A major new cancer study suggests that when it comes to cancer, nagging wives may just save lives. Nagging husbands too, of course.
The study just out in the Journal of Clinical Oncology found that marriage appears to confer three signal advantages on cancer patients: Married people are likelier to be diagnosed before the cancer has spread. They are likelier to get and stick through the right treatments. And they are likelier to live longer after the diagnosis.
In some cancers, the paper found, being married appears to improve a patient’s survival odds even a bit more than chemotherapy.
The study is the biggest yet on the link between marriage and cancer outcomes, said its lead author, Dr. Ayal Aizer, chief resident of the Harvard Radiation Oncology Program. It began with a database of more than 1 million patients and looked at the ten cancers that cause the most deaths, including cancers of the prostate, breast, lung and colon.
How might marriage improve cancer outcomes? Couldn’t married people just be richer or healthier or better able to get care? “We think it’s actually the marriage itself that really causes better outcomes,” Dr. Aizer said. “And we think it’s the support that a patient with cancer gets from their spouse that really is the difference-maker.”
How much of a difference does it make?
Dr. Aizer and his team generated a single analysis of all the patients with all their cancers and found: “Patients who were married are 20 percent more likely to be alive after their diagnosis of cancer at any time point” compared to patients who were not married, he said. “They’re also about 17 percent more likely to present with localized cancers, ones that are treatable or curable; and they’re about 53 percent more likely to get the recommended or appropriate treatment for their cancer.”
That 53 percent was striking and a bit baffling. Wouldn’t most patients get appropriate cancer treatment?
“That was one we were very surprised by,” Dr. Aizer agreed. It could have to do with spouses pushing patients with cancers whose treatments can include a “watch-and-wait” approach — such as early prostate cancer — to be treated aggressively instead, he said.
“But for most of the cancers, these patient should be getting either radiation or surgery, because they are curable, and for most cancers, observation is not an option,” he said. “So we think that it’s something to do with the spouse providing the necessary encouragement or pressure in order for that patient to A, get to the doctor, and B, when they get to the doctor, and the doctor provides a recommendation, to actually adhere to and follow through on that recommendation, and ultimately finish the course of therapy.”
Treatment for head and neck cancer, he noted, can involve going in for radiation every day for seven weeks, and patients can have tough side effects. “Having a spouse there for encouragement and also to just physically get there every day is making the difference for these patients,” he said.
The study turned up some intriguing gender differences: Being married appears to help men with cancer more than it helps women, generally by several percentage points, it found.
Personally, I couldn’t help but be reminded of past studies that found that men tend to benefit more from marriage than women do, at least health-wise, and a 2011 study that found that far more husbands leave wives with cancer than vice versa. ABC News reported that “Nearly 21 percent of couples split up when the woman was the patient, compared to just about 3 percent when the man was the patient.”
The punditry at the time speculated that men had a harder time coping with a caregiver role; might that also explain the gender gap in this study?
In fact, Dr. Aizer said, it seems that marriage may be less of an advantage for married women compared to single women because single women tend to be good at marshaling the support they need to go through cancer treatments.
So the message, he said, is that single men are a group of particular concern, and may need extra help setting up support after a diagnosis.
In general, he said, “We didn’t want this to be a pat on the back for patients who are married. We didn’t want it to be, ‘Good job. You’re married. You’ve done all that you can do.”
“We want doctors to be aware of this so that they can get their unmarried population the support they need after a diagnosis with cancer. And we wanted health systems and hospitals to really invest in studies that look at the role of support among patients with cancer, and consider interventions to help people get the support they need. That could be social work, that could be support groups, that could be other kinds of interventions that just get people better support.”
Cancer patients, too, should be oriented toward building systems to help them through, Dr. Aizer said. “The more support people can obtain, the better,” he said.