Though the disease cancer evolves from gene mutations, convincing evidence supports that social issues like marriage—a formal financial and emotional union between two individuals—play significant roles in the survival of cancer patients.
What Is Cancer?
Cancer is a genetic disease. Mutation or specific gene changes convert normal cells into cancer cells by accelerating cell growth and inhibiting programmed cell death.
Cancer remains the leading cause of death in many countries. In Canada, an estimated 2 in 5 individuals are diagnosed with cancer, and one-fourth of the total population dies from this disease (Brenner, Poirier, et al., 2022).
Despite the improvement in cancer treatment, the incidence of the disease continues to grow. Therefore, it is essential to understand the factors that affect the prognosis of the disease.
In most societies, marriage is seen as a permanent social and formal union between two individuals. It establishes rights and obligations between them, as well as between them and their children.
Globally, of the total population, 67% are married, which is only 50% in the USA, and the trend of being unmarried is gradually increasing.
Since marriage has been described as one of the most powerful predictors of well-being and positive mental health (Gove, Hughes, et al. 1983), the relationship between marital status and cancer prevention is worthy of investigation.
Protective Effect of Marriage on Health
Marital status has an enormous role in protective health effects on survival (Rendall, Weden, et al. 2011).
Israel-based longitudinal studies involving 152,150 and 209,125 individuals during the period (1983-1992) and (1995-2004), respectively, have calculated mortality inequalities based on marital status (Jaffe, Manor, et al. 2007).
In the studies, unmarried status appeared to be a significant factor in increasing mortality risk, +25% from cancer and + 38% from other causes in middle-aged men.
Being married has been shown to lower the risk of dementia (Sommerlad, Ruegger, et al. 2018), have a strong positive effect on longevity (Gardner and Oswald 2004), and have positive, healthy behaviors (Schone and Weinick 1998).
A systematic review involving 34 studies with more than two million participants showed that unmarried status is associated with an increased risk of cardiovascular diseases, coronary heart diseases, myocardial infarction, and stroke-related death (Wong, Kwok, et al. 2018). On the other hand, being married was 2.5 times more likely to be alive 15 years after coronary artery bypass surgery (King and Reis 2012).
Impact of Marital Status on Cancer Survival
Studies have long shown that married people with cancer live longer than unmarried people.
In 1987, Goodwin et al. examined the effects of marital status on the diagnosis, treatment, and survival of patients with cancer in population-based data on 27,779 cancer cases and found that unmarried people had decreased overall survival (relative hazard, 1.23) (Goodwin, Hunt, et al. 1987).
A Norwegian study investigated 100,000 deaths during the period 1960-91 and compared all-cause excess mortality among cancer patients with death in the absence of cancer. The study found a 15% higher for the never-married individual than unmarried people (Kravdal 2001).
Data collected from 261,070 patients with late-stage cancer at multiple sites in the United States showed that married patients with cancers of all major primary sites had significantly better survival than single, separated, divorced, or widowed patients (Lai, Lai, et al. 1999).
Analyzing data collected from Surveillance, Epidemiology, and End Results (SEER) cancer registry database, several recent reports also identified social factors, particularly marital status, as an independent factor in the progression of cancer and cancer-related mortality (Du, Zhan, et al. 2022, Jiao, Ma, et al. 2022, Wu, Zhu, et al. 2022).
Scientists from the University of California San Diego School of Medicine and Fremont’s Cancer Prevention Institute of California analyzed the data of 783,167 cancer patients. They found that the risk of death was 27 percent greater for unmarried men who have developed the disease than for married men and 19 percent higher for unmarried women. After correcting for socioeconomic differences, they still found that unmarried men were 22 percent more likely to succumb to cancer and unmarried women 15 percent more likely to die. The result of the study was published in CANCER, a journal of the American Cancer Society (Gomez, Hurley, et al. 2016).
A SEER study selected 6627 people from 2004 to 2013 to study gallbladder cancer (GBC) patients. The study found that GBC married patients had significantly higher survival (20.1%) than unmarried GBC (17.8%).
However, the risk of death of widowed women increases more than that of single women. The result was published in a famous nature journal (Li, Lu, et al., 2017).
Science Behind the Survival Advantage
The explanations behind the survival advantage of being married are the early cancer diagnosis, receiving recommended or aggressive therapy, a higher economic status, and better social support. The unmarried person is most probably diagnosed at a distant stage, remains untreated for longer, and suffers from poor economic and social status.
Experts say that the role of a partner’s emotional support is crucial to survival. A married individual usually takes special care of his health and his partner. He needs to take special care for the well-being of both.
Dr. Gomez, the first author of the Nature study, stated in a press release, “Our study provides evidence for social support as a key driver” behind the survival advantage of married cancer patients.
Diagnosis and treatment are faster in married people. Post-treatment follow-up is also essential. In these respects, married people are ahead of unmarried people in most cases, so they have a higher survival rate from the disease.
Despite some conflicting reports that show a lower risk of death from cancer in married people compared to unmarried ones does not apply to all cancers, convincing evidence support the idea that the psychological and emotional support of married cancer patients plays a significant role in the survival other than the active treatment for primary diseases.