In sickness and in health: the role of marital partners in cancer survival

Astri Syse, Cancer Registry of Norway
Torkild Hovde Lyngstad, University of Oslo

Cancer mortality is associated with marital status, with married persons having a survival advantage relative to others. Underlying mechanisms appear unclear, but some research suggests that persons with partners have better general health at diagnosis which is favorable for tolerating cancer treatment and thus prolongs survival, that having a partner is associated with earlier contact with health personnel in general and when one suspects something is wrong, and that having a partner at time of diagnosis will help ensure more optimal treatment and follow-up care, which in turn affects survival positively. All these suggested mechanisms invoke the mere presence of partners, but it is likely that partners bring varying amounts of resources into the household and that these resources of various types may produce differentials in survival net of own resources. The present study examines the role of marital partners’ sociodemographic characteristics for cancer survival. Data on complete birth cohorts were obtained from the Cancer Registry of Norway, with other variables linked from different national registers through personal identification numbers. Data on the patients’ spouses at time of diagnosis were linked through unique family numbers. Altogether, more than 280,000 patients diagnosed with their first cancer after age 50 during 1975-2008 were included. We studied gross differences in survival by partners’ education and age. Next, we assessed the impact of these partner characteristics net of stage differences at diagnosis and other illness characteristics. Lastly, we simultaneously studied the impact of the resources of patients and their partners. Our results clearly indicate that partners’ characteristics matter for survival. The relative survival of patients with highly educated partners, net of their own education, is significantly higher than that of patients with lesser-educated partners. Thus, the naïve perspective of only considering the presence of partners will conceal important differences in survival among cancer patients.