Marital Status, Living Arrangement, and Cancer Recurrence and Survival in Patients with Stage III Colon Cancer: Findings from CALGB 89803 (Alliance)

Seohyuk Lee, Chao Ma, Sui Zhang, Fang-Shu Ou, Tiffany M Bainter, Donna Niedzwiecki, Leonard B Saltz, Robert J Mayer, Renaud Whittom, Alexander Hantel, Al Benson, Daniel Atienza, Hedy Kindler, Cary P Gross, Melinda L Irwin, Jeffrey A Meyerhardt, Charles S Fuchs, Seohyuk Lee, Chao Ma, Sui Zhang, Fang-Shu Ou, Tiffany M Bainter, Donna Niedzwiecki, Leonard B Saltz, Robert J Mayer, Renaud Whittom, Alexander Hantel, Al Benson, Daniel Atienza, Hedy Kindler, Cary P Gross, Melinda L Irwin, Jeffrey A Meyerhardt, Charles S Fuchs

Abstract

Background: Limited and conflicting findings have been reported regarding the association between social support and colorectal cancer (CRC) outcomes. We sought to assess the influences of marital status and living arrangement on survival outcomes among patients with stage III colon cancer.

Patients and methods: We conducted a secondary analysis of 1082 patients with stage III colon cancer prospectively followed in the CALGB 89803 randomized adjuvant chemotherapy trial. Marital status and living arrangement were both self-reported at the time of enrollment as, respectively, married, divorced, separated, widowed, or never-married, and living alone, with a spouse or partner, with other family, in a nursing home, or other.

Results: Over a median follow-up of 7.6 years, divorced/separated/widowed patients experienced worse outcomes relative to those married regarding disease free-survival (DFS) (hazards ratio (HR), 1.44 (95% CI, 1.14-1.81); P =.002), recurrence-free survival (RFS) (HR, 1.35 (95% CI, 1.05-1.73); P = .02), and overall survival (OS) (HR, 1.40 (95% CI, 1.08-1.82); P =.01); outcomes were not significantly different for never-married patients. Compared to patients living with a spouse/partner, those living with other family experienced a DFS of 1.47 (95% CI, 1.02-2.11; P = .04), RFS of 1.34 (95% CI, 0.91-1.98; P = .14), and OS of 1.50 (95% CI, 1.00-2.25; P =.05); patients living alone did not experience significantly different outcomes.

Conclusion: Among patients with stage III colon cancer who received uniform treatment and follow-up within a nationwide randomized clinical trial, being divorced/separated/widowed and living with other family were significantly associated with greater colon cancer mortality. Interventions enhancing social support services may be clinically relevant for this patient population.

Trial registration: ClinicalTrials.gov Identifier: NCT00003835.

Keywords: clinical trial; colonic neoplasms; marital status; residence characteristics; survival analysis.

© The Author(s) 2022. Published by Oxford University Press.

Figures

Figure 1.
Figure 1.
Derivation of the study cohort.
Figure 2.
Figure 2.
Kaplan-Meier curves according to marital status for (A) disease-free survival, (B) recurrence-free survival, and (C) overall survival.
Figure 3.
Figure 3.
Kaplan-Meier curves according to living arrangement for (A) disease-free survival, (B) recurrence-free survival, and (C) overall survival.

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