Impact of marital status during diagnosis on cancer-caused specific survival in acute myeloid leukemia patients: a case-control and population-based study.

Zhuojun Zheng,Jingting Jiang,Wenwei Hu,Xiaodong Li,Yuandong Zhu

doi:10.18632/oncotarget.16989

Zhuojun Zheng, Jingting Jiang + Show 3 more

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https://doi.org/10.18632/oncotarget.16989

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Abstract

ObjectiveThis study investigated the impact of marital status on cancer-caused specific mortality among acute myeloid leukemia (AML) patients in the United States.MethodsWe used the Surveillance, Epidemiology and End Results program to identify 50,825 patients who had their clinical and follow-up information available and were diagnosed for AML between the years 1988 and 2015. The univariate and multivariable Cox regression models were used to analyze the patient data, and to minimize the group differences due to covariates between groups, a 1:1 propensity score matching was used in subsequent subgroup analysis.ResultsOur study demonstrated that married patients were less likely to die due to AML after adjusting for demographic and clinicopathological variables, than patients with variable unmarried status. Further analysis indicated that widowed, divorced and never married status correlated with poor cancer-cause specific survival than being married in almost all subgroups after being adjusted for the aforementioned variables (P<0.05). However, the difference between married and separated was not apparent. Moreover, similar survival analysis results were also observed in the 1:1 matched subgroups of marital status, but they displayed varied prognostic factors between them. The association of survival benefit with marriage in AML was consistent with the published survival benefit of conventional therapeutic approaches.ConclusionOverall, our study concluded that unmarried AML patients were at greater risk of cancer-specific mortality than married, and thus indicated that physicians should focus on health care strategies that target social support, in order to reduce the cancer-specific mortality in unmarried patients.

Highlights

Among the hematological malignancies, humans usually display high frequency of acute leukemia
Abbreviation: not otherwise specified (NOS), no other specific; SEER, Surveillance, Epidemiology and End Results; AML, acute myeloid leukemia. aData represented number of patients. bP value of the Chi-square test or Wilcoxon-Mann-Whitney test refers to comparison for the differences in proportions among subgroups
In demographic and clinicopathological characteristics, including sex, race, age at diagnosis, AML subtype, adjuvant therapy and cause of death were observed in patients from marital status groups

Summary

Introduction

Humans usually display high frequency of acute leukemia. The social support among the many factors exerts a significant effect on the clinical outcome, especially in patients with malignant diseases [2, 3]. The study by Borate et al showed that single (never married) and divorce status were poor prognostic factors for survival in younger AML patients [15]. On the contrary, the study by Fintel et al [16] reported that marriage did not have any influence on the survival outcome in adolescent and young adults with AML, thereby suggesting that social issues like marital status were less important than disease-specific therapies. We believe that a better understanding of the impact of marital status on AML would lead to better understanding of the importance of social mechanisms in the management of this malignancy and can help to establish a more holistic approach to improve patient outcomes. We in this study have tried to explore the underlying mechanisms of the correlation between marital status and the survival of younger and elderly AML patients

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Conclusion