Specifically, we hypothesized that unmarried patients may have lower access to treatment than their married counterpart. Additionally, we also hypothesized that being unmarried may be a risk factor for poor survival outcomes in this patient population. To address this topic, we tested the effect of marital status on access to cytoreductive nephrectomy, metastasectomy and systemic therapy, which represent the main treatments for metastatic kidney cancer. Moreover, we also examined the relationship between marital status and cancer-specific mortality. Since previous data indicated differences in unmarried status between men and women,5,6 we relied on separate, gender-specific analyses.
As we postulated, our analyses demonstrated that unmarried patients have lower access to treatment than their married counterpart. Specifically, unmarried status in men is an independent predictor of lower access to cytoreductive nephrectomy (OR: 0.54), metastasectomy (OR: 0.70) and systemic therapy (OR: 0.70). Differently, unmarried status in women is an independent predictor of lower access to cytoreductive nephrectomy (OR: 0.63) and systemic therapy (OR: 0.80), but not to metastasectomy (OR: 0.83; p=0.12). Moreover, survival analyses revealed that unmarried men have higher cancer-specific mortality than their married counterpart (HR 1.15, p<0.001). Conversely, this relationship failed to achieve independent predictor status in women (p>0.05).
Our findings revealed that unmarried status may undermine the rates of access to treatment in patients with metastatic clear cell renal carcinoma, both in men and in women. However, our analyses also showed that lower access to treatment in unmarried men may be related to poor survival outcomes in this patient population, compared to their married counterpart. In consequence, we believe that the evidence provided by our findings could give scientific support and sensitize the medical community about the added vulnerability of unmarried patients and possibly grater vulnerability of unmarried males.
Written by: Giuseppe Rosiello, MD, IRCCS San Raffaele Scientific Institute, Milan, Italy
1. Knipper S, Preisser F, Mazzone E, Mistretta FA, Palumbo C, Tian Z, et al. Contemporary analysis of the effect of marital status on survival of prostate cancer patients across all stages: A population-based study. Urol Oncol Semin Orig Investig 2019:S1078143919301565. doi:10.1016/j.urolonc.2019.04.023.
2. Sammon JD, Morgan M, Djahangirian O, Trinh Q-D, Sun M, Ghani KR, et al. Marital status: a gender-independent risk factor for poorer survival after radical cystectomy: MARITAL STATUS AND SURVIVAL AFTER RADICAL CYSTECTOMY. BJU Int 2012;110:1301–9. doi:10.1111/j.1464-410X.2012.10993.x.
3. He X-K, Lin Z-H, Qian Y, Xia D, Jin P, Sun L-M. Marital status and survival in patients with primary liver cancer. Oncotarget 2017;8. doi:10.18632/oncotarget.11066.
4. Bai D-S, Chen P, Qian J-J, Jin S-J, Jiang G-Q. Effect of marital status on the survival of patients with gallbladder cancer treated with surgical resection: a population-based study. Oncotarget 2017;8:26404–13. doi:10.18632/oncotarget.15476.
5. Niu Q, Lu Y, Wu Y, Xu S, Shi Q, Huang T, et al. The effect of marital status on the survival of patients with bladder urothelial carcinoma: A SEER database analysis. Medicine (Baltimore) 2018;97:e11378. doi:10.1097/MD.0000000000011378.
6. Pruthi RS, Lentz AC, Sand M, Kouba E, Wallen EM. Impact of marital status in patients undergoing radical cystectomy for bladder cancer. World J Urol 2009;27:573–6. doi:10.1007/s00345-009-0380-6.
Read the Abstract