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The effect of marital status by age on patients with colorectal cancer over the past decades: a SEER-based analysis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Objective

Marital status has been found as an independent prognostic factor for survival in colorectal cancer (CRC). However, it is unclear whether patients with different marital status have benefited the same from the treatment improvement.

Methods

We queried the Surveillance, Epidemiology, and End Results (SEER) 9 database for patients diagnosed with CRC from 1975 to 2009. Yearly survival data was presented with overlying loess smoothing lines, stratifying by marital status. We further referred to the SEER 18 database for patients diagnosed with CRC from 1973 to 2014. We also performed yearly data for stage proportion, surgery-performed rate, cancer-specific survival (CSS), and multivariate hazard ratio with overlying loess smoothing lines across all marital status.

Results

Five-year CSS of married, single, and separated/divorced patients showed remarkable increase since 1975; however, survival of widowed patients remained low and no survival gains were observed since 1990. The same trends persisted after stratifying patients by stage and gender. Married and widowed patients tended to have more localized disease and less distant disease compared with the other two groups, and married patients were more likely to receive surgery. Multivariate analysis revealed the hazard ratio of widowed patients dropped dramatically when including age at diagnosis.

Conclusions

Widowed patients have not benefited substantially from the remarkable treatment improvement over the past four decades, which may be the result of the older age of this particular group. This study is a wake-up call to the medical community for additional care for the widowed patients.

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Acknowledgements

The authors acknowledged the efforts of the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER database.

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Author notes

  1. Yang Feng and Weixing Dai contributed equally to this work.

Authors and Affiliations

  1. Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032, China

    Yang Feng, Weixing Dai, Yaqi Li, Shaobo Mo, Qingguo Li & Sanjun Cai

  2. Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong’an Road, Shanghai, 200032, China

    Yang Feng, Weixing Dai, Yaqi Li, Shaobo Mo, Qingguo Li & Sanjun Cai

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Contributions

Y.F. and Q.G.L. planned the study. W.X.D. and S.B.M. calculated statistics and analyzed the data. Y.F. and Y.Q.L. wrote the manuscript. S.J.C. and Q.G.L. supervised the entire project. All authors reviewed the manuscript.

Corresponding authors

Correspondence to Qingguo Li or Sanjun Cai.

Ethics declarations

We obtained permission to access research data files with the reference number 10319-Nov 2016. The data did not include the use of human subjects or personal identifying information. Thus, no informed consent was required for this part of the study.

Conflict of interest

The authors declare that they have no conflict of interests.

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Originality statement

We first described secular trends of long-term clinical outcome of marital status over the past four decades and demonstrated survival of widowed patients remained low and showed no survival gains since 1990, which may be the result of more elderly patients in this particular group.

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Feng, Y., Dai, W., Li, Y. et al. The effect of marital status by age on patients with colorectal cancer over the past decades: a SEER-based analysis. Int J Colorectal Dis 33, 1001–1010 (2018). https://doi.org/10.1007/s00384-018-3017-7

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