My daughter is getting married next week (Mazel tov!) so I felt this topic would be good. While some may feel it is inappropriate to combine marriage with cancer, it is what I know about. If I were Rabbi Jachter, I would write about how a Sephardic and Ashkenazic ketubah differ. If I were Mitchell First, I would write about how the words “chatunah” and “chatan” were derived from Sumerian. But cancer is what I write about.
In a prior article, I mentioned the importance of social support in cancer. It is most strongly evinced through the marital bond for the patient with cancer. In study after study, it is difficult to find a variable that is more consistently associated with the positive or negative outcome of the cancer patient.
A study published in 2013 evaluated over 1,260,000 cancer patients. It compared those who were married to those who were single, which included those widowed, separated or divorced. They found that those who were single were more likely to present with metastatic disease, to not complete appropriate therapy, and to have worse survival. After adjustment for age, type of tumor, and stage, married patients were 20% less likely to die of their disease. This survival benefit held true consistently for all of the top ten cancers (prostate, breast, lung, colorectal, pancreas, liver, esophageal, ovary, head and neck, non-Hodgkin lymphoma) and was consistent across the various subcategories of the single group (separated, widowed, divorced, single).
Another very large study was published recently in 2020. It combined the results from 21 prior studies on the subject, creating a total of 7,890,000 individuals in its analysis. This study found that, compared to married individuals, unmarried men and women had a 12% and 9% higher risk of mortality, respectively. This study was also able to subgroup the categories of single individuals. They found that separated/divorced men had a 16% higher rate of mortality compared to their married equivalents, while separated/divorced women had a 28% higher rate of mortality. Being divorced/separated was associated with a 7% higher risk of mortality in men than women; for widowed or never married men and women there was no gender difference.
Studies suggest that marriage provides a major source of social support. Furthermore, those who are “able” to marry may have psychological advantages that also stand them in good stead when illness strikes. Studies also suggest that women are better able to deal with stress and that 66% of men rely on their wives as their main source of social support. Men living alone are more likely to have small social networks and to be lonely.
Approximately 50% of U.S. adults over age 15 are married. Less than a third have never married and about 13% are divorced or separated and not re-married. The average age of first marriage in both New York and New Jersey is about 30.8 years for men and 29.3 for women. About 50% of marriages make it to twenty years.
In the meantime, a recent survey from the Pew Research Center demonstrated that the percentage of unmarried adult couples living together has doubled since 1993 from 3% to 7%. Married couples in the survey reported a higher level of satisfaction with their relationships than those in the less committed relationships.
I cite these statistics to give context to the statistics in the cancer studies above. Marital status was not determined as a legal construct, i.e., the presence of a marriage license. The status for each person was self-reported. Hence some fraction of those included as married could well have been “significant others” living together, and likewise, some of those reporting themselves as single could have been living in committed relationships—this may add some degree of uncertainty to the results.
Another interesting and important issue is the rise of gay married couples. I could not find any data on the association of marital status and cancer outcomes, but a priori I have no reason to doubt that it will give the same positive impact as heterosexual marriage—and for both genders.
All of this is really to highlight the importance of social support in general to the cancer patient. Social support can derive from multiple relatives—children, parents, siblings, others—as well as from friends and social networks. There is a large robust and growing literature to support its importance.
But the marital bond is at the heart of our social system going back to the Garden of Eden, and it forms the core of our social support system. “It is not good that the man should be alone.” Thus, we go on to learn that, “Therefore a man shall leave his mother and his father and shall cleave to his wife…” Among all the other ways it pays off, is when you get cancer.
But may the newly married couple (and all of us) never have to experience that. Mazel tov!
Alfred I. Neugut, MD, PhD, is a medical oncologist and cancer epidemiologist at Columbia University Irving Medical Center/New York Presbyterian and Mailman School of Public Health in New York.
This article is for educational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and does not constitute medical or other professional advice. Always seek the advice of your qualified health provider with any questions you may have regarding a medical condition or treatment.