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Marriage makes impact on cancer treatment, support

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Married people get diagnosed earlier with cancer, are more likely to get the appropriate treatment, and are less likely to die from the disease than nonmarried people, finds a new Dana-Farber Cancer Institute study. The researchers used a national database to survey nearly 735,000 patients diagnosed with one of 10 different types of cancer and found that those who were married were 20 percent less likely to die of their cancers compared with those who weren’t married.

Patients who were divorced, widowed, or never married were 17 percent more likely to have been diagnosed with disease that had spread to other organs and were 53 percent less likely to receive potentially lifesaving treatments, according to the study published last Monday in the Journal of Clinical Oncology.

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“The impact of marriage was profound on every cancer we studied,” including lung, breast, colon, and prostate cancer, said study leader Dr. Ayal Aizer, a radiation oncologist at Dana-Farber. “It’s a sign that marriage is providing crucial support for those diagnosed with cancer.”

But the study — based on cancer diagnoses made from 2004 through 2008 and stored in a National Cancer Institute database — couldn’t determine specifically what that extra support might have entailed.

“Marital status could be a proxy for social support, which previous research suggests could buffer the harmful effects of stress that are associated with life-threatening diseases,” said Kevin Stein, managing director of behavioral research at the American Cancer Society, who was not involved with the study.

Married patients might also have more tangible medical support like a partner to drive them to medical appointments or remind them to take their medications.

Aizer pointed out that patients with certain head and neck cancers need to come in for daily radiation treatments for seven weeks. Married men with these cancers were 42 percent more likely to have received these radiation treatments and 36 percent less likely to have died from their cancers during the study.

The researchers took into account a number of other factors that could have also affected survival chances like age, income, and education.

“We really didn’t want our results to be a pat on the back for married people,” Aizer said. “But we think they suggest that unmarried patients aren’t getting support they need.”

Many cancer doctors already consider the practicalities of coming back for repeat treatments when forming a therapy plan for their patients. “We think about whether they have someone to help them at home and whether they have transportation to their treatments,” said Dr. Paul Nguyen, a study co-author and radiation oncologist at Dana-Farber.

Social workers at Dana-Farber have increasingly been playing important roles in treatment recommendations, he added, because they have a better understanding of barriers to care in particular patients.

While some hospitals can provide transportation or housing near their facilities for patients who live too far to drive, they can’t provide the kind of emotional support that often comes from having a life partner.

Marital status made a bigger difference in cancer outcomes for men than for women, probably because women have stronger social connections with riends and family members. Men may also be more reluctant to have regular cancer screenings or see doctors to investigate suspicious symptoms if they don’t have a wife pushing them to seek medical attention.

“Men have a stronger inclination than women to avoid doctors sometimes,” Aizer said. “But a spouse with a vested interest in their health may encourage them to go for care.”

Stein called the new findings “intriguing” but called for additional research to determine whether marriage — or any close emotional partnership — really does improve outcomes in cancer patients.

“Can a patient get the same benefits from a sibling, a parent, or a really close friend?” he said. “Is there something about the legalities of a marriage contract that would provide someone with access to better care than a live-in romantic partner outside of marriage?”

Aizer acknowledged that he’d like to see these questions addressed in future studies. “We’re not sure we have a clear game plan in terms of the best option for nonmarried patients.”

Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2.
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