Abstract A87: Which head and neck cancer patient benefits from being married: The man or the woman?
Authors: Osazuwa-Peters Nosayaba , Simpson Matthew C. , Cass Lauren M. , Challapalli Sai Deepika , Zahirsha Zisansha S. , Boakye Eric Adjei , Massa Sean T. 
Published: February 2019

Abstract
Introduction: Among the known nonclinical prognostic factors for head and neck squamous cell carcinoma (HNSCC) survivorship, there has been recent focus on the potential benefits of being married. Several studies have shown that marriage confers a survival advantage for HNSCC patients. However, anecdotal evidence suggests that there may be marked differences in this survival benefit based on the sex of the patient. To date, no study has described how sex differences influence head and neck cancer survivorship based on marital status. Our study aimed to determine whether marital status at diagnosis impacts survivorship of HNSCC differently based on sex.
Methods: In this retrospective study, we utilized a patient cohort of 27,208 confirmed HNSCC cases from the Surveillance, Epidemiology, and End Results (SEER) 18 database (2004–2014) who received chemotherapy and radiotherapy. Actuarial survival curves stratified by marital status at diagnosis (married/partnered, never married, divorced/separated, widowed) indicated cancer-specific survival from HNSCC. Survival differences between marital status groups were first assessed by log-rank tests with Bonferroni adjustments. Second, patients' demographic and clinical characteristics including sex, marital status, race/ethnicity, insurance status, HNSCC site, stage, age at diagnosis, year of diagnosis, and county-level poverty were utilized in Fine and Gray competing risk proportional hazard models to examine the potential interaction between sex and marital status and estimate adjusted hazard ratios (aHR) for death from HNSCC.
Results: The cohort was mostly men (80.8%) and married/partnered (56.5%). Married/partnered patients had the best survival of any marital status group (log-rank and Bonferroni p &lt; 0.001). The initial Fine and Gray model controlling for covariates indicated a significant interaction between sex and marital status (p &lt; 0.05), with married women having a 13% increased hazard of death compared to married men (aHR=1.13, 95% CI: 1.04, 1.24). Final Fine and Gray models stratified by sex showed that widowed women had an increased hazard of death compared to married/partnered women (aHR=1.19, 95% CI: 1.03, 1.38), while there was no statistically significant survival difference between married and unmarried women. For men, patients who were unmarried (aHR=1.37, 95% CI: 1.27, 1.46), widowed (aHR=1.36, 95% CI: 1.20, 1.54), or divorced/separated (aHR=1.30, 95% CI: 1.21, 1.39) had an increased hazard of HNSCC death compared to men who were married/partnered at the time of diagnosis. Racial disparities persisted irrespective of marital status; non-Hispanic black women had higher hazards of HNSCC death compared with non-Hispanic white women (aHR=1.29, 95% CI: 1.12, 1.48). Hispanic men (aHR=1.12, 95% CI: 1.02, 1.23) and non-Hispanic black men (aHR =1.27, 95% CI: 1.17, 1.37) had a higher hazard of HNSCC death compared with non-Hispanic white men.
Conclusions: Our study has shown for the first time in the head and neck cancer literature that while being married confers survival benefits in general, married men with HNSCC may benefit more than women. Unmarried men seemed to fare the worst compared with every marital status for both men and women. More research is needed to understand this differential marital status benefit based on sex. Additionally, efforts should focus on developing analogous support systems for men and women who are head and neck cancer patients that could improve their survival, especially unmarried men and widowed men and women.
Citation Format: Nosayaba Osazuwa-Peters, Matthew C. Simpson, Lauren M. Cass, Sai Deepika Challapalli, Zisansha S. Zahirsha, Eric Adjei Boakye, Sean T. Massa. Which head and neck cancer patient benefits from being married: The man or the woman? [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A87.