Impact of gender on the association between marital status and head and neck cancer outcomes

Matthew C Simpson; Sai D Challapalli; Lauren M Cass; Zisansha S Zahirsha; Eric Adjei Boakye; Sean T Massa; Nosayaba Osazuwa-Peters

doi:10.1016/j.oraloncology.2018.12.009

Impact of gender on the association between marital status and head and neck cancer outcomes

Oral Oncol. 2019 Feb:89:48-55. doi: 10.1016/j.oraloncology.2018.12.009. Epub 2018 Dec 18.

Authors

Matthew C Simpson¹, Sai D Challapalli², Lauren M Cass¹, Zisansha S Zahirsha³, Eric Adjei Boakye⁴, Sean T Massa⁵, Nosayaba Osazuwa-Peters⁶

Affiliations

¹ Saint Louis University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, St. Louis, USA.
² University of Texas Health Science Center at Houston, McGovern Medical School, Department of Otorhinolaryngology-Head and Neck Surgery, Houston, USA.
³ Saint Louis University School of Medicine, St. Louis, USA.
⁴ Saint Louis University Center for Health Outcomes Research, St. Louis, USA.
⁵ Washington University School of Medicine in St. Louis, Department of Otolaryngology-Head and Neck Surgery, St. Louis, USA.
⁶ Saint Louis University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, St. Louis, USA; Saint Louis University Cancer Center, St. Louis, USA. Electronic address: nosazuwa@slu.edu.

PMID: 30732958
DOI: 10.1016/j.oraloncology.2018.12.009

Abstract

Objectives: To determine whether the impact of marital status on head and neck cancer (HNC) outcomes vary by gender.

Methods: The Surveillance, Epidemiology, and End Results 18 database from 2007 to 2014 was queried for eligible cases of HNC (n = 71,799). An interaction term (gender*marital status) was tested for each outcome of interest (cancer-specific survival, stage of presentation, adequate treatment), and when significant (p < 0.05), the model was stratified by gender. A competing risks proportional hazards (subdistribution [sd]) model estimated the interaction effect on cancer-specific survival. Logistic regression estimated effect on stage of presentation and treatment type.

Results: There was significant gender*marital status interaction for cancer-specific survival and stage of presentation. While married/partnered patients had the highest survival among both genders, males benefitted more: widowed (male sdHR = 1.41, 95% CI 1.31, 1.52; female sdHR = 1.15, 95% CI 1.06, 1.26), divorced/separated (males: sdHR = 1.39, 95% CI 1.32, 1.46; females: sdHR = 1.17, 95% CI 1.06, 1.28), or never married (males: sdHR = 1.42, 95% CI 1.36, 1.49; females: sdHR = 1.15, 95% CI 1.05, 1.26). When stratified by oropharyngeal cancer vs. non-oropharyngeal HNC, unmarried males had 50-60% increased hazard of death, while no difference was found for females. Unmarried males also had greater odds of presenting with late-stage disease compared with females. No gender*marital status interaction was observed for adequate treatment, although married/partnered survivors had greater odds of receiving adequate treatment.

Conclusions: While there are survival benefits for married patients with HNC, married/partnered males, especially those with oropharyngeal cancer, may benefit more than females.

Keywords: Cancer survivorship; Cancer-specific survival; Gender; Head and neck cancer (HNC); Marital status; SEER; Stage of presentation; Treatment type.

MeSH terms

Aged
Female
Head and Neck Neoplasms / epidemiology*
Humans
Male
Marital Status
Middle Aged
Risk Factors
Treatment Outcome