Marital status doesn't affect lung cancer survival

Jan 2 2008

Contrary to previous studies, married patients with lung cancer do not have longer survival, according to analysis of an extensive Mayo Clinic database in the December issue of "The Oncologist."

However, the results suggest some other potentially important differences among patient subgroups -- including the possibility that married patients receive a more aggressive approach to lung cancer treatment, write Dr. Aminah Jatoi and colleagues.

The researchers analyzed data on nearly 5,900 patients from a Mayo Clinic database of patients with non-small cell lung cancer (NSCLC), the most common type of lung cancer. The database included information on a wide range of factors, including cancer stage, cancer treatment, and other factors affecting prognosis.

The study also included information on marital status: 76 percent of the patients were married (average age, 65 years), four percent single, seven percent divorced, and twelve percent widowed (average age, 73 years). The researchers analyzed the data to see if there was any relationship between the patients' marital status at the time their cancer was diagnosed and their survival outcomes.

Initial analysis found no significant differences in survival among the different marital status groups. This remained true after adjustment for important prognostic factors, including age, tumor stage, and smoking. The results were in contrast to previous studies suggesting that married patients with lung cancer tended to have longer survival.

However, exploratory analyses found some significant differences in lung cancer treatment by marital status. Widowed and divorced patients received less aggressive treatment for cancer, which in some cases seemed to lead to shorter survival times. Survival was also shorter for patients in certain subgroups -- for example, widowed patients with stage IA lung cancer (the least advanced stage).

Some aspects of quality of life also differed among marital groups. Divorced patients had greater financial concerns than patients in the other groups, while married and widowed patients had greater spirituality and better social support.

Smaller, less well-controlled studies have reported longer survival for married patients with lung cancer. The extensive Mayo Clinic NSCLC database provided an opportunity to re-evaluate the relationship between marriage and lung cancer survival.

The findings show no differences in survival based on marital status. "Nonetheless, marital status at times appeared to have influenced whether or not a patient received certain types of cancer therapy," the researchers write.

The subgroup analyses also suggest other differences in lung cancer treatment and quality of life that are worthy of further exploration, Dr. Jatoi and coauthors believe. They conclude, "Thus, health care providers

should continue to remain sensitive to the importance of human bonds as they care for patients with NSCLC."