Abstract
Background: Survival after a cancer diagnosis is largely a function of tumor biology. However, social factors may influence cancer treatment choices, potentially affecting patient survival. In the current study, we studied the interrelations between marital status, cancer-directed surgery received, and disease-specific survival in patients with hepatocellular carcinoma (HCC), using population-based data.
Methods: The Surveillance, Epidemiology, and End Results (SEER) Program database (1988–2004) was used to identify cases of HCC. The 2 statistic was used to determine significant differences between groups of patient, tumor, and treatment factors. HCC-CC Disease-specific survival (DSS) was calculated. Significant differences in survival were determined by Cox regression in multivariate analyses.
Results: Of 28,100 patients with HCC, 47.4% were married, 49.3% were unmarried, and 3.3% were of unknown marital status. Unmarried patients were less likely to be recommended for (31.9% of unmarried patients vs. 36.9% of married patients, P <0.001) and less likely undergo (14.6% of unmarried patients vs. 21.1% of married patients, P <0.001) cancer-directed surgery; Unmarried patients were more likely to refuse cancer-directed surgery (1.99% in unmarried patients vs. 1.6% in married patients, P <0.001). On multivariate analysis, the odds ratio (OR) for recommendation of cancer-directed surgery in divorced/separated, single or windowed patients was 0.805([95% CI], 0.731–0.886; P <0.001), 0.738([95% CI], 0.677–0.805; P <0.001), 0.819 ([95% CI], 0.742–0.903; P <0.001), respectively. Divorced/separated, single or windowed patients were 1.993, 1.582, 1.683 times more likely to refuse recommended cancer directed surgery. Unmarried patients with HCC were found to have a shorter survival than married patients with HCC (hazard ratio for divorced/separated, single and widowed patients were 1.291, 1.113, 1.807, respectively; P <0.00001).
Conclusion: Unmarried patients with HCC were less likely to be recommended for and undergo cancer-directed surgery; age at diagnosis, gender, ethnicity, tumor size> 5cm, stage, marital status, cancer directed surgery, and year of diagnosis were indentified as independent predictors for disease specific survival in the patients with HCC.
Second AACR International Conference on the Science of Cancer Health Disparities— Feb 3–6, 2009; Carefree, AZ