Singlehood and cancer

Definition: The development and outcome of all kinds of cancer are influenced by a variety of risk factors, such as ethnicity, genetic disposition, preventive health behavior, and socioeconomic or sociodemographic factors. The impact of singlehood as a sociodemographic factor on cancer is rather complex but seems to show a trend toward a statistically unsalutary outcome of this chronic disease.

Description of the population: Singlehood defines the marital status of individuals who never married or are separated, divorced, or widowed.

Incidence, death, and survival statistics: The impact of singlehood on the incidence, death, or survival of cancer patients is very complex, because the studies and surveys conducted on this topic are often differently designed, investigating only one specific kind and stage of cancer in a specific population group. Therefore, the survival or death percentages in the individual studies cannot be generalized for all cancers and population groups.

However, studies suggest that there may be a trend toward a somewhat detrimental impact of singlehood on cancer survival or mortality, as well as on the quality of life of cancer patients. Studies also suggest that the evolution of cancer and therefore cancer incidence may not be affected by marital status per se; however, several surveys indicate that single individuals may be less willing to participate in specific screening programs, such as breast, prostate, or colorectal screenings, to help diagnose and subsequently remove the cancer at an earlier stage or before it becomes inoperable.

The most attractive model of the generally more salutary effect of marriage on cancer survival and quality of life relies on social support, such as access to appropriate health care, and mood. Some investigators have found an interaction between mood and the body’s immune function, which may affect cancer survival.

Risk statistics: Only a few analytical studies have been conducted to assess the direct relationship between singlehood (or marital status in general) and the etiology of cancer. One analysis from an Italian databank containing data (collected between 1983 and 2001) from almost 18,000 incident cancer cases assessed the relationship between marital status and the development of cancer at different sites such as oral cavity and pharynx, esophagus, stomach, colon, rectum, liver, gallbladder, pancreas, larynx, breast, endometrium, ovary, prostate, bladder, kidney, and thyroid, as well as Hodgkin disease, multiple myelomas, and sarcomas. The analysis, published in 2004, indicated that never-married individuals, but not divorced or widowed individuals, were at a significantly increased risk of oral cavity and pharyngeal cancers but at a reduced risk of cancer of the colon, liver, bladder, kidney, and thyroid. Overall, the study suggested that marital status is not materially associated with cancer risk.

In 2011, a BMC Public Health retrospective study of Norwegians showed that more never-married cancer patients and an increasing number of widowed patients are dying of their disease. The authors postulate that unmarried patients may have poorer overall health at diagnosis, that social support through close partnership may have protective effects against stress, or that the complexity of treatment regimens may be difficult for never-married individuals to follow. A study by A. Aizer et al. published in 2013 in the Journal of Clinical Oncology reviewed 2004–8 data for the ten deadliest cancers in the United States and found higher rates of metastasis, undertreatment, and cancer deaths among unmarried cancer patients as compared to their married counterparts. In 2014, the journal published a letter to the editor critiquing the analysis of Aizer et al. on the basis that it did not take the health disparities of LGBT cancer patients into account and that, given the data collection period, the married category included some same-sex married individuals for states where it was recognized while the unmarried category also included those who were in long-term domestic partnerships, thereby skewing the results. The original study authors acknowledged that classification problem contributed to an understimation of the detriment of singlehood and suggested that the positive effect was from the social support of close partnership, rather than marriage, per se. More research is needed to confirm social-support hypothesis and to further investigate health disparities in the LGBT community.

In addition, because there is the not uncommon belief that cancer may be associated with psychological distress that may, for example, arise from major life events such as becoming a widow or widower, many studies have focused on the relationship between psychological factors and cancer risk. In 2002, the Danish Cancer Society published the results of a review of several prospective and retrospective studies about the relationship between major life events, depression, personality factors, and the risk of cancer. The outcome failed to support the hypothesis that psychological factors are risk factors of cancer. These results are in agreement with numerous other studies that failed to find an association between depression and cancer deaths. Psychological stress can, however, affect a cancer patient's quality of life and ability to cope, and may even enhance tumor growth and spread, according to the National Cancer Institute.

Other studies and surveys have investigated the relationship between several sociodemographic factors, such as marital status, and preventive health behaviors, such as participating in screening programs to detect cancer at early stages. In 2004, the US Centers of Disease Control and Prevention (CDC) published data from the 1999 Behavioral Risk Factor Surveillance System. These data showed that not having a mammogram within the past two years to detect breast cancer in women over the age of forty was associated with, among other factors, not being currently married. Other studies support this finding that being single may be associated with fewer positive intentions and lower attendance rates at screening programs.

Perspective and prospects: Studies and surveys have shown that marital status, such as singlehood, may play a role in cancer mortality, the quality of life after cancer diagnosis, and the overall adjustment to the disease, although it does not directly affect the evolution of human cancer. Therefore, health care professionals should take sociodemographic characteristics into consideration in addition to ordinary clinical health care when treating cancer patients, such as providing social and psychological support, as needed, to improve quality of life or adjustment to the disease. They should also be more aware of properly identifying those having trouble coping with cancer.

Bibliography

Aizer, Ayal, et al. "Marital Status and Survival in Patients with Cancer." Journal of Clinical Oncology 31.31 (2013): 3869–76. PDF file.

Aizer, Ayal, and Paul Nguyen. "Reply to M.G. Bare et al." Journal of Clinical Oncology 32.20 (2014): 2184. PDF file.

Bare, Michael G., Liz Margolies, and Ulrike Boehmer. "Omission of Sexual and Gender Minority Patients." Journal of Clinical Oncology 32.20 (2014): 2182–83. PDF file.

Coughlin, S. S., et al. “Nonadherence to Breast and Cervical Cancer Screening: What Are the Linkages to Chronic Disease Risk?” Preventing Chronic Disease 1.1 (2004): A04. Print.

"Family Life." Cancer.net. Amer. Soc. of Clinical Oncology, July 2014. Web. 30 Oct. 2014.

"Kravdal, Håkon, and Astri Syse. "Changes over Time in the Effect of Marital Status on Cancer Survival." BMC Public Health 11.804 (2014): 1–13. PDF file.

Kravdal, O. “The Impact of Marital Status on Cancer Survival.” Social Science and Medicine 52.3 (2001): 357–68. Print.

"Psychological Stress and Cancer." Cancer.gov. Natl. Cancer Inst., Natl. Inst. of Health, 10 Dec. 2012. Web. 31 Oct. 2014.

Randi, Giorgia, et al. “Marital Status and Cancer Risk in Italy.” Preventive Medicine 38.5 (2004): 523–28. Print.