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An Argument for the Sanctity of Marriage, but Beware: Separated Cancer Patients Have Poorer Survival

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It has been a while since I’ve posted here, and it is nice to be back again! I have been compiling a list of some interesting topics (to me) for future posts, so hopefully we can have some good discussions in the comments section. This particular topic is not specific to lung cancer, but certainly applies to lung cancer patients as much as any other malignancy so I think it will still be of interest.

For many years there has been a consistent observation made among cancer patients that married individuals tend to live significantly longer than do unmarried individuals. This observation holds true across different types of cancer including prostate, breast, and lung. For some reason, the warm support of the spouse at your side seems to be a broadly positive prognostic factor, in addition to the other numerous benefits…

marriagecartoon2

There are any number of reasons for exactly why this might be so. Patients who are married tend to have better financial resources and also have better social support, two elements that independently seem to predict for patients doing better. Marriage also frequently results in children (although marriage not required), which can provide additional support at trying times for elderly patients. There are also reasons to think that patients who are NOT married may have problems that contribute to poor outcomes including psychological problems such as depression, substance abuse, and poor health for reasons other than their cancer. Loneliness is a big problem for my unmarried, elderly patients and I can see first hand that their lives are much harder during treatment than those with big families at their sides.

Of course, this is not new data. What is new is a recent study by Dr. Gwen Sprehn and colleagues as Indiana University School of Medicine, recently published in the journal Cancer. Dr. Sprehn used the SEER database to examine the marital status of more than 3 million cancer patients, and this time broke down the 5 and 10-year survival rates by not just married/unmarried but by more specific states. She included married, never married, separated, divorced, and widowed status (at the time of cancer diagnosis) in her analysis.

marriage-and-survival

The best overall survival was seen in the married group, with 5 and 10 year survivals of 63% and 57% respectively. This simply confirmed what we already knew. However, the next highest survival was seen in those who had never been married, at 57% and 52% at 5 and 10 years. The patients who had been divorced or widowed each did worse than never married patients, and the worst of all was those who were married but separated at diagnosis (45% and 37%). Clearly having marrital strife affected their disease outcomes!

There did not appear to be any specific disease-related factor that caused this affect, so why would separation be worse for cancer survival than divorce or being widowed? The authors argue that this could be due to the relationship between high levels of stress and a depressed immune system, which is a well documented effect. Apparently animals that are put under stress have enhanced cancer growth and metastasis in cancer models compared to calm and happy animals. There have also been a number of observations that stress can adversely affect the immune system in cancer patients, as measured by blood markers of immune function and assays of immune cells. Of course, this is only speculation, and other factors such as lack of acute social support and financial problems associated with impending divorce could also be in play.

In any case, it appears that if you get benefit from being married, it is only if you STAY married. The next question is, of course, what can be done about this? Identifying patients having marital issues at diagnosis or during treatment may be an important issue to pick up on. Such patients may benefit from counseling and additional support, which at the very least may improve their quality of life even if it doesn’t improve their survival!

Marriage counseling

Marriage counseling


3 Responses to An Argument for the Sanctity of Marriage, but Beware: Separated Cancer Patients Have Poorer Survival

  • LovesLife says:

    Welcome back Dr. Pennell – nice to see your smiling face!

    I cannot imagine having gone through my cancer experience (and life) without my wonderful, supportive husband by my side. He was, and always will be, my rock. How lucky I am to have that!

    As to the above post however; I always thought that if one was in a stressful (aka rotten!) relationship/marriage that it would have a negative benefit on one’s health. I agree that being separated would be very stressful, but what about the ones that STAY married and don’t contribute in a healthy manner to the relationship? I see where counselling would then become an important step to healing as long as both parties are willing. What I have often seen; however, is that only one is willing to work to “fix it” and that simply doesn’t work. One lady I met left her husband after her diagnosis and four years later is happier (and disease free I might add) than she was before. She fully believes, to this day, that the stress from their toxic relationship brought about her cancer. I certainly don’t know what caused her cancer; however, I believe in each case the goal should be to find the appropriate plan that would provide the most “peace” for the patient.

    Just my thoughts on the subject.

    Linda

  • Catharine says:

    Dr. Pennell –

    Very interesting and informative. I appreciate a look at the emotional side of cancer as well and the medical/physical aspects. Thank you.

    – Catharine

  • Dr Pennell says:

    Hi Linda, I think what you says makes perfect sense. Of course this study only looked at numbers and specific checks in boxes for millions of patients, not specific patient and family situations. I think the patients who are in bad marriages but do not take the initiative to either get out or to try and fix it would be even worse than other groups for the same reason: stress and the associated problems that go with it. However, I this was not assessed and in our divorce-happy society probably was a minority of the 2 million married folks.

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