Differences in cancer amputee survival based on marital status: an analysis of the Surveillance, Epidemiology, and End Results (SEER) database

Abstract

Purpose

Limb amputation is a life-altering procedure used to treat certain cancer patients. The influence of psychosocial factors (such as marital status) on outcomes is poorly understood, hindering the development of targeted resources for the specific needs of these patients. This study was conducted to characterize the influence of marital status on survival after cancer-related amputation.

Design/Research Approach

Retrospective cohort study.

Sample

1,516 patients with cancer-related amputation were studied from the Surveillance, Epidemiology and End Results database.

Methods

Patients were grouped by marital status as single, married or divorced/separated/widowed and survival was compared using multivariate cox regression adjusted for demographic, tumor and treatment factors.

Findings

Adjusted analysis showed that single (HR, 1.213; p = .044) patients had a significantly higher overall mortality-risk, while divorced/separated/widowed patients had both a significantly higher overall (HR, 1.397; p < .001) and cause-specific mortality-risk (HR, 1.381; p = .003) compared to married patients.

Conclusion

We posit that the increased psychosocial support available to married cancer patients may play a key role in improving survival.

Implications for Psychosocial Providers

These findings provide new insight about the psychosocial needs of cancer amputees and the prognostic implications for those lacking social support of a spouse.

Keywords:

• Amputation
• cancer
• limb
• marital status
• oncology
• SEER
• survivorship

Acknowledgements

We would like to thank the National Cancer Institute for its establishment of the SEER program as means to promote cancer research—Surveillance Research Program, National Cancer Institute SEER*Stat software (seer.cancer.gov/seerstat) version 8.3.5.

Data availability statement

The data that support the findings of this study are openly available within the Surveillance Epidemiology and End Results (SEER) database at http://seer.cancer.gov/. The Registry of Research Data Repositories persistent identifier for this resource is RRID: nif-0000-21366. The data can be extracted via case listing session from the dataset titled: Incidence—SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2017 Sub (1973–2015 varying). This is cited as reference number 19 within the manuscript.

Disclosure statement

The authors of this study have not received grant support or research funding and do not have any proprietary interests in the materials described in this article.

Patient consent statement

This study was conducted using de-identified data contained in a publicly accessible national cancer database registry. For this type of study, participant written informed consent was not required.