1. DiGiulio, Sarah

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On the list of factors that affect a patient's outcome after being diagnosed with cancer is marital status. Research that looked at more than 730,000 patients with any one of the 10 leading cancers in the U.S. suggests that being married yields an advantage for patients with cancer in terms of having a lower risk of having metastatic disease, undertreatment, and death from cancer (J Clin Oncol 2013;31:3869-3876). But now new research suggests the story might be different for some people, depending on their race.

Carol Parise, PhD. C... - Click to enlarge in new windowCarol Parise, PhD. Carol Parise, PhD

The new data included 23,493 women who had been diagnosed with triple negative breast cancer. The findings were presented during a poster presentation at the 2017 ASCO Annual Meeting (Abstract 1098).


"Being married at the time of diagnosis of triple negative breast cancer provides a survival advantage for women who are white and Asian/Pacific Islander, but not for black or Hispanic women," study author Carol Parise, PhD, Research Scientist at Sutter Institute for Medical Research, Sacramento, Calif., shared with Oncology Times.


The data also showed that the single white and Asian/Pacific Islander women with triple negative breast cancer had worse survival than women who were white and Asian/Pacific Islander and married at the time they were diagnosed with the disease.


Of the women in the study, 13,241 were white, 2,775 were black, 5,059 were Hispanic, and 2,418 were Asian/Pacific Islander. The researchers used Kaplan-Meier survival analysis and Cox regression to assess the risk of mortality associated with marital status (married, single/never married, separated, divorced, or widowed). The models were adjusted for cancer stage and grade, age, socioeconomic status, and treatment type.


Here's why Parise says these findings are significant and what implications they have for addressing disparities in cancer care outcomes.


1 What led you to specifically look at how marital status affects breast cancer outcomes among different races?

"Our research in breast cancer has centered on the topic of disparities in incidence and mortality due to race/ethnicity and socioeconomic status. Since marital status has been shown to be an advantage for cancer survival, we wanted to know if this was true for all race/ethnicities for the subtype of breast cancer with the worst survival.


"We investigated whether there was a survival advantage [in triple negative breast cancer] for women of the same race/ethnicity who were married versus single, divorced, and widowed. No other study has compared differences in risk of mortality of [triple negative breast cancer] associated with being married within a single race."


2 Why do you suspect that race played a role in whether or not being married provided a survival advantage for the women in this study with triple negative breast cancer-and do you suspect the same pattern would exist for patients with other types of cancer, too?

"We cannot draw conclusions given the nature of our data, but we can speculate that since social support is a correlate of survival for breast cancer that this could account for why marital status is associated with improved survival. This area deserves further research.


"We focused on [triple negative breast cancer] because it is the subtype with the worst survival. ... While we did not conduct the analysis with the combined subtypes for each race, we believe the results would be similar for all cancers."


3 What is the next step given these findings?

"This study was an epidemiologic investigation. These types of studies tend to raise more questions than answers since they are correlational in nature.


"While we do not have the resources to further pursue this topic, a next step would be to determine the social support factors that are important for women with [triple negative breast cancer] and determine if there are differences in what constitutes support for women of different races. It appears as if there are other factors associated with survival besides surgery, radiation, [chemotherapy], and hormonal therapy-and these should be explored."