title: Impact of marital status on survival among women with invasive cervical cancer: analysis of population-based surveillance, epidemiology, and end results data.
abstract: OBJECTIVE
  For some cancers, married individuals present with less advanced stage of disease, receive more aggressive treatment, and live longer after diagnosis compared with unmarried individuals. We examined survival differences by marital status among women with cervical cancer using a population-based sample of patients in the United States while considering patient, tumor, and treatment characteristics.
  
  
  METHODS
  We identified 7,997 women (1,835 single, 3,849 married, 1,193 separated/divorced, and 1,120 widowed) diagnosed with primary invasive cervical cancer from 1992 to 1996 (with follow-up through December 31, 2004) from the Surveillance, Epidemiology, and End Results program. Associations of marital status, race, age at diagnosis, tumor grade, tumor stage, cancer-directed radiotherapy, and cancer-directed surgery with survival were examined using Cox proportional hazard regression models.
  
  
  RESULTS
  Five-year survival was highest for married women and lowest for widowed women (p <.0001). Compared with married women, risks of death for single, separated/divorced, and widowed women were 1.13 (95% confidence interval [CI] = 1.03-1.25), 1.41 (95% CI = 1.28-1.57), and 2.51 (95% CI = 2.29-2.76), respectively. After adjustment, marital status was not independently associated with risk of death (p =.21), although it interacted with tumor stage and cancer-directed radiation therapy. Married women with early stage disease who did not receive radiation therapy had improved survival compared with single, separated/divorced, or widowed women.
  
  
  CONCLUSIONS
  Marital status interacted with tumor stage and cancer-directed radiation therapy to influence survival among women with cervical cancer. Additional study of the pathways through which partner status influences survival after cancer diagnosis could inform the development of social support interventions.
authors.affiliation: Department of Radiation Oncology, Henry Ford Health System, Detroit, MI 48202, USA.
authors.forename: Mehul K
authors.initials: MK
authors.lastname: Patel
authors.forename: Divya A
authors.initials: DA
authors.lastname: Patel
authors.forename: Mei
authors.initials: M
authors.lastname: Lu
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Elshaikh
authors.forename: Adnan
authors.initials: A
authors.lastname: Munkarah
authors.forename: Benjamin
authors.initials: B
authors.lastname: Movsas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D017533:Marital Status / Q000706:statistics & numerical data*; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000401:mortality* / Q000532:radiotherapy / Q000628:therapy