The most incisive guide to issues facing the American family today . . . An invaluable resource for anyone wishing to stay on the cutting edge of research on family trends.

-W. Bradford Wilcox
Associate Professor of Sociology, University of Virginia 

Surviving Cancer: The Spousal Advantage

Bryce J. Christensen and Robert W. Patterson

Epidemiologists have known for some time that when cancer strikes, married men and women are more likely to survive than are their unmarried peers. Now a study completed at the University of Oslo suggests that this wedlock advantage has actually grown in recent decades.

As the Oslo researchers acknowledge, the context for their work is defined by earlier studies. In particular, they note earlier studies establishing that “all-cause mortality rates are higher among the unmarried, especially the never-married, than among the married.” They further take note of studies showing that “a similar pattern is also found for cause-specific mortality,” their attention being particularly drawn to “a number of studies [that] have shown that . . . prognosis following a cancer diagnosis is influenced by marital status.” Sharpening their research perspective are recent studies highlighting “an increase in the excess mortality among the unmarried” in recent decades, an increase evident in both all-cause and specific-cause mortality.

Intrigued by “the differences in mortality trends,” the researchers wondered “whether there has been a similar strengthening of the association between marital status and cancer survival.” To resolve this issue, they pored over data collected for 441,556 men and women diagnosed with cancer between 1970 and 2000. These data show that “unmarried Norwegians with a cancer diagnosis have poorer survival (i.e., higher cancer mortality) than the married.” But this finding—which is “in line with what has been reported previously”—breaks no new ground.

The new finding in this study emerges when the researchers take the mortality rates among married cancer patients across time as their baseline and compare those rates to those for unmarried peers across time. This across-time comparison reveals a clear pattern: “Never-married cancer patients appear to have had increasingly poor survival prospects compared to the married over the last four decades.” More particularly, “excess mortality has increased steadily for never-married men, in particular the elderly. A similar development is seen for older never-married women and elderly widows.” On the other hand, “the excess mortality among the divorced, for both sexes, has been stable.”

The researchers offer a number of possible explanations of the higher survival rates seen among married cancer patients. In the first place, the researchers suggest that, compared to married peers, the unmarried may be suffering from “poorer overall physical health at time of diagnosis.” After all, marriage typically means “social support” and “economic advantages,” which foster “a healthier lifestyle; with for example better nutrition and less smoking and alcohol abuse.”

Identifying a second possible reason that married cancer victims are more likely to survive the disease than are unmarried peers, the researchers speculate that “married individuals, because they are taken care of by their spouse, are more prone than the unmarried to visit a physician at occurrence of symptoms, thus possibly discovering tumors at an earlier stage,” so increasing the likelihood of successful treatment.

The researchers point to differences in “the mental health at time of diagnosis” as a third possible reason that married cancer victims fare better than unmarried peer. After all, “studies have shown that mental health problems are more common in the unmarried population, presumably in part because of lack of social and emotional support.”

Parenthood—still generally a life role linked to marriage—constitutes a fourth possible reason that cancer is less likely to kill its married victims than its unmarried victims. “Raising children,” the researchers explain, “appears to have a positive effect on cancer survival, probably because children induce a healthier lifestyle and (especially if they are adults) may provide support during treatment and later.”

Saving their most provocative conjecture for last, the researchers speculate that unmarried cancer victims are increasingly at risk because “the social cohesion in the society may have decreased over time.” “In a setting of reduced social cohesion,” they reason, “it is not unlikely that the never-married individuals would be particularly vulnerable.”

Though they conducted this study in Norway, the researchers believe that its implications are “broadly relevant, so it is reasonable to expect similar trends in many other countries.” In other words, unmarried patients may face increasingly unfavorable odds in the cancer wards of hospitals in Oakland as well as Oslo, in Baltimore as well as Bergen.

(Håkon Kravdal and Astri Syse, “Changes Over Time in the Effect of Marital Status on Cancer Survival,” BMC Public Health11 [October 14, 2011]: 804.)