Prior studies have only considered the association between static marital status and cancer-specific outcomes. We aim to measure the effect of recent divorce on cancer-specific outcomes.
Methods
There were 83,804 patients with 2 malignancies, diagnosed 12 to 60 months apart, from 1973-2006 from the Surveillance, Epidemiology, and End Results database. Patients were identified as newly divorced if married at their first diagnosis and single/divorced at their second. Multivariable logistic regression and competing-risks regression were used to analyze the association of becoming newly divorced or newly married with cancer-specific outcomes from the second malignancy, including advanced diagnosis (T4 or N1 or M1), receipt of treatment, and cancer-specific survival.
Results
Four percent became newly divorced and 3.4% became newly married. Compared with long-term married, newly divorced patients were most likely to be diagnosed with advanced disease (adjusted odds ratio [AOR] 1.31; 95% confidence interval [CI], 1.19-1.43), followed by long-term divorced (AOR 1.18; 95% CI, 1.11-1.25), and were least likely to receive curative treatment (AOR 0.74; 95% CI, 0.67-0.81). Newly divorced patients had the worst cancer-specific survival (adjusted hazard ratio [AHR] 1.17; 95% CI, 1.05-1.30, P = .005), followed by long-term divorced (AHR 1.08; 95% CI, 1.01-1.16, P = .032), while newly married patients had similar cancer-specific survival to long-term married (AHR 0.96; 95% CI, 0.85-1.08, P = .46).
Conclusion
Recent divorce, which represents an acute disruption of a patient’s social support network, was associated with the worst cancer outcomes, followed by long-term divorce. Clinicians should consider recent divorce as a risk factor for worse cancer outcomes, and encourage appropriate screening, treatment, and access to social and financial supports for recently divorced patients.
An estimated 1.7 million people will be diagnosed with cancer in 2015,1 and all of these patients will provide demographic information to clinicians, including self-reported marital status. However, marital status can change over time,2, 3 which may have an effect on health care utilization and health outcomes. Married patients have better cancer outcomes than divorced patients in prior studies,4, 5, 6, 7, 8, 9, 10, 11, 12 but few population-based studies have considered the effect of recent changes in marital status. These studies may miss the effect of a recent divorce, which likely causes an acute disruption of social support and financial stability, leaving patients even less capable to manage their health, especially in the face of a life-threatening cancer diagnosis. In this study, we use a novel approach in the Surveillance, Epidemiology and End Results (SEER) database, using 2 time-points for a single patient to measure the effect of recent divorce, compared with long-term marriage and long-term divorce, on cancer-specific outcomes.
Methods
Data Set
The SEER database is a population-based registry sponsored by the US National Cancer Institute for cancer patients across 13 US regions. SEER collects demographic and clinical information including features of each cancer diagnosis, treatment, and survival outcome. We utilized a feature of SEER linking 2 primary tumors for a single patient, as well as the demographic data collected at each diagnosis.
Population
We identified 121,815 patients over age 18 years in SEER diagnosed with 2 primary malignancies between 12 and 60 months apart, from 1973 to 2011. All patients had complete marital status at both diagnoses. Patients were excluded if other demographics were not available at the second diagnosis (n = 6227). Finally, patients who were single or widowed at both primaries or newly widowed at their second primary were excluded (n = 31,784), leaving a final cohort of 83,804 patients.
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-Kathryn T. Dinh, BS, Ayal A. Aizer, MD, Vinayak Muralidhar, MSc, Brandon A. Mahal, BS, Yu-Wei Chen, MD, Clair J. Beard, MD, Toni K. Choueiri, MD, Karen E. Hoffman, MD, MPH, Jim C. Hu, MD, MPH, Neil E. Martin, MD, Christopher J. Sweeney, MBBS, Quoc-Dien Trinh, MD, Paul L. Nguyen, MD
This article originally appeared in the March issue of The American Journal of Medicine.
