Unmarried patients with bladder urothelial carcinoma have a higher risk for cancer-specific mortality than those who are married, according to the results of a recent study by Junjie Yu, MD, and colleagues (Medicine [Baltimore]. 2018;97[29]:e11378).

Existing literature has shown that marital status affects survival rates among patients with many types of cancer. In addition, research indicates that widowed patients may be at a higher risk for cancer death than their unwidowed peers.

“There are many different mechanisms to explain the association between cancer survival and marital status,” Dr Yu and colleagues explained, adding that marital status frequently indicates the level of social support a patient with cancer has.

The Link Between Mortality and Marital Status

Citing specific research that pointed to a higher rate of mortality among unmarried patients with bladder cancer than among those who are married and have bladder cancer, Dr Yu and colleagues conducted a study to explore the connection between marital status and survival in patients with bladder urothelial carcinoma.

Using Surveillance, Epidemiology, and End Results data, they analyzed the survival rates of 133,846 patients who were diagnosed with bladder urothelial carcinoma between 1988 and 2009.

Kaplan-Meier methods and multivariable Cox regression models were employed, and assisted in analyzing survival data and measuring the association between marital status and survival. Data were controlled for sex, age, race, primary site, topography, lymph node, metastasis stage, pathological grading, and surgery.

Patient Characteristics and Cancer-Specific Survival

Patients who were married were more likely to be men, white, older in age, recipients of surgical treatment, and have an earlier clinical disease stage at diagnosis than those who were unmarried, a comparative value that the investigators deemed statistically significant (P < .001).

Compared with married patients, the risks for death from bladder urothelial carcinoma were 28%, 25%, and 67% among single, divorce/separated, and widowed patients, respectively. The respective 5-year cause-specific survival rates of widowed versus married patients were 89.8% versus 95.8% at the noninvasive papillary carcinoma stage, 84.1% versus 91.6% at the occur-in-situ stage, 74.3% versus 86.1% at stage I, 41.2% versus 61.6% at stage II, 39.2% versus 52.5% at stage III, and 8.8% versus 17.0% at stage IV (all P  < .001).  

Of note, a significantly higher risk for bladder cancer–specific mortality was common among widowed patients.

Marital Status Affects Survival Rates

According to Dr Yu and colleagues, these findings underscored the relevancy of marital status to improved cause-specific survival in patients with bladder urothelial carcinoma.

“[T]he results in present study confirmed that unmarried patients had greater risk of cancer-specific mortality. Furthermore, our study showed the widowed patients were at the highest risk of bladder-cancer- specific mortality than those in other groups,” they said.

“Social and psychosocial factors may be some of main reasons for poor survival outcomes in unmarried patients. Therefore, to improve postoperative survival, close social and family care may improve the survival outcomes for unmarried patients, especially for those who were widowed,” Dr Yu and colleagues concluded.—Hina Khaliq