A number of studies have consistently shown lower mortality among those who are married compared to those who are not. More recently, this phenomenon has been demonstrated in studies of cancer patients, across all types of cancers that have been studied. Curiously, males seem to be benefit more from being married than females.
In a pair of companion papers (here and here) published last month in the journal Cancer, Dr. Elena Martinez and I set out to understand whether the marriage benefit is in fact due to having greater social support or having greater economic resources, or a combination of the two. Using the California Cancer Registry, a large, population-based dataset (containing data from essentially everyone diagnosed with cancer in California), we assessed the role of economic resources in one paper, and whether the benefit of marriage on survival differed across different racial/ethnic groups in a second paper.
We found that having access to greater economic resources including private health insurance and living in higher socioeconomic status neighborhoods were indeed associated with improved survival, and married patients were more likely than unmarried to have greater economic resources. However, to our surprise, these factors barely influenced the beneficial effects on survival rate among married patients. Interestingly, the marriage benefit differed across racial/ethnic groups – strongest among white males, and weaker among foreign-born Asian males and females.
These studies generated considerable media attention, with headlines such as “A happy marriage may help you survive cancer. Especially if you are a man”, “Marriage may be a cancer fighter”, and the more reasonable “Social support of marriage may improve cancer survival."
So, does this mean that we should all go out and get married as a means to increase odds of survival after a cancer diagnosis? Definitely not!
Being married is clearly a proxy for something in these studies. If it’s not due to economic resources, what could it be due to? We concluded that the beneficial effects of marriage likely reflects greater social support provided by a spouse and children. Social support can translate into tangible or emotional support. Spousal or children support/encouragement can lead to better health behaviors, such as adherence to recommended health screening and treatment, and health-promoting behaviors, such as more exercise and better diet. Tangible support, even things as simple as driving someone to his/her medical appointments; helping with meals, chores, and taking care of children; and offering assistance with finding and interpreting information and making decisions about treatment, can all make a difference. Social support may also help to buffer stress, which in turn can inhibit tumor progression through immunologic or neuroendocrine processes.
This research should also motivate further research into the exact ways in which marriage can increase longevity, so that we can use this information to improve survival for everyone. In the meantime, clinicians should ask their patients about the extent of social network support available to them, and health care facilities should ensure that resources are available to those patients with no or minimal support. It could mean the difference between life and death.
Scarlett Lin Gomez is a research scientist at the Cancer Prevention Institute of California, a member of the Stanford Cancer Institute, and a consulting associate professor at the Stanford University School of Medicine.
Photo by Jason Pier