Impact of marital status on diagnosis and survival of patients with ocular cancer: An observational study

Marital status may influence cancer management by affecting factors such as emotional support, health-related decision-making, and access to medical care. Its impact has been reported across various cancer types. However, the role of marital status in the diagnosis and survival of ocular cancer remains underexplored. Patients diagnosed with ocular cancer between 2000 and 2019 were identified from the Surveillance, Epidemiology, and End Results database, a population-based cancer registry in the United States. Multivariable ordinal logistic regression was used to evaluate the association between marital status and stage at diagnosis. Propensity score matching was used to match baseline characteristics between married and unmarried patients, and overall survival (OS) and cancer-specific survival (CSS) were estimated using Kaplan-Meier curves. A total of 7556 patients were included. Unmarried patients were more likely to be present with advanced disease at diagnosis than married patients (OR = 1.31, 95% CI, 1.11-1.55; P = .001). After propensity score matching, 2625 married and 2625 unmarried patients were included. Unmarried patients showed significantly worse OS (HR = 1.40, 95% CI, 1.29-1.52, P < .001) and CSS (HR = 1.13, 95% CI, 1.02-1.26, P = .022) compared with married patients. Subgroup analysis suggests that females (female vs male; OS: HR 1.45 vs 1.33; CSS: HR 1.18 vs 1.07), older individuals (>60 vs 18-60; OS: HR 1.51 vs 1.17; CSS: HR 1.36 vs 1.23), and low-risk populations (localized [localized vs regional vs distant; OS: HR 1.47 vs 1.20 vs 1.30; CSS: HR 1.21 vs 1.15 vs 1.18], low grade [Grade I-II vs Grade III-IV; OS: HR 1.87 vs 1.14; CSS: HR 1.70 vs 1.08], nonmelanoma [nonmelanoma vs melanoma; OS: HR 1.50 vs 1.34; CSS: HR 1.22 vs 1.11]) appear to derive greater survival benefits from marriage. Additionally, the survival disparity attributable to marriage has increased over time (2010-2019 vs 2000-2009: OS, HR 1.45 vs 1.36; CSS, HR 1.22 vs 1.11). In the multivariable Cox regression analysis, unmarried status was identified as an independent predictor of poor OS (HR = 1.37, 95% CI, 1.27-1.49, P < .001) and CSS (HR = 1.12, 95% CI, 1.02-1.22, P = .031). In ocular cancer patients, unmarried individuals are typically diagnosed at later disease stages and have poorer survival outcomes.