title: Decreased cancer survival in individuals separated at time of diagnosis: critical period for cancer pathophysiology?
abstract: BACKGROUND
  : It long has been recognized that married patients have improved cancer survival when compared with unmarried patients. This has been postulated as being due to increased support, potentially leading to better compliance with therapy. Conversely, some data exist pointing to a relationship between marital discord and decreased immunity. We examined whether unmarried patients have a different prognosis by whether they are 1) never married, 2) divorced, 3) widowed, or 4) separated at time of diagnosis.
  
  
  METHODS
  : The public access data of the Surveillance, Epidemiology and End Results (SEER) registry were queried for cancer survival across all 17 registries between 1973 and 2004. SEER last updated data in April 2007. Records of 3.79 million patients were included in the analysis. We specifically analyzed 5-year and 10-year relative survival (RS; 5yRS, 10yRS), defined as observed survival divided by observed survival of an age-matched, race-matched, and gender-matched population without disease, for all cancer patients by marital status, with specific subset analyses as indicated.
  
  
  RESULTS
  : Among unmarried patients, those separated at time of diagnosis had the lowest survival, followed by widowed, divorced, and never married patients. 5-year and 10-year RS of separated patients was 72% and 64% than that of married patients, respectively. This relationship persists when data are analyzed by gender.
  
  
  CONCLUSIONS
  : Separated marital status is associated with a significant decrement in cancer survival, even in comparison with other unmarried groups. While other socioeconomic variables could contribute to this phenomenon, further research into the immunologic correlates of the acutely stressful condition of marital separation should be conducted. Cancer 2009. (c) 2009 American Cancer Society.
authors.affiliation: Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA. gsprehn@iupui.edu
authors.forename: Gwen C
authors.initials: GC
authors.lastname: Sprehn
authors.forename: Joanna E
authors.initials: JE
authors.lastname: Chambers
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Saykin
authors.forename: Andre
authors.initials: A
authors.lastname: Konski
authors.forename: Peter A S
authors.initials: PA
authors.lastname: Johnstone
mesh_terms: D004243:Divorce; D006801:Humans; D017533:Marital Status; D009369:Neoplasms / Q000401:mortality*; D018426:SEER Program; D012847:Single Person; D016019:Survival Analysis; D017805:Widowhood
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