Survivors of childhood cancer less likely to marry

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Electra D. Paskett, Ph.D.

Nina S. Kadan-Lottick, M.D., M.S.P.H.

Childhood cancer survivors typically suffer from the long-term effects of cancer treatment on physical health, and results of a new study suggest that social implications also exist, which may affect their chance of an "I do" at the altar. Survivors are 20 to 25 percent more likely "to never marry" compared with siblings and the general population, according to findings published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

"Many childhood cancer survivors still struggle to fully participate in our society because of the lasting cognitive and physical effects of their past cancer therapy," said lead researcher Nina S. Kadan-Lottick, M.D., M.S.P.H., assistant professor at Yale School of Medicine and Yale Cancer Center, and medical director of the Health Education, Research & Outcomes for Survivors (HEROS) Clinic for childhood cancer survivors.

Using data from the Childhood Cancer Survivor Study, a retrospective cohort of more than 10,000 childhood cancer survivors (who are now adults) treated at 26 institutions around the country, Kadan-Lottick and colleagues evaluated the frequency of marriage and divorce rates among survivors compared with their sibling group and U.S. Census data. The Childhood Cancer Survivor Study is an ongoing study funded by the National Cancer Institute.

Researchers distributed surveys to participants to determine late outcomes of therapy, medical problems, subsequent cancers, psychosocial functioning and other aspects of survivorship, according to the researchers. They identified patients and treatment factors that may predict marital status, including psychosocial distress and neurocognitive impairment.

"Our study pinpointed what aspects of the survivor experience likely contribute to altered marriage patterns: short stature, poor physical functioning and cognitive problems," said Kadan-Lottick. "These conditions are known to be associated with certain chemotherapy and radiation exposures."

Results showed that an estimated 42 percent of survivors were married, 7.3 percent were separated or divorced and 46 percent were never married.

Those who survived brain tumors were 50 percent more likely never to marry. Survivors of central nervous system tumors and leukemia had the greatest likelihood of never marrying, according to the study. Cranial radiation was the therapy most associated with not getting married.

Likelihood of divorce did not vary between the study populations.

"While it can be debated whether marriage is a desirable outcome, marriage is generally an expected developmental goal in our society to the extent that most U.S. adults are married by the age of 30. Our results suggest that survivors of childhood cancer need ongoing support even as they enter adulthood," Kadan-Lottick suggested.

Electra D. Paskett, Ph.D., who was not involved with the study, but is a deputy editor of Cancer Epidemiology, Biomarkers & Prevention, said these findings shed light on the use of certain treatments and their long-term implications, which may affect a patient's physical appearance, thereby resulting in social effects.

"In other studies marital status has been found to be a significant predictor of survival. Will we see this among the childhood survivors as well?" asked Paskett, who is the Marion N. Rowley professor of cancer research in the Division of Epidemiology, and associate director for population sciences in The Ohio State University Comprehensive Cancer Center.

As a follow-up to this report, separate analyses are underway to better understand factors that contribute to other adult benchmarks among childhood cancer survivors, such as living independently, achieving higher education and income. The National Institutes of Health funded this study.

Source: American Association for Cancer Research