Abstract
The impact of marital status at diagnosis on survival outcomes and its change over time in patients with nasopharyngeal carcinoma (NPC) are unclear. The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients diagnosed with NPC in the United States from 1973 to 2012. A primary comparison (married vs. unmarried) was implemented with 1:1 propensity score matching. Secondary comparisons were performed individually between three unmarried subgroups (single, separated/divorced, widowed) and married group. The effect of marital status on cause‐specific survival (CSS) and overall survival (OS) were evaluated using univariate/multivariate analysis. Moreover, we investigated the change over time (1973–2012) in the effect of marital status on NPC survival. Married patients had better 5‐year CSS/OS than unmarried patients (61.1% vs. 52.6%, P < 0.001; 55.6% vs. 45.3%, P < 0.001, respectively). In multivariate analysis, unmarried patients had significantly poorer CSS/OS than married patients (adjusted hazard ratio [aHR] = 1.35, P < 0.001; aHR = 1.40, P < 0.001, respectively). The survival benefit of being married was only detected in non‐Hispanic white and Chinese American patients. Single, separated/divorced, and widowed patients had significantly poorer CSS/OS than married patients (aHR = 1.37 and 1.37; 1.46 and 1.42; 1.43 and 1.48, respectively; all P < 0.001). The change over time in the effect of marital status on survival was more stable in male than female. The strength of the negative effect of separated/divorced and widowed status showed a downward and upward trend, respectively. Gender difference in the adverse effect of single status on NPC survival became smaller over time. Only non‐Hispanic white and Chinese American patients with NPC obtain survival benefits from married status. Single and widowed patients are regarded as high‐risk population
Highlights
Nasopharyngeal carcinoma (NPC) is a malignant head and neck cancer with an uneven global distribution; the highest incidences are observed in Southeast Asia, North Africa, the Middle East and Alaska [1]
Patients identification and baseline characteristics We extracted data on 9851 patients diagnosed with NPC between 1973 and 2012 from the SEER-18
The original data set (n = 8702) included 5786 married patients and 2916 unmarried patients; significant difference in all baseline characteristics was observed between the two groups
Summary
Nasopharyngeal carcinoma (NPC) is a malignant head and neck cancer with an uneven global distribution; the highest incidences are observed in Southeast Asia, North Africa, the Middle East and Alaska [1]. Social support is of great importance for patients with NPC. Married status is regarded as a type of social support with general beneficial to all individuals (e.g., cancer-free people and cancer patients), especially in the elderly [4]. A previous study reported generally significant survival benefit for married patients compared to unmarried patients in analyses of the ten leading causes of cancer-related deaths in the United States. Marriage conferred a greater survival benefit than the published survival benefits reported for chemotherapy in five of the ten leading cancers [5]. The strength of the association between marriage and survival outcomes varies depending on the type of malignancy. In studies that investigated the value of marital status on survival in a single malignancy, conflicting conclusions have been obtained with both positive [6,7,8] and nonsignificant results [9, 10]
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