In daily medical practice, patients who are alone or without a spouse appear less inclined to accept therapies or follow medical recommendations. Previously studies demonstrated that unmarried status is a known risk factor for poor cancer control outcomes and survival in several malignancies.1-4 Since no contemporary data exists to specifically address the role of marital status on access to treatment and survival in patients with metastatic renal cell carcinoma, we examined this relationship in a contemporary cohort of patients identified within the Surveillance, Epidemiology and End Results database (2004-2015).
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
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