title: Marital status and head and neck cancer outcomes.
abstract: BACKGROUND
  The objective of this study was to examine the effects of marital status on stage at presentation, receipt of treatment, and survival in patients with head and neck cancer (HNC).
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results database was used to analyze 51,272 patients who were diagnosed with HNC from 2007 to 2010. The impact of marital status on cancer stage at presentation, receipt of definitive treatment, and HNC-specific mortality (HNCSM) was determined using multivariable logistic and Fine and Gray competing-risks regression models, as appropriate.
  
  
  RESULTS
  Marriage had a protective effect against metastatic presentation of oral and laryngeal cancers (oral cancer: adjusted odds ratio [AOR], 0.72; 95% confidence interval [CI], 0.60-0.87; P < .001; laryngeal cancer: AOR, 0.53; 95% CI, 0.42-0.67; P < .001) but not against oropharyngeal, hypopharyngeal, or nasopharyngeal cancers. Among patients with nonmetastatic disease, married patients were more likely to receive definitive treatment (overall AOR, 1.77; 95% CI, 1.60-1.95; P < .001) and had a lower risk of HNCSM (overall adjusted hazard ratio, 0.72; 95% CI, 0.68-0.77; P < .001); these associations remained significant across all HNC sites.
  
  
  CONCLUSIONS
  Among patients with oral and laryngeal cancers, those who are married are less likely to present with metastatic disease. In addition, married patients are more likely to receive definitive treatment and less likely to die from HNC across all HNC sites. This suggests that spousal support may have a role in the surveillance of visual and symptomatic HNC types and leads to higher rates of treatment and better survival across all HNC sites.
authors.affiliation: Harvard School of Dental Medicine, Boston, Massachusetts.
authors.forename: Gino
authors.initials: G
authors.lastname: Inverso
authors.forename: Brandon A
authors.initials: BA
authors.lastname: Mahal
authors.forename: Ayal A
authors.initials: AA
authors.lastname: Aizer
authors.forename: R Bruce
authors.initials: RB
authors.lastname: Donoff
authors.forename: Nicole G
authors.initials: NG
authors.lastname: Chau
authors.forename: Robert I
authors.initials: RI
authors.lastname: Haddad
mesh_terms: D000368:Aged; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality* / Q000473:pathology; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000401:mortality* / Q000473:pathology; D009362:Neoplasm Metastasis / Q000473:pathology; D011379:Prognosis; D018426:SEER Program; D018454:Spouses / Q000523:psychology
keywords: Surveillance, Epidemiology, and End Results; cancer outcomes; cancer social support; head and neck cancer; marriage