Marriage an ally in cancer fight

Married cancer patients fare better, a

new study shows, leading researchers to
wonder: Can you put that in a pUl?
By KAREN KAPLAN Los Angeles Times
Is it possible to identify the specific benefits of
marriage and put them into a hypothetical "pill"
that could give the same benefits to patients who
are smgle? It may sound far-fetched, but that's at
least part of the motivation behind new research
on cancer patients.
Married people who are diagnosed with the
most common types of cancer are 20 percent
less likely to die than patients who are single
and depending on the type of cancer they have,
their odds of dying may be reduced by as much
as 33 percent, said a new study published by the
Journal of Clinical Oncology.
The researchers noted that the National Can-
cer Institute and the rest of the National Insti-
tutes of Health spend about $5 billion each year
to understand the molecular basis of cancer and
to develop biological treatments. But medicine
is only part of the story social support can
matter just as much when it comes to long-term
survival, and only 51 percent of American adults
are married, they wrote.
So the team, led by doctors from hospitals
and research programs affiliated with Harvard
Medical School, examined the medical records
of734,889 patients, from across the covmtry, who
were diagnosed with cancer from 2004 to 2008.
Instead of focusing on a single type of cancer,
as previous studies have, the team included
patients with the 10 types of cancer that cause
the most deaths: lung, colorectal, breast, pancre-
atic, prostate, liver, non-Hodgkin's lymphoma,
head/neck, ovarian and esophageal cancer.
Marriage seems to benefit patients at all
stages of illness, the researchers found.
People with spouses were 17 percent less
likely to be diagnosed with an advanced can-
cer that has already spread to another organ.
For prostate cancer, the risk of being diagnosed
with metastatic cancer was 48 percent lower for
patients who were married; for breast cancer,
the risk was 40 percent lower.
In addition, married patients whose cancer
hadn't spread were 53 percent more likely than
their single counterparts to opt for a "defini-
tive" treatment, including surgery and radiation
(the medical records did not include informa-
tion about chemotherapy treatments). For some
cancers, patients were as much as 76 percent
more hkely to get the defmitive treatment. The
researchers speculate that patients who were
married were more likely to stick to their treat-
ment than patients who didn't have that spousal
support.
Better outcomes all aiound
After controlling for demographic factors, as
well as the severity of the cancer and the treat-
ment plan followed, the reseai-chers found that
married patients were less likely to die of all 10
types of cancer analyzed. The benefits ranged
from a 33 percent reduced chance of dying of
head and neck cancer or non-Hodgkin's lym-
phoma to a 12 percent reduced chance of dying
of liver cancer.
These benefits were not trivial. For patients
with head and neck cancer, being married
reduced the risk of death by 33 percent much
more than the 13 percent reduced risk of death
shown in previous studies to be offered by che-
motherapy. Marriage was more helpful than
chemotherapy for breast, prostate, colorectal
and esophageal cancer as well.
Married people had better cancer outcomes
than all categories of single patients those
who were never married, separated, divorced
or widowed. Husbands and wives reaped the
rewards of marriage, but the benefits were
greater for men than for women.
This study couldn't answer the question of
why marriage seemed to help cancer patients,
but the researchers offered some theories.
Spouses probably pushed patients to get to the
doctor sooner (so that their tumors are caught
at an earlier stage) and they probably encourage
patients to get and stick with more aggres-
sive treatment.
Less stress, better health
Although a cancer diagnosis would be upset-
JOHN ROBERGE Talahassee Democrat
ting to anyone, previous studies have found that
married patients are less distressed, less anxious
and less likely to be depressed than patients who
are single. They also have lower levels of the
stress hormone Cortisol and that puts their
immune systems in a better position to fight
tumors.
How can single people get the social benefits
of marriage without being married? That's the
key question that should be answered in future
studies, the researchers wrote.
It should be possible to close that gap. Dr.
David Kssane of Monash University wrote in
an editorial that accompanies the study. He cited
studies showing that people who are part of a
"close and cohesive family" are 1.7 times more
likely to stick with their cancer treatment and
that people who get "practical support" are 3.6
times more likely to persevere.
Perhaps single patients should be screened
for depression at the time of diagnosis, so they
can be treated if necessary, Kissane wrote. Can-
cer patients who are depressed are 19 to 39 per-
cent more likely to die of the disease, previous
studies have found.
"Our humanity is relational in its essence
we are tribal people, drawn into connection with
one another to share what is most meaningful
and fulfilling in life," he wrote. "Our medicine
needs to follow a pai-allel paradigm."
If it did, it could be as powerful as any pill.