婚姻狀況會影響癌症存活


  August 26, 2009 — 根據8月24日線上發表於癌症期刊的新研究,婚姻狀態可能對癌症存活有所影響。已婚的病患有最高的存活率,診斷時分居者的存活率最低。已婚者以下的存活率,依序是診斷時為鰥寡者、離婚者、未婚者。
  
  研究者發現,已婚病患的5年存活率有63.3%、10年存活率有57.5%。相反的,分居者的存活最差,5年存活率和10年存活率分別是45.4%和36.8%。
  
  第一作者、印第安那大學醫學院的Gwen Sprehn博士在聲明中表示,診斷時經歷分居的病患,應優先給予相關介入。確認診斷時婚姻關係的相關壓力,有助於及早介入而對存活有正面影響。
  
  研究者指出,個人的婚姻關係對於生理健康一直都有重要影響,良好的婚姻關係對健康有所裨益,不良的婚姻關係則對健康有所傷害。之前的研究已經顯示,已婚之癌症病患的存活比未婚病患為佳;推測是因為已婚的病患有較佳的支持,而改善了治療的順從性。
  
  作者們解釋,不過,此一親密關係若瓦解或有間隙,則會對免疫系統有負面系統。腦下垂體與腎上腺素也會受到不和諧或對立的婚姻關係影響。
  
  【分居者的結果最差】
  之前的研究聚焦在病患是已婚或未婚,較少著墨於診斷時的其他婚姻狀態(離婚、鰥寡、分居、單身)的影響。研究者假設,癌症診斷當時的各種婚姻狀態對於存活有不同的影響,而分居的結果最差。
  
  Sprehn博士等人使用「流行病監督及最終結果資料庫(Surveillance, Epidemiology, and End Results,SEER)」的資料,379萬名病患的紀錄被納入他們的分析。他們特別分析5年和10年存活率,方法是「觀察到的存活率依照年齡相仿、種族相仿、性別相仿但無疾病之族群所觀察到的存活率區分,依據所有癌症病患的婚姻狀態區分,進行各類型的分析。」
  
  【依據婚姻狀態區分的5年和10年存活率】

狀態

5 年存活率 (%)

10 年存活率(%)

已婚

63.3

57.5

從未結婚

57.3

51.7

離婚

52.4

45.6

鰥寡

47.2

40.9

分居

45.4

36.8


  【壓力是主因】
  研究者推論,已婚婦女觀察到的存活利益可能是因為一些有相互關聯的因素。其一是已婚者的特徵,例如經濟較穩定、支持度較大。有些研究也顯示,已婚婦女通常會接受比較積極的癌症治療。
  
  他們也指出,分居是一種獨特的婚姻狀態,帶有相當程度的不確定性。分居的壓力會損害免疫系統,他們指出,壓力會引起促發炎性細胞激素、黏著分子、急性時期反應物增加,導致中樞神經系統改變,後續產生憂鬱、疲勞、睡眠不足、認知障礙。
  
  他們寫道,壓力和癌症之間的關係可能是雙向的;有壓力的病患會損傷免疫系統,癌症診斷和分居的婚姻關係兩者都是壓力源。
  
  Sprehn博士表示,理想的話,後續研究應更詳細探討婚姻狀態隨著時間的變化,對於和壓力、免疫、癌症有關的基因資料和生物標記的個別影響,以確認癌症發病時之關鍵時刻的機轉。
  
  國家癌症研究中心的癌症存活辦公室部份資助本研究。
  
  Cancer.線上發表於2009年8月24日。
  
  

Marital Status Can Affect Cancer Survival

By Roxanne Nelson
Medscape Medical News

August 26, 2009 — Marital status might have an impact on cancer survival, according to a new study published online August 24 in Cancer. Married patients had the highest survival rates, and those who were undergoing a marital separation at the time of diagnosis had the lowest rates. After married patients, the next highest survival rates, in descending order, were in those who were widowed, divorced, and never married at the time of diagnosis.

The researchers found that at the upper end of the spectrum, married patients had 5-year survival rates of 63.3% and 10-year survival rates of 57.5%. Conversely, patients who were separated had the poorest survival; 5- and 10-year survival rates for separated patients were 45.4% and 36.8%, respectively.

"Patients who are going through a separation at the time of diagnosis may be a particularly vulnerable population for whom intervention could be prioritized," said lead author Gwen Sprehn, PhD, from the Indiana University School of Medicine in Indianapolis, in a statement. "Identification of relationship-related stress at time of diagnosis could lead to early interventions that might favorably [affect] survival."

The researchers note that personal relationships have persistently played a significant role in physical health, in that good relationships are beneficial and poor relationships can adversely affect health. Previous studies have also shown that married cancer patients have better survival than unmarried patients; it has been speculated that married patients have better support networks, which could lead to improved treatment compliance.

However, disruption of a close relationship and abrasive relationships can negatively affect the immune system, the authors explain. Pituitary and adrenal hormones can also be altered by discordant or hostile relationships.

Poorest Outcomes in Separated Patients

Previous studies have focused on whether patients were married or unmarried, so less information is available concerning the specific subtype of unmarried status at time of diagnosis (divorced, widowed, separated, and single). The researchers hypothesized that the specific subtype of marital status at time of cancer diagnosis would have a differential impact on survival, with separation having the poorest outcome.

Dr. Sprehn and colleagues used data from the Surveillance, Epidemiology, and End Results (SEER) database, and the records of 3.79?million patients were included in their analysis. They specifically analyzed 5- and 10-year relative survival, defined as "observed survival divided by observed survival of an age-matched, race-matched, and gender-matched population without disease, for all cancer patients by marital status, with specific subset analyses as indicated."

5- and 10-Year Survival Stratified by Marital Status
Status 5-Year Survival (%) 10-Year Survival (%)
Married 63.3 57.5
Never married 57.3 51.7
Divorced 52.4 45.6
Widowed 47.2 40.9
Separated 45.4 36.8

Stress Could Be Primary Culprit

The researchers speculate that the survival benefit observed in married patients could be due to a number of interrelated factors. One is the special characteristics of the married population, such as greater financial stability and support. Some studies have also shown that married patients often receive more aggressive treatment for their cancer.

They also note that separation is a unique marital status that carries with it a degree of uncertainty. The stress of separation can compromise the immune system, and they point out that stress has been shown to "cause an increase in proinflammatory cytokines, adhesion molecules, and acute-phase reactants, leading to central nervous system changes, with sequelae including depression, fatigue, impaired sleep, and cognitive dysfunction."

The role of stress and cancer is likely "bidirectional," they write; patients under stress can have a compromised immune system, and a cancer diagnosis and marital separation are both major causes of stress.

"Ideally, future research will study marital status in more detail over time and address individual differences in genetic profile and biomarkers related to stress, immune, and cancer pathways in order to determine mechanisms that might underlie this possible critical period for cancer pathogenesis," said Dr. Sprehn.

The study was supported in part by a grant from the Office of Cancer Survivorship of the National Cancer Institute.

Cancer. Published online August 24, 2009.

    
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