title: Partner status and survival after cancer: A competing risks analysis.
abstract: OBJECTIVE
  The survival benefits of having a partner for all cancers combined is well recognized, however its prognostic importance for individual cancer types, including competing mortality causes, is less clear. This study was undertaken to quantify the impact of partner status on survival due to cancer-specific and competing mortality causes.
  
  
  METHODS
  Data were obtained from the population-based Queensland Cancer Registry on 176,050 incident cases of ten leading cancers diagnosed in Queensland (Australia) from 1996 to 2012. Flexible parametric competing-risks models were used to estimate cause-specific hazards and cumulative probabilities of death, adjusting for age, stage (breast, colorectal and melanoma only) and stratifying by sex.
  
  
  RESULTS
  Both unpartnered males and females had higher total cumulative probability of death than their partnered counterparts for each site. For example, the survival disadvantage for unpartnered males ranged from 3% to 30% with higher mortality burden from both the primary cancer and competing mortality causes. The cause-specific age-adjusted hazard ratios were also consistent with patients without a partner having increased mortality risk although the specific effect varied by site, sex and cause of death. For all combined sites, unpartnered males had a 46%, 18% and 44% higher risk of cancer-specific, other cancer and non-cancer mortality respectively with similar patterns for females. The higher mortality risk persisted after adjustment for stage.
  
  
  CONCLUSIONS
  It is important to better understand the mechanisms by which having a partner is beneficial following a cancer diagnosis, so that this can inform improvements in cancer management for all people with cancer.
authors.affiliation: Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia. Electronic address: paramitadasgupta@cancerqld.org.au.
authors.forename: Paramita
authors.initials: P
authors.lastname: Dasgupta
authors.affiliation: School of Public Health and Social Work, Queensland University of Technology, Herston Road, Kelvin Grove, QLD 4059, Australia. Electronic address: g.turrell@qut.edu.au.
authors.forename: Gavin
authors.initials: G
authors.lastname: Turrell
authors.affiliation: Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia; School of Public Health and Social Work, Queensland University of Technology, Herston Road, Kelvin Grove, QLD 4059, Australia; School of Population Health, University of Queensland, Brisbane, Australia. Electronic address: joanneaitken@cancerqld.org.au.
authors.forename: Joanne F
authors.initials: JF
authors.lastname: Aitken
authors.affiliation: Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia; School of Public Health and Social Work, Queensland University of Technology, Herston Road, Kelvin Grove, QLD 4059, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD 4222, Australia. Electronic address: peterbaade@cancerqld.org.au.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Baade
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D011793:Queensland; D018570:Risk Assessment; D018454:Spouses; D013534:Survival
keywords: Cancer; Competing risks; Inequalities; Partner status; Survival