The effect of marital status on stage at diagnosis and survival in Saudis diagnosed with colorectal cancer: cancer registry analysis

Mesnad Alyabsi,Mohammed Algarni,Kanan Alshammari,Majed Ramadan,Abdul Rahman Jazieh

doi:10.1038/s41598-021-88042-9

Abstract

Colorectal cancer (CRC) is the most common cancer in males and third in females in Saudi Arabia, with the majority (66%) diagnosed at a late stage. We evaluated the effect of marital status on stage at diagnosis and CRC survival. We hypothesized that married patients would be more likely to present at an early stage and have higher survival than unmarried patients. The Ministry of National Guard-Health Affairs (MNG-HA) cancer registry was used to identify patients diagnosed with CRC from 2009 to 2017. A competing risk analysis was performed to assess the 5-year CRC-specific survival, adjusting for potential confounders. The Kaplan–Meier method and the Cox regressions were used to assess survival. Two-thirds (76.50%) of the 936 CRC patients were married, 11.64% were unmarried, and 11.86% had an unknown marital status. With multiple imputation-based analysis, the multivariate analysis indicated that unmarried patients were 52% more likely to present at an advanced stage [adjusted odds ratio (aOR) 1.52; 95% CI 1.33–1.73], and had a 30% higher risk of death due to CRC compared to the married patients (aHR 1.30; CI 1.17, 1.44). Future CRC screening and survivorship programs should assess the needs of the vulnerable unmarried population. Interventions supporting the early detection of CRC in this population may be beneficial in the long term and lead to improved cancer outcomes.

Highlights

Colorectal cancer (CRC) is the most common cancer in males and third in females in Saudi Arabia, with the majority (66%) diagnosed at a late stage
Given the vital role that marital status plays as social support for CRC patients, the present study was designed to assess the influence of marital status on the CRC stage at diagnosis and survival in CRC patients
Most non-Saudi patients did not continue their treatment in Saudi Arabia and possibly decided to receive it in their home country

Summary

Introduction

Colorectal cancer (CRC) is the most common cancer in males and third in females in Saudi Arabia, with the majority (66%) diagnosed at a late stage. We hypothesized that married patients would be more likely to present at an early stage and have higher survival than unmarried patients. A Chinese study assessing CRC survival in surgically treated colon cancer patients reported that married patients had higher survival than unmarried patients, despite a similar stage of cancer and adjuvant therapy use[15]. Contrary to these studies, marital status was not an independent predictor of CRC survival in a tertiary hospital in the United States (US)[19]. This study’s findings will support practitioners who attend to patients during the survivorship phase of the cancer continuum

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Discussion

Conclusion