Marital Status and Survival in Locally Advanced Cervical Cancer Treated With Radiation and Brachytherapy

Abstract

Several studies have shown a positive association between marital status and enhanced survival among cancer patients. Improving cervical cancer outcomes requires a better understanding of social and biologic factors to develop effective targeted intervention and therapeutics. We explored the association of martial status on survival of locally advanced cervical cancer patients treated with brachytherapy in California. All residents of California diagnosed with cancer are reported to the California Cancer Registry (CCR). Using data from the CCR, we identified patients with a new diagnosis of cervical cancer stage FIGO stage IB2- IVA from 2004-2014 treated with external beam radiotherapy (EBRT). We examined the patient and tumor characteristics including marital status: married vs. single/widowed/divorced (single), the use of brachytherapy, age, race, socioeconomic status (SES), histology, stageand treatment year. Using Cox proportional hazards, we examined the impact of martial status on overall survival in cervical cancer. We identified 4,481 patients with complete radiation boost information (brachytherapy vs. EBRT). Distribution by FIGO stage was 11% IB2; 32% II, 54% III, 4% IVA. The majority of patients (57%) were single/widowed/divorced, 41% married, and 2% unknown marital status. Over a third of patients (36%) were white, 6% black, 41% Hispanic, and 16% Asian. Nearly half of patients (45%) of the single and married patients were treated with a brachytherapy boost. There was no association between the receipt of a brachytherapy boost and marital status. Single patients had a worse overall survival compared to married patients, HR 1.152 95% CI (1.0. 1.3), p<0.037, after controlling variables such as stage, histology, tumor grade, age, race, SES, treatment year, and brachytherapy boost receipt. The majority of locally advanced cervical cancer patients presenting in California are single. Despite the equity in brachytherapy treatment, single patients had worse survival outcomes compared to those that are married. Clarification of causes and evaluation of social support networks could illuminate novel interventions to improve survival in this vulnerable population.