Marriage predicts for survival in patients with stage III non–small-cell lung cancer
Background Comprehensive anal
Objective To evaluate whether marital status is an independent predictor of clinical outcomes in patients with stage III NSCLC who are treated uniformly with curative intent.
Methods The Kaplan-Meier method and Cox proportional hazards model were used to estimate the overall survival and freedom from recurrence (FFR) in 355 patients with stage III NSCLC who were treated during 2000-2013.
Results 52% of patients in the cohort were married and were more likely to self-identify as white (P < .0001), reside in zip codes with a higher household median income (P < .0001), have Eastern Cooperative Oncology Group Performance Status of 0 (P = .001), have higher pretreatment albumin (P = .009), undergo surgery (P = .001), and have insurance (P = .029). On multivariate analysis, marital status remained an independent predictor of survival and was associated with a 40% decreased risk of death (P < .0001), further stratifying outcomes beyond gender and stage grouping. FFR was comparable between the 2 groups (P = .108).
Limitations Retrospective analysis; information on individual support system beyond the marital and insurance status and zip code income was not available.
Conclusions In a cancer such as NSCLC, in which modern therapeutic approaches have yielded only modest survival improvements despite considerable treatment-related toxicity, marital status remains an independent predictor for survival. Marriage is likely a surrogate for better psychosocial support; the scale of survival improvements seen justifies investments into supportive care interventional strategies to help advance overall outcomes.
Funding/sponsorship None
Accepted for publication September 6, 2018
Correspondence
Melissa AL Vyfhuis, MD, PhD; mvyfhuis@umm.edu OR
Josephine L Feliciano, MD; jfelici4@jhmi.edu
Disclosures: The authors report no disclosures/conflicts of interest.
Citation JCSO 2018;16(5):e194-e201
©2018 Frontline Medical Communications
doi https://doi.org/10.12788/jcso.0427
Non–small-cell lung cancer (NSCLC) remains the leading cause of cancer death in the United States, where 29% of patients will present with stage III disease.1,2 Ongoing research efforts seek to improve these outcomes using novel systemic therapy options or modern radiation techniques. However, there have also been recent studies showing the importance of marital and/or partner status on clinical outcomes.3-7 For example, in a large Surveillance, Epidemiology, and End Results (SEER) analysis of 734,889 patients diagnosed with several types of cancer (including lung cancer), patients identified as married were less likely to present with metastatic disease, more likely to receive definitive therapy, and had superior cancer-related mortality even after adjusting for other variables such as cancer stage and treatment when compared with single patients.3 Population-based assessments are important in relaying information about trends and general outcomes based on marital status, but because they are large, they often lack patient-specific information such as nutrition, immunologic status, and variability in treatment paradigms, all of which can independently have an impact on overall survival (OS) in stage III NSCLC.8-10 In addition, population analyses have typically included patients of all cancer stages and hence involved a multitude of treatment approaches ranging from curative to palliative. There are limited well-annotated institutional data on the association of marital status on nonmetastatic, locally advanced (LA-NSCLC) in the setting of National Comprehensive Cancer Network-guided, standard-of-care definitive treatment.
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