or have had the marital relationship severed through divorce or separation is needed.

Keywords: Florida population-based cancer registry; Lung cancer; Marital status; Outcomes; Support system.