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Original research
Relationship status and other demographic influences on survival in patients with ovarian cancer
  1. Austin B Gardner1,2,
  2. Brooke E Sanders3,
  3. Amandeep K Mann4,
  4. Cheng-I Liao5,
  5. Ramez Nassef Eskander3,
  6. Daniel S Kapp6 and
  7. John K Chan7
  1. 1 Obstetrics and Gynecology, University of California Irvine School of Medicine, Irvine, California, USA
  2. 2 Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
  3. 3 Obstetrics and Gynecology, University of California San Diego School of Medicine, La Jolla, California, USA
  4. 4 Palo Alto Medical Foundation, Palo Alto, California, USA
  5. 5 Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
  6. 6 Stanford University School of Medicine, Stanford, California, USA
  7. 7 California Pacific Medical Center, San Francisco, California, USA
  1. Correspondence to Dr John K Chan, California Pacific Medical Center, San Francisco, CA 94109, USA; johnkchanmd{at}gmail.com

Abstract

Objective To evaluate the influence of marital status and other demographic factors on survival of patients with ovarian cancer.

Study design Data were obtained from the Surveillance, Epidemiology, and End Results database from 2010 to 2015. Analyses were performed using Kaplan–Meier and multivariate Cox proportional hazard methods.

Results Of 19 643 patients with ovarian cancer (median age 60 years, range 18–99), 16 278 (83%), 1381 (7%), 1856 (9%), and 128 (1%) were White, Black, Asian, and Native American, respectively. The majority of patients (10 769, 55%) were married while 4155 (21%) were single, 2278 (12%) were divorced, and 2441 (12%) were widowed. Patients were more likely to be married if they were Asian (65%) or White (56%) than if they were Black (31%) or Native American (39%) (p<0.001). Most married patients were insured (n=9760 (91%), non-Medicaid) compared with 3002 (72%) of single, 1777 (78%) divorced, and 2102 (86%) of widowed patients (p<0.001). Married patients were more likely to receive chemotherapy than single, divorced, and widowed patients (8515 (79%) vs 3000 (72%), 1747 (77%), and 1650 (68%), respectively; p<0.001). The 5-year disease-specific survival of the overall group was 58%. Married patients had improved survival of 60% compared with divorced (52%) and widowed (44%) patients (p<0.001). On multivariate analysis, older age (HR 1.02, 95% CI 1.016 to 1.021, p<0.001), Black race (HR 1.24, 95% CI 1.11 to 1.38, p<0.001), and Medicaid (HR 1.19, 95% CI 1.09 to 1.30, p<0.001) or uninsured status (HR 1.23, 95% CI 1.05 to 1.44, p<0.01) carried a worse prognosis. Single (HR 1.17, 95% CI 1.08 to 1.26, p<0.001), divorced (HR 1.14, 95% CI 1.04 to 1.25, p<0.01), and widowed (HR 1.16, 95% CI 1.06 to 1.26, p<0.001) patients had decreased survival.

Conclusion Married patients with ovarian cancer were more likely to undergo chemotherapy with better survival rates. Black, uninsured, or patients with Medicaid insurance had poorer outcomes.

  • ovary
  • ovarian cancer

https://doi.org/10.1136/ijgc-2020-001512

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    Footnotes

    • Contributors All authors contributed substantially to the design, data analysis, drafting, and preparation of the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available in a public, open access repository. Data is available from the Surveillance, Epidemiology, and End Results Program provided by the National Cancer Institute in the United States. Data is accessible after signing an agreement form and downloading the server client at https://seer.cancer.gov/data/access.html. The data is already deidentified by this government institution.