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Why Cancer Treatment Can Differ For Those Who Aren't Married


Now, every now and again on this program, we have conversations about the single life, about things like how to tell your relatives to stop bugging you about your single life. Today, though, we're going to talk about some disturbing research that suggests that single people with cancer - whether divorced, widowed or never married - may receive less aggressive treatment than married people. Joan DelFattore is a writer and former professor at the University of Delaware. She wrote about this research in The Washington Post, and she's with us now in our studios in Washington, D.C. Welcome. Thank you so much for joining us.

JOAN DELFATTORE: Thank you very much.

MARTIN: Now, you looked at 59 studies based on this massive database, which is maintained by the National Cancer Institute. Altogether, this covers more than 7 million patients with 28 kinds of cancer. And you found what?

DELFATTORE: Two things. First, if you are currently married and show up with cancer, you are more likely to survive than if you are divorced, widowed or never married. And we've heard that a lot. You will have seen headlines about that for years. But, in those same studies, there's another statistic that has not made the headlines, which is that if you show up with a current partner, you are significantly more likely to get surgery or radiotherapy, if those are the recommended treatments for what you have.

MARTIN: And did the literature suggest why that would be?

DELFATTORE: The literature made a few suggestions, speculations. There's no real research on this. The first one was that, perhaps, the problem is that unmarried people refuse surgery or radiotherapy when the doctor recommends it. But there was a big study done on almost a million patients. It was done by researchers at Harvard, MD Anderson, Mayo Clinic so gold-standard research that showed very small differences between married and unmarried.

There are fewer than 1 percent of unmarried people who refuse surgery when a doctor has recommended it and only slightly more than 1 percent who refuse radiotherapy when a doctor has recommended it. So that explanation - check that one off. That one does not hold water. The other explanations that are offered sound very much like the stereotypes of single people.


DELFATTORE: Like we are depressed. We are not compliant with medical instructions. Now, again, these are all speculations. The authors of these studies are drawing their research from SEER, from this database. That provides no information about psychological characteristics.

So one of the things I did in my research was to check the footnotes. When an article says - an article written by oncologists says, we assume that patients who are unmarried don't do as well because they're depressed, I look at the footnote, what is the evidence they're using. The evidence leaves a good deal to be desired.

MARTIN: And I noticed that you used the word we in describing this. Is it fair to say that what sparked your interest in this is your own experience...


MARTIN: ...Where you were diagnosed with cancer? And I'm very glad to see that you are here and that you recovered. So congratulations on that...

DELFATTORE: Thank you.

MARTIN: ...And - but tell me about your experience.

DELFATTORE: Let me say first - the surgeon and the medical oncologist who actually took care of me were very open to social support from friends and extended family. They were concerned to make sure that, if they gave me very aggressive treatment, which they did, that I would have the help to deal with it. But they were concerned with what they should've been concerned with. That is, you are going to need this. Who will provide it? You will need that. Who will provide it? They were not concerned with, will it be a husband? Will it be a spouse? Will it be adult children?

But, along the way, I consulted one oncologist who I didn't stay with, who proposed to give me one mild drug in a situation where the only thing that had any chance of allowing me to stay alive would've been a very challenging combination chemotherapy. He went through my family tree - do you have a husband? No. Do you have children? No. Do you have siblings? No. Do you have living parents? No - and then immediately said he would give me just this one mild drug.

So I said why? Because I knew it wouldn't help. He said, oh, I wouldn't risk the side effects with somebody in your situation. So I tried to tell him. I have cousins who live nearby. They're very supportive. I have good friends. He literally talked right over me.

MARTIN: It sounds like profiling.

DELFATTORE: You know what's especially chilling about that? It was not malicious, which, in a way, almost makes it worse. It was not prejudice in the sense that he was trying to harm me. He could not distinguish between legitimate medical judgment and his personal social views.

MARTIN: We've talked about the role of kind of assumptions and stereotypes, but I have a countervailing stereotype around single women, which is that there is a support group, that - I guess, based on my own personal experience, my bias is that we have very strong bonds. People were very supportive of each other, you know? "Girlfriends," you know, "Sex And The City." I mean, you know what I mean?

Like, how much - sort of in the popular culture shows that women can have very strong friendships, where they're extremely supportive of each other. So I'm just - I guess this is where I'm asking you to speculate. Why do you think that this negative attitude or this assumption persists?

DELFATTORE: I think it persists because no matter how much doctors try - and I believe they do try - to treat patients, appropriately, they're not immune to what's in the culture. If you look at our culture, you see, movie after movie, where the happy ending is they get married; the unhappy ending is they don't. Doctors are not immune to that.

One of the people I interviewed for this study was a psychiatrist named Jonathan Metzl. He's at Vanderbilt University. He suggested we really need to get these assumptions on the table because doctors are taught to believe that it is wrong to have those stereotypes. So they don't want to say they have them. They don't want to look at whether they have them - to kind of decriminalize that so we can talk about it.

MARTIN: One of the things that you mentioned is that, even when you have a strong support system as a single person, sometimes, the institutions are reluctant to acknowledge that, even if you've made it clear that this is a person you want to receive information. Can you just talk about that?

DELFATTORE: Actually, it's not so much the institutions that don't want to honor that. It's individual employees. The institution would be aware that under the - under HIPAA, the federal law that governs patient privacy, patient has a right to designate who is to get information, and the institution must comply. But individual staff people - the clerk at the desk - have marriage-centered, family-centered attitudes themselves.

So I'll give you a specific example. I had surgery that lasted six hours. I had two cousins and a close friend who were in the hospital. One of my cousins had my medical proxy. I fill out a form - the hospital's form on who is to be given information. I put their names down. I signed it. They could not find out anything while I was in surgery because the staff person at the desk insisted only immediate family could be informed.

MARTIN: That's Joan DelFattore, writer and former professor at the University of Delaware, talking about the phenomenon of unmarried patients getting less aggressive cancer treatment. Joan, thanks so much for talking to us.

DELFATTORE: Thank you. Transcript provided by NPR, Copyright NPR.