title: Marital Status and Survival in Patients with Carcinoid Tumors.
abstract: BACKGROUND
  Marital status is a known prognostic factor in overall and disease-specific survival in several types of cancer. The impact of marital status on survival in patients with carcinoid tumors remains unknown. We hypothesized that married patients have higher rates of survival than similar unmarried patients with carcinoid tumors.
  
  
  METHODS
  Using the Surveillance, Epidemiology, and End Results database, we identified 23,126 people diagnosed with a carcinoid tumor between 2000 and 2011 and stratified them according to marital status. Univariate and multivariable analyses were performed to compare the characteristics and outcomes between patient cohorts. Overall and cancer-related survival were analyzed using the Kaplan-Meier method. Multivariable survival analyses were performed using Cox proportional hazards models (hazards ratio [HR]), controlling for demographics and tumor-related and treatment-related variables. Propensity score analysis was performed to determine surgical intervention distributions among married and unmarried (ie, single, separated, divorced, widowed) patients.
  
  
  RESULTS
  Marital status was significantly related to both overall and cancer-related survival in patients with carcinoid tumors. Divorced and widowed patients had worse overall survival (HR, 1.33 [95% confidence interval {CI}, 1.08-1.33] and 1.34 [95% CI, 1.22-1.46], respectively) and cancer-related survival (HR, 1.15 [95% CI, 1.00-1.31] and 1.15 [95% CI, 1.03-1.29], respectively) than married patients over five years. Single and separated patients had worse overall survival (HR, 1.20 [95% CI, 1.08-1.33] and 1.62 [95% CI, 1.25-2.11], respectively) than married patients over five years, but not worse cancer-related survival. Unmarried patients were more likely than matched married patients to undergo definitive surgical intervention (62.67% vs 53.11%, respectively, P < 0.0001).
  
  
  CONCLUSIONS
  Even after controlling for other prognostic factors, married patients have a survival advantage after diagnosis of any carcinoid tumor, potentially reflecting better social support and financial means than patients without partners.
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
authors.forename: Erin K
authors.initials: EK
authors.lastname: Greenleaf
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
authors.forename: Amanda B
authors.initials: AB
authors.lastname: Cooper
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.; Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
keywords: carcinoid; marital status; survival