However, a focused examination of upper tract urothelial carcinoma (UTUC) patients has been lacking. The current study fills this gap by investigating the impact of marital status on the stage at presentation and treatment modalities namely, radical nephroureterectomy (RNU) and systemic therapy (ST) in non-metastatic UTUC patients identified within the SEER database.
Key Findings
The study evaluated 8,544 non-metastatic UTUC patients, with a nearly balanced gender distribution: 56% male and 44% female. Among these, 25% of the males and 50% of the females were unmarried. The analysis revealed several critical findings:
1. Marital Status and RNU:
- Unmarried males were significantly less likely to undergo RNU compared to their married counterparts (Odds Ratio [OR]: 0.56; p<0.001).
- This association was not observed in females (OR: 0.81; p=0.1).
- Unmarried status was linked to lower ST rates in both males (OR: 0.73; p=0.03) and females (OR: 0.64; p<0.001).
- No significant association was found between marital status and the likelihood of presenting with a locally advanced stage (T3-4N0-2) in either gender (males OR: 0.95; p=0.5; females OR: 0.99; p=0.9).
These findings underscore the complex interplay between social support systems and cancer treatment decisions. The lower rates of RNU among unmarried males might be attributed to the absence of a supportive partner, which is often crucial in navigating the healthcare system and managing the postoperative care associated with invasive treatments. The role of a partner in encouraging and supporting through the treatment process cannot be underestimated. It is possible that unmarried males, lacking this support, may opt out of or delay definitive surgical treatment due to concerns about recovery and overall support.
Conversely, the lack of a significant difference in RNU rates between unmarried and married females suggests that females might have different coping mechanisms or support structures that are not solely dependent on marital status. This could include support from extended family, friends, or community resources, highlighting potential sex-specific differences in how social support influences medical decision-making.
The consistent finding that unmarried patients of both genders were less likely to receive ST further emphasizes the potential disparities in treatment based on marital status. Systemic therapy, often involving prolonged and complex regimens, requires a robust support system for adherence and management of side effects. Unmarried individuals might face greater challenges in this regard, potentially leading to lower initiation or completion rates of ST.
Clinical Implications
The results of this study suggest that healthcare providers should be particularly mindful of the potential barriers faced by unmarried UTUC patients. This awareness should translate into proactive measures to ensure that these patients receive adequate counseling and support throughout their treatment journey. For unmarried males, in particular, there may be a need for additional interventions to facilitate access to RNU and ensure postoperative care is adequately managed.
Moreover, the study highlights the necessity of creating and strengthening support networks for unmarried patients. This could involve social workers, patient navigators, and community support programs aimed at providing the necessary support structures that unmarried patients might lack. Addressing these needs can potentially improve treatment uptake and outcomes in this vulnerable group.
Conclusion
Our provides significant insights into how marital status affects treatment decisions and stage presentation in UTUC patients. While no difference in stage at presentation was observed, the lower rates of RNU and ST in unmarried patients underscore the critical role of social support in cancer care. These findings call for targeted strategies to support unmarried patients, ensuring they receive the comprehensive care necessary to improve their outcomes. As the healthcare system continues to evolve, recognizing and addressing these social determinants of health will be crucial in providing equitable and effective cancer care.
Written by: Simone Morra, MD, Urology Resident, University of Naples Federico II, Naples, Italy, Clinical FellowOnze Lieve Vrouwziekenhuis Hospital- Aalst, Belgium Orsi Academy- Ghent, Belgium, Former Research FellowCentre hispitalier de l'Universite' de Montreal (CHUM)- Montreal, Canada
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