Marriage Increases Cancer Survival: What the Studies Mean
Lori DuBenske, PhD, a cancer psychologist at the UW Carbone Cancer Center, provides psychotherapy to patients and family members. She also conducts research with the UW Center for Health Enhancement Systems Studies (CHESS), examining ways to use technology to enhance cancer patient, caregiver and clinician communication to improve the cancer experience.
In 2013, Dr. Ayal Aizer published findings in The Journal of Clinical Oncology that caught national attention demonstrating that married cancer patients are 20 percent less likely to die from the disease than unmarried cancer patients. These findings were based on review of 734,889 patient records for people diagnosed between 2004-2008 across 10 leading types of cancer.
Since then similar studies in additional types of cancer and international patient populations have found similar results. Yet, none of the studies were designed to examine reasons for the benefits that marriage seems to confer. Some suspect the benefits have more to do with the type of support a spouse can offer rather than a characteristic specific to marriage itself. Consider the following findings:
First, married patients are more likely to be diagnosed at earlier stages of disease. It is believed they are likely to have someone who is invested in their health and encourages seeking medical care, either routine screening or in reaction to presenting medical concerns. Earlier detection affords better prognosis and increased chance of remission.
Second, married patients are more likely to receive more aggressive treatments. Such cancer therapies are likely to make patients very ill with potentially debilitating side effects. Spouses often accompany patients to their clinic visits, make sure they understand recommendations and complete all their treatments. They also monitor symptoms and can provide at home medication management and serve as liaison to the medical team in times of changing symptoms or concerns, in turn facilitating care. Without such support, aggressive treatments can be unrealistic or unsustainable.
But this likely does not tell the whole story.
Beyond the practical considerations of managing aggressive treatment lie the emotional considerations. As a clinical psychologist in the UW Carbone Cancer Center, I have supported many patients who debate the merits of pursuing treatment. These patients are backed into a corner of weighing the value of quantity versus quality of life. And they often evaluate the impact on their own lives as well as on their loved ones.
For many married patients, considering the impact of their cancer and potentially their death on their spouse takes a greater emotional toll than facing their own mortality. While the research has yet to examine what specifically about marriage facilitates cancer survival, I urge, albeit anecdotally, that beyond making treatment realistic and sustainable, for some, having a spouse that you feel you need to be around for may make enduring harsh aggressive treatment more appealing.
These findings are not to say that marriage is the answer for cancer survival. But rather, they highlight critical roles of social support networks in supporting, and potentially motivating, optimal cancer therapies. As clinicians, we need to be aware of our patient’s available social support resources and encourage patients to accept support. As family, friends and acquaintances of someone with cancer, we need to offer support in practical ways that can allow a patient to take every advantage of treatments available, if that is their preference to do so.
Aizer, Ayal A., et al. "Marital status and survival in patients with cancer." Journal of Clinical Oncology 31.31 (2013): 3869-3876.
Aizer, Ayal A., et al. "Refusal of curative radiation therapy and surgery among patients with cancer." International Journal of Radiation Oncology* Biology* Physics 89.4 (2014): 756-764.
Eriksson, Hanna, et al. "Later stage at diagnosis and worse survival in cutaneous malignant melanoma among men living alone: a nationwide population-based study from Sweden." Journal of Clinical Oncology (2014): JCO-2013.
Schaefer, Eric W., et al. "Effect of marriage on outcomes for elderly patients with head and neck cancer." Head & Neck 37.5 (2015): 735-742.