Unmarried patients are less likely to undergo treatment for metastatic renal cell carcinoma (mRCC) compared with their married counterparts, according to a new study.
Among men, but not women, unmarried status, compared with being married, is associated with an increased risk of cancer-specific mortality (CSM).
Investigators led by Giuseppe Rosiello, MD, of IRCCS San Raffaele Scientific Institute in Milan, Italy, examined rates of cytoreductive nephrectomy, metastasectomy, and systemic therapy use according to marital status among 6975 patients with clear cell mRCC (2169 women and 4806 men) within the Surveillance, Epidemiology and End Results database. Of these, 1018 women (47%) and 1450 men (30.2%) were unmarried.
Compared with married men, unmarried men had significant 46%, 30%, and 39% lower odds of receiving cytoreductive nephrectomy, metastasectomy, and systemic therapy, respectively, Dr Rosiello and his collaborators reported in International Urology and Nephrology. Unmarried women had significant 37% and 20% decreased odds of receiving cytoreductive nephrectomy and systemic therapy, respectively, compared with married women. The investigators found no significant difference between married and unmarried women with regard to undergoing metastasectomy.
In multivariable competing-risk regression analyses, unmarried men had a significant 15% increased risk of CSM compared with married men, but unmarried and married women had similar CSM risk.
“In clinical practice, we have the perception that patients who are alone or without a spouse appear to be less inclined to accept therapy as well as to follow medical recommendations,” Dr Rosiello told Renal & Urology News. “It may be related to the absence of a person who motivates or gives them a reason ‘to still be alive.’”
He added that this behavior is more pronounced among patients who already have a very short life expectancy, such as those with mRCC, whose life expectancy is roughly 20 months.
“For this reason, these patients are less likely to accept therapy as well as to undergo medical examination,” Dr Rosiello said.
Moreover, among men, who already have a shorter life expectancy than women with mRCC, unmarried status also is significantly associated with worse mortality. “This may be related to the stronger role of women to take care of their husbands, more than what husbands do for their wives,” Dr Rosiello explained.
He added: “We are glad to see that our data support what we see in daily practice, hoping that our findings will sensitize the medical community about added vulnerability of unmarried patients and possibly greater vulnerability of unmarried males,” Dr Rosiello said. Men might benefit from closer follow-up, he said.
Rosiello G, Knipper S, Palumbo C, et al. Unmarried status is a barrier for access to treatment in patients with metastatic renal cell carcinoma [published online August 29, 2019]. Int Urol Nephrol. doi: 10.1007/s11255-019-02266-3