Abstract
Purpose
We examined marital outcomes among cancer survivors diagnosed during early adulthood from the 2009 Behavioral Risk Factor Surveillance System dataset.
Methods
Eligible participants were ages 20–39 years. Of the 74,433 eligible, N = 1,198 self-reported a cancer diagnosis between the ages of 18 and 37, were ≥2 years past diagnosis, and did not have non-melanoma skin cancer. The remaining N = 67,063 were controls. Using generalized linear models adjusted for age, gender, race, and education, we generated relative risks (RR) and 95 % confidence intervals (95 % CI) to examine survivor status on indicators of ever married, currently married, and divorced/separated.
Results
Survivors were slightly older than controls [33.0 (SD = 3.8) vs. 30.0 (SD = 4.0); p < 0.001]. Average time since diagnosis was 7.4 years. Most common diagnoses were cervical (females; 45 %) and non-Hodgkin lymphoma (males; 20 %). Survivors were less likely to be currently married than controls (58 % vs. 64 %; RR = 0.92, 95 % CI 0.85–0.99). Among ever married participants, survivors were at an increased risk of divorce/separation than controls (18 % vs. 10 %; RR = 1.77, 95 % CI 1.43–2.19). Divorce/separation risk persisted for female survivors (RR 1.83, 95 % CI 1.49–2.25), survivors ages 20–29 (RR 2.57, 95 % CI 1.53–4.34), and survivors ages 30–39 (RR 1.62, 95 % CI 1.29–2.04).
Conclusions
The emotional and financial burdens of cancer may lead to marital stress for younger cancer survivors.
Implications for cancer survivors
Young survivors may face a higher risk of divorce; support systems are needed to assist them in the years following diagnosis.
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References
National Cancer Institute. A snapshot of adolescent and young adult cancers. 2011. http://nci.nih.gov/aboutnci/servingpeople/snapshots/AYA.pdf. Accessed 5 December 2011
Baucom DH, Porter LS, Kirby JS, Gremore TM, Keefe FJ. Psychosocial issues confronting young women with breast cancer. Breast Dis. 2005;23:103–13.
Fobair P, Hoppe RT, Bloom J, Cox R, Varghese A, Spiegel D. Psychosocial problems among survivors of Hodgkin’s disease. J Clin Oncol. 1986;4(5):805–14.
Arai Y, Kawakita M, Okada Y, Yoshida O. Sexuality and fertility in long-term survivors of testicular cancer. J Clin Oncol. 1997;15(4):1444–8.
van Dijk EM, van Dulmen-den BE, Kaspers GJ, van Dam EW, Braam KI, Huisman J. Psychosexual functioning of childhood cancer survivors. Psychooncology. 2008;17(5):506–11. doi:10.1002/pon.1274.
Frobisher C, Lancashire ER, Winter DL, Jenkinson HC, Hawkins MM. Long-term population-based marriage rates among adult survivors of childhood cancer in Britain. Int J Cancer. 2007;121(4):846–55. doi:10.1002/ijc.22742.
Gurney JG, Krull KR, Kadan-Lottick N, Nicholson HS, Nathan PC, Zebrack B, et al. Social outcomes in the Childhood Cancer Survivor Study cohort. J Clin Oncol. 2009;27(14):2390–5. doi:10.1200/jco.2008.21.1458. Accessed 23 April 2012
Cancer epidemiology in older adolescents and young adults 15 to 29 years of age, including SEER incidence and survival: 1975–2000. Bethesda, MD: National Cancer Institute 2006.
Canadian Cancer Society. Canadian cancer statistics 2009, special topic in young adults. Toronto: Canadian Cancer Society; 2009.
Green DM, Zevon MA, Hall B. Achievement of life goals by adult survivors of modern treatment for childhood cancer. Cancer. 1991;67(1):206–13.
Rauck AM, Green DM, Yasui Y, Mertens A, Robison LL. Marriage in the survivors of childhood cancer: a preliminary description from the Childhood Cancer Survivor Study. Med Pediatr Oncol. 1999;33(1):60–3.
Janson C, Leisenring W, Cox C, Termuhlen AM, Mertens AC, Whitton JA, et al. Predictors of marriage and divorce in adult survivors of childhood cancers: a report from the Childhood Cancer Survivor Study. Cancer Epidemiol Biomarkers Prev. 2009;18(10):2626–35. doi:10.1158/1055-9965.epi-08-0959.
Frobisher C, Lancashire ER, Winter DL, Taylor AJ, Reulen RC, Hawkins MM. Long-term population-based divorce rates among adult survivors of childhood cancer in Britain. Pediatr Blood Cancer. 2010;54(1):116–22. doi:10.1002/pbc.22290.
Kapp JM, Jackson-Thompson J, Petroski GF, Schootman M. Reliability of health-related quality-of-life indicators in cancer survivors from a population-based sample, 2005, BRFSS. Public Health. 2009;123(4):321–5. doi:10.1016/j.puhe.2008.10.005.
Moriarty DG, Zack MM, Kobau R. The Centers for Disease Control and Prevention’s Healthy Days Measures—population tracking of perceived physical and mental health over time. Health Qual Life Outcomes. 2003;1:37. doi:10.1186/1477-7525-1-37.
Measuring Healthy Days: Population Assessment of Health-Related Quality of Life, 2000. Atlanta: Centers for Disease Control and Prevention. http://www.cdc.gov/hrqol/pdfs/mhd.pdf. Accessed 25 August 2011.
Barros AJD, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol 2003;3:21.
Heeringa SG, West BT, Berglund PA. Applied survey data analysis. New York: Chapman and Hall; 2010.
Noss A. Household Income for States: 2008 and 2009. Suitland: US Census Bureau; 2010. http://www.census.gov/prod/2010pubs/acsbr09-2.pdf. Accessed 17 July 2012
Carlsen K, Dalton SO, Frederiksen K, Diderichsen F, Johansen C. Are cancer survivors at an increased risk for divorce? A Danish cohort study. Eur J Cancer. 2007;43(14):2093–9. doi:10.1016/j.ejca.2007.05.024.
Dorval M, Maunsell E, Taylor-Brown J, Kilpatrick M. Marital stability after breast cancer. J Natl Cancer Inst. 1999;91(1):54–9.
Joly F, Heron JF, Kalusinski L, Bottet P, Brune D, Allouache N, et al. Quality of life in long-term survivors of testicular cancer: a population-based case–control study. J Clin Oncol. 2002;20(1):73–80.
Hagedoorn M, Sanderman R, Bolks HN, Tuinstra J, Coyne JC. Distress in couples coping with cancer: a meta-analysis and critical review of role and gender effects. Psychol Bull. 2008;134(1):1–30. doi:10.1037/0033-2909.134.1.1.
Glantz MJ, Chamberlain MC, Liu Q, Hsieh CC, Edwards KR, Van Horn A, et al. Gender disparity in the rate of partner abandonment in patients with serious medical illness. Cancer. 2009;115(22):5237–42. doi:10.1002/cncr.24577.
Levin AO, Carpenter KM, Fowler JM, Brothers BM, Andersen BL, Maxwell GL. Sexual morbidity associated with poorer psychological adjustment among gynecological cancer survivors. Int J Gynecol Cancer. 2010;20(3):461–70. doi:10.1111/IGC.0b013e3181d24ce0.
When Marriage Disappears: The New Middle America. The National Marriage Project, University of Virginia. Charlottesville, VA 2010. http://www.virginia.edu/marriageproject/pdfs/Union_11_12_10.pdf. Accessed 23 April 2012.
Brown ML, Yabroff KR. Economic impact of cancer in the United States. In: Schottenfeld D, Fraumeni Jr JF, editors. Cancer epidemiology and prevention. 3rd ed. New York: Oxford University Press; 2006. p. 202–14.
Yabroff KR, Kim Y. Time costs associated with informal caregiving for cancer survivors. Cancer. 2009;115(18 Suppl):4362–73. doi:10.1002/cncr.24588.
Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System. 2009 Summary Data Quality Report. February 18, 2011.
Schneider KL, Clark MA, Rakowski W, Lapane KL. Evaluating the impact of non-response bias in the Behavioral Risk Factor Surveillance System (BRFSS). J Epidemiol Community Health. 2010. doi:10.1136/jech.2009.103861.
Zebrack BJ. Psychological, social, and behavioral issues for young adults with cancer. Cancer. 2011;117(10 Suppl):2289–94. doi:10.1002/cncr.26056.
Hall AE, Boyes AW, Bowman J, Walsh RA, James EL, Girgis A. Young adult cancer survivors’ psychosocial well-being: a cross-sectional study assessing quality of life, unmet needs, and health behaviors. Support Care Cancer. 2011. doi:10.1007/s00520-011-1221-x.
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Anne Kirchhoff is supported by the Huntsman Cancer Institute/Huntsman Cancer Foundation.
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Kirchhoff, A.C., Yi, J., Wright, J. et al. Marriage and divorce among young adult cancer survivors. J Cancer Surviv 6, 441–450 (2012). https://doi.org/10.1007/s11764-012-0238-6
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DOI: https://doi.org/10.1007/s11764-012-0238-6