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The effect of marital status on stage and survival of prostate cancer patients treated with radical prostatectomy: a population-based study

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Abstract

Objective

The detrimental effect of unmarried marital status on stage and survival has been confirmed in several malignancies. We set to test whether this applied to patients diagnosed with prostate cancer (PCa) treated with radical prostatectomy (RP).

Methods

We identified 163,697 non-metastatic PCa patients treated with RP, within 17 Surveillance, Epidemiology, and End Results registries. Logistic regression analyses focused on the rate of locally advanced stage (pT3-4/pN1) at RP. Cox regression analyses tested the relationship between marital status and cancer-specific (CSM), as well as all-cause mortality (ACM).

Results

Respectively, 9.1 and 7.8% of individuals were separated/divorced/widowed (SDW) and never married. SDW men had more advanced stage at surgery (odds ratio: 1.1; p < 0.001), higher CSM and ACM (both hazard ratio [HR]: 1.3; p < 0.001) than married men. Similarly, never married marital status portended to a higher ACM rate (HR:1.2, p = 0.001). These findings were consistent when analyses were stratified according to organ confined vs. locally advanced stages.

Conclusions

Being SDW significantly increased the risk of more advanced stage at RP. Following surgery, SDW men portended to a higher CSM and ACM rate than married men. Consequently, these individuals may benefit from a more focused health care throughout the natural history of their disease.

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References

  1. Hu Y, Goldman N (1990) Mortality differentials by marital status: an international comparison. Demography 27:233–250

    Article  PubMed  CAS  Google Scholar 

  2. Kaplan R, Kronick R (2006) Marital status and longetivity in the United States population. J Epidemiol Community Health 60:760–765

    Article  PubMed  Google Scholar 

  3. Ortmeyer C (1974) In: Erhardt LLBJe (ed) Variations in mortality, morbidity, and health care by marital status. Harvard University Press, Cambridge

    Google Scholar 

  4. Goodwin JS, Hunt WC, Key CR, Samet JM (1987) The effect of marital status on stage, treatment, and survival of cancer patients. JAMA 258:3125–3130

    Article  PubMed  CAS  Google Scholar 

  5. Chang SM, Barker FG (2005) Marital status, treatment, and survival in patients with glioblastoma multiforme: a population based study. Cancer 104:1975–1984

    Article  PubMed  Google Scholar 

  6. Datta GD, Neville BA, Kawachi I, Datta NS, Earle CC (2009) Marital status and survival following bladder cancer. J Epidemiol Commun Health 63:807–813

    Article  Google Scholar 

  7. Gore JL, Kwan L, Saigal CS, Litwin MS (2005) Marriage and mortality in bladder carcinoma. Cancer 104:1188–1194

    Article  PubMed  Google Scholar 

  8. Hellenthal NJ, Chamie K, Ramirez ML, deVere White RW (2009) Sociodemographic factors associated with nephrectomy in patients with metastatic renal cell carcinoma. J Urol 181:1013–1018 discussion 8-9

    Article  PubMed  Google Scholar 

  9. Konski A, Desilvio M, Hartsell W et al (2006) Continuing evidence for poorer treatment outcomes for single male patients: retreatment data from RTOG 97–14. Int J Radiat Oncol Biol Phys 66:229–233

    Article  PubMed  Google Scholar 

  10. Konski AA, Pajak TF, Movsas B et al (2006) Disadvantage of men living alone participating in Radiation Therapy Oncology Group head and neck trials. J Clin Oncol 24:4177–4183

    Article  PubMed  Google Scholar 

  11. Kravdal O (2001) The impact of marital status on cancer survival. Soc Sci Med 52:357–368

    Article  PubMed  CAS  Google Scholar 

  12. Nelles JL, Joseph SA, Konety BR (2009) The impact of marriage on bladder cancer mortality. Urol Oncol 27:263–267

    Article  PubMed  Google Scholar 

  13. Pruthi RS, Lentz AC, Sand M, Kouba E, Wallen EM (2009) Impact of marital status in patients undergoing radical cystectomy for bladder cancer. World J Urol 27:573–576

    Article  PubMed  Google Scholar 

  14. Torssander J, Erikson R (2009) Marital partner and mortality: the effects of the social positions of both spouses. J Epidemiol Commun Health 63:992–998

    Article  CAS  Google Scholar 

  15. Denberg TD, Beaty BL, Kim FJ, Steiner JF (2005) Marriage and ethnicity predict treatment in localized prostate carcinoma. Cancer 103:1819–1825

    Article  PubMed  Google Scholar 

  16. Denberg TD, Glodé LM, Steiner JF, Crawford ED, Hoffman RM (2006) Trends and predictors of aggressive therapy for clinical locally advanced prostate carcinoma. BJU Int 98:335–340

    Article  PubMed  Google Scholar 

  17. Harvei S, Kravdal O (1997) The importance of marital and socioeconomic status in incidence and survival of prostate cancer. Prev Med 26:623–632

    Article  PubMed  CAS  Google Scholar 

  18. Krongrad A, Lai H, Burke MA, Goodkin K, Lai S (1996) Marriage and mortality in prostate cancer. J Urol 156:1696–1770

    Article  PubMed  CAS  Google Scholar 

  19. Stamey TA, Yang N, Hay AR, McNeal JE, Freiha FS, Redwine E (1987) Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate. N Engl J Med 317:909–916

    Article  PubMed  CAS  Google Scholar 

  20. Welch HG, Albertsen PC (2009) Prostate cancer diagnosis and treatment after the introduction of prostate-specific antigen screening: 1986–2005. J Natl Cancer Inst 101:1325–1329

    Article  PubMed  Google Scholar 

  21. Ries LAG, Melbert D, Krapcho M, et al. (2007) SEER Cancer Statistics Review, 1975-2004. National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2004/, based on November 2006 SEER data submission, posted to the SEER Web site

  22. Du XL, Fang S, Coker AL et al (2006) Racial disparity and socioeconomic status in association with survival in older men with local/regional stage prostate carcinoma: findings from a large community-based cohort. Cancer 106:1276–1285

    Article  PubMed  Google Scholar 

  23. Schoenfeld D (1982) Partial residuals for the proportional hazards regression model. Biometrika 69:239–241

    Article  Google Scholar 

  24. Barroso U Jr, Oskanian P, Tefilli MV et al (1999) Population-based study of pelvic lymph node positivity in clinically localized prostate cancer: a study comparing African Americans and whites. Urology 53:187–191

    Article  PubMed  Google Scholar 

  25. Powell IJ, Schwartz K, Hussain M (1995) Removal of the financial barrier to health care: does it impact on prostate cancer at presentation and survival? A comparative study between black and white men in a Veterans Affairs system. Urology 46:825–830

    Article  PubMed  CAS  Google Scholar 

  26. Reddy S, Shapiro M, Morton R Jr, Brawley OW (2003) Prostate cancer in black and white Americans. Cancer Metastasis Rev 22:83–86

    Article  PubMed  CAS  Google Scholar 

  27. Goldman N, Korenman S, Weinstein R (1995) Marital status and health among the elderly. Soc Sci Med 34:907–917

    Google Scholar 

  28. Umberson D (1992) Gender, marital status and the social control for health behavior. Soc Sci Med 34:907–917

    Article  PubMed  CAS  Google Scholar 

  29. Waldron I, Hugues M, Brooks T (1996) Marriage protection and marriage selection-protective evidence for reciprocal effects of marital status and health. Soc Sci Med 43:113–123

    Article  PubMed  CAS  Google Scholar 

  30. Rosengren A, Wedel H, Wilhelmsen L (1989) Marital status and mortality in middle-aged Swedish men. Am J Epidemiol 129:54–64

    PubMed  CAS  Google Scholar 

  31. Bartrop RW, Lazarus L, Luckhurst E, Kiloh LG, Penny R (1977) Depressed lymphocyte function after bereavement. Lancet 309:834–836

    Article  Google Scholar 

  32. Christakis NA, Allison PD (2006) Mortality after the hospitalization of a spouse. N Engl J Med 354:719–730

    Article  PubMed  CAS  Google Scholar 

  33. Kemeny ME, Weiner H, Duran R, Taylor SE, Visscher B, Fahey JL (1995) Immune system changes after the death of a partner in HIV-positive gay men. Psychosom Med 57:547–554

    PubMed  CAS  Google Scholar 

  34. Kiecolt-Glaser JK, Glaser R, Cacioppo JT et al (1997) Marital conflict in older adults: endocrinological and immunological correlates. Psychosom Med 59:339–349

    PubMed  CAS  Google Scholar 

  35. Kiecolt-Glaser JK, Kennedy S, Malkoff S, Fisher L, Speicher CE, Glaser R (1988) Marital discord and immunity in males. Psychosom Med 50:213–229

    PubMed  CAS  Google Scholar 

  36. Kiecolt-Glaser JK, Malarkey WB, Chee M et al (1993) Negative behavior during marital conflict is associated with immunological down-regulation. Psychosom Med 55:395–409

    PubMed  CAS  Google Scholar 

  37. Sprehn GC, Chambers JE, Saykin AJ, Konski A, Johnstone PAS (2009) Decreased cancer survival in individuals separated at time of diagnosis: critical period for cancer pathophysiology? Cancer 115:5108–5116

    Article  PubMed  Google Scholar 

  38. Joung IM, van de Mheen HD, Stronks K, van Poppel FW, Mackenbach JP (1998) A longitudinal study of health selection in marital transitions. Soc Sci Med 46:425–435

    Article  PubMed  CAS  Google Scholar 

  39. Ben-Eliyahu S, Page GG, Yirmiya R, Shakhar G (1999) Evidence that stress and surgical interventions promote tumor development by suppressing natural killer cell activity. Int J Cancer 80:880–888

    Article  PubMed  CAS  Google Scholar 

  40. Antoni MH, Lutgendorf SK, Cole SW et al (2006) The influence of bio-behavioural factors on tumour biology: pathways and mechanisms. Nat Rev Cancer 6:240–248

    Article  PubMed  CAS  Google Scholar 

  41. Miller AH, Ancoli-Israel S, Bower JE, Capuron L, Irwin MR (2008) Neuroendocrine-immune mechanisms of behavioral comorbidities in patients with cancer. J Clin Oncol 26:971–982

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

Pierre I. Karakiewicz is partially supported by the University of Montreal Health Center Fonds de la Recherche en Santé du Quebec, the University of Montreal Department of Surgery and the University of Montreal Health Center (CHUM) Foundation.

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None.

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Authors and Affiliations

  1. Cancer Prognostics and Health Outcome Unit, University of Montreal Health Center (CHUM), 1058, rue St-Denis, Montreal, QC, H2X 3J4, Canada

    Firas Abdollah, Maxine Sun, Rodolphe Thuret, Al’a Abdo, Monica Morgan, Claudio Jeldres, Paul Perrotte & Pierre I. Karakiewicz

  2. Department of Urology, Vita Salute University/San Raffaele Hospital, Milan, Italy

    Firas Abdollah & Francesco Montorsi

  3. Department of Urology, University of Montpellier Health Centre, Montpellier, France

    Rodolphe Thuret

  4. Department of Urology, Weill Medical College of Cornell University, New York, NY, USA

    Shahrokh F. Shariat

Authors
  1. Firas Abdollah
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  2. Maxine Sun
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  3. Rodolphe Thuret
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  4. Al’a Abdo
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  5. Monica Morgan
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  7. Shahrokh F. Shariat
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  8. Paul Perrotte
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  9. Francesco Montorsi
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  10. Pierre I. Karakiewicz
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Corresponding author

Correspondence to Firas Abdollah.

Additional information

The authors Firas Abdollah and Maxine Sun contributed equally to this work.

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Abdollah, F., Sun, M., Thuret, R. et al. The effect of marital status on stage and survival of prostate cancer patients treated with radical prostatectomy: a population-based study. Cancer Causes Control 22, 1085–1095 (2011). https://doi.org/10.1007/s10552-011-9784-x

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  • DOI: https://doi.org/10.1007/s10552-011-9784-x

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