Abstract
Marital status was found to be an independent prognostic factor for survival in various cancer types, but it hasn't been fully studied in colorectal cancer (CRC). The Surveillance, Epidemiology and End Results database was used to compare survival outcomes with marital status in each stage. In total, 112, 776 eligible patients were identified. Patients in the widowed group were more frequently elderly women, more common of colon cancer, and more stage I/II in tumor stage (P < 0.001), but the surgery rate was comparable to that for the married group (94.72% VS 94.10%). Married CRC patients had better 5year cause-specific survival (CSS) than those unmarried (P < 0.05). Further analysis showed that widowed patients always presented the lowest CSS compared with that of other' group. Widowed patients had 5% reduction 5-year CSS compared with married patients at stage I (94.8% vs 89.8%, P < 0.001), 9.4% reduction at stage II (85.9% vs 76.5%, P < 0.001), 16.7% reduction at stage III (70.6% vs 53.9%, P < 0.001) and 6.2% reduction at stage IV(14.4% VS 8.2%, P < 0.001). These results showed that unmarried patients were at greater risk of cancer specific mortality. Despite favorable clinicpathological characteristics, widowed patients were at highest risk of death compared with other groups.
Highlights
Married individuals enjoy longer overall survival and lower mortality for many major causes of death compared with those who have never married, separated, widowed, or divorced [1,2,3]
In a larger population-based study on data from the Surveillance, Epidemiology and End Results (SEER) database indicated that unmarried patients are at significantly higher risk of presentation with metastatic cancer, undertreatment, and death resulting from their cancer in ten leading causes of cancer-related death [4]
Patients in the widowed group had the highest proportion of women, more common of colon cancer, more prevalence of elderly patients (≥60 years), and more tumor at stage I/II, all of which were statistically significant (P < 0.001)
Summary
Married individuals enjoy longer overall survival and lower mortality for many major causes of death compared with those who have never married, separated, widowed, or divorced [1,2,3]. The study by Johansen et al compared survival outcomes of married and unmarried individuals without differentiating among single, divorced and widowed status. Marital statuses in the population, stage at presentation, mortality, as well as therapy options, have changed in more recent years This change may be related to possible increases or decreases in the proportion of married and unmarried individuals and their effect on cause-specific survival (CSS) [10, 11]. Two reported reasons of poor survival among unmarried patients were delayed diagnosis and undertreatment If this were true, marital status may have no effect on early CRC, because these patients do not require adjuvant therapy. Our hypothesis was that the unmarried subgroup of CRC patients may differ in terms of survival outcomes
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