title: Lower treatment intensity and poorer survival in metastatic colorectal cancer patients who live alone.
abstract: BACKGROUND
  Socioeconomic status (SES) and social support influences cancer survival. If SES and social support affects cancer treatment has not been thoroughly explored.
  
  
  METHODS
  A cohort consisting of all patients who were initially diagnosed with or who developed metastatic colorectal cancer (mCRC, n=781) in three Scandinavian university hospitals from October 2003 to August 2006 was set up. Clinical and socioeconomic data were registered prospectively.
  
  
  RESULTS
  Patients living alone more often had synchronous metastases at presentation and were less often treated with combination chemotherapy than those cohabitating (HR 0.19, 95% CI 0.04-0.85, P=0.03). Surgical removal of metastases was less common in patients living alone (HR 0.29, 95% CI 0.10-0.86, P=0.02) but more common among university-educated patients (HR 2.22, 95% CI 1.10-4.49, P=0.02). Smoking, being married and having children did not influence treatment or survival. Median survival was 7.7 months in patients living alone and 11.7 months in patients living with someone (P<0.001). Living alone remained a prognostic factor for survival after correction for age and comorbidity.
  
  
  CONCLUSIONS
  Patients living alone received less combination chemotherapy and less secondary surgery. Living alone is a strong independent risk factor for poor survival in mCRC.
authors.affiliation: Department of Radiology, Oncology and Radiation Science, Uppsala University, 751 85 Uppsala, Sweden. nina.cavalli-bjorkman@onkologi.uu.se
authors.forename: N
authors.initials: N
authors.lastname: Cavalli-Björkman
authors.forename: C
authors.initials: C
authors.lastname: Qvortrup
authors.forename: S
authors.initials: S
authors.lastname: Sebjørnsen
authors.forename: P
authors.initials: P
authors.lastname: Pfeiffer
authors.forename: T
authors.initials: T
authors.lastname: Wentzel-Larsen
authors.forename: B
authors.initials: B
authors.lastname: Glimelius
authors.forename: H
authors.initials: H
authors.lastname: Sorbye
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000191:economics* / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis; D012537:Scandinavian and Nordic Countries; D012944:Social Support; D012959:Socioeconomic Factors; D055815:Young Adult