main article image
(BrianAJackson/iStock)

There Seems to Be a Big Issue When It Comes to Single People Being Treated For Cancer

MIKE MCRAE
15 SEP 2019

When it comes to receiving cancer treatment, your marital status might make a significant difference in the level of medical care you get, according to a new study.

University of Delaware researcher Joan DelFattore suggests there's a subtle bias at work when physicians weigh up which treatments best suit their patients' needs - one that prizes a spouse's support above all others, in sickness and in health.

 

DelFattore, a professor emerita of English and legal studies, was inspired by her life experience as a cancer patient to delve into a close examination of literature analysing data from the US National Cancer Institute database.

Her findings have led her to conclude single patients are less likely to receive the kind of surgery and radiotherapy that could save their life.

"The statistics definitely show a connection between marital status and the treatment patients receive," says DelFattore.

In 2011, DelFattore was diagnosed with stage IV gallbladder cancer that had spread into her liver.

Thanks in no small part to modern medical science, she lived to tell her tale. But by DelFattore's own reckoning, there was a chance that by not having a husband, her life might have been at unnecessary risk.

The pivotal moment came when she was asked by an oncologist how she'd cope with the harsh side effects of a particularly nasty course of chemotherapy without the dedicated support of a loving partner, children, or parents.

Of course, a nuclear family is no guarantee that a patient will have a network of volunteers to help out when the ravages of chemo make everyday life that much harder to manage. By the same token, being single doesn't necessarily mean support isn't available.

 

Still, the specialist wasn't comfortable risking a more intense course of combined chemotherapy on someone in her "situation", even if it offered a more promising avenue of treatment.

DelFattore's "situation" notwithstanding, she sought a second opinion which led to her maximising her odds with the combination therapy after all.

Whether or not it truly made a difference, nobody can say. But it did leave the researcher wondering if her experience represented a general bias discouraging single folk from getting efficient treatments if they came with debilitating side effects.

A review of the literature resulted in a pool of 84 studies, all based on statistics from a US government cancer program tracking data on millions of cancer patients.

Her conclusion that unmarried cancer patients have slightly lower odds of survival is hardly news. While the association itself has long been clear, the cause is less obvious.

The debate over the reasons for the discrepancy has included unsupported speculation that unmarried people might somehow have less to live for, and therefore 'give up' more easily. As DelFattore points out, the balance of the research either doesn't back this up, or is based on flimsy arguments.

 

One cited study did show twice as many unmarried patients refusing surgery as those who were married. But with both statistics well under 1 percent, it's not a large-enough discrepancy to support the argument they're more likely to refuse treatment, let alone link it to 'giving up'.

Surprisingly, direct research addressing the topic is pretty thin on the ground. This is in spite of research showing how unmarried individuals are often stigmatised.

But generalisations in the literature combined with scant evidence backing up assumptions about the discrepancy in treatment have convinced DelFattore that single patients aren't being prescribed the same level of life-saving treatment.

"Even if medical researchers mean to recommend what's best for patients, as they presumably do, their reliance on stereotypes about unmarried adults is misleading, especially when they misinterpret sociological and psychological studies that do not, in fact, support those stereotypes," says DelFattore.

Having a good support network certainly makes the road to recovery an easier one, and most people would agree that the benefits of having a doting partner are considerable. The problem comes when marriage is presumed to provide adequate human resources.

"It's not about blame," says DelFattore. "It's about asking people to examine their assumptions – in this case, with respect to potentially life-or-death decisions."

This research was published in the New England Journal of Medicine.