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Recommended treatments for cancer may not be the same for patients who are not married as for those who are. Instead, based on the stereotype that single people “don’t have anyone,” physicians may be prescribing less aggressive treatments for them. Joan DelFattore, Ph.D., made that argument after examining 84 medical articles that draw data from a massive National Cancer Institute database that categorizes patients by, among other things, marital status. She also found, from research in psychology and sociology, that stereotypes of single people were not supported by evidence. Her article, “Death by Stereotype: Cancer Treatment in Unmarried Patients,” was published in the September 5, 2019 issue of the New England Journal of Medicine.
Victim-Blaming Explanations for the Undertreatment of Patients Who Are Not Married
“As compared with married patients with cancer,” Professor DelFattore noted, “those who are widowed, divorced, or separated or who have never been married are significantly less likely to undergo surgery or radiotherapy when those are the treatments of choice.” She scrutinized the reports to see how the researchers explained their findings.
Several lines of reasoning seemed to amount to blaming the victim. Cancer patients who are not married, it was suggested, are refusing the treatment that is recommended. Or, unlike married patients, they are just too depressed.
Are Unmarried Cancer Patients Refusing Treatment?
The belief that unmarried cancer patients refuse treatment was based on degrading stereotypes of single people. Several sets of authors, for example, suggested that single people just don’t have the same “fighting spirit”, as married people. Another team of researchers expressed their belief that “having a committed life partner gives patients more to live for.”
What about actual data? DelFattore found that in a study of nearly a million cancer patients, only about a half of one percent (0.52%) of the people who were not married declined to have surgery when their doctor recommended it. Only a little over one percent (1.33%) declined radiotherapy when it was recommended.
Married cancer patients were only a shade less likely to decline such physician-recommended treatments. For surgery, 0.24% declined, and for radiotherapy, 0.69% said no. Compared to patients who were not married, that’s a difference of less than 1% in each instance.
Are Unmarried Cancer Patients More Depressed than Married Patients?
In her review of the studies in the medical journals, DelFattore found claims that unmarried cancer patients are more depressed than married patients. As evidence, one team of researchers pointed to a study that did not even include any lifelong single people.
Again, the more reliable and comprehensive data do not support the stereotypes. As DelFattore noted:
“When the Mayo Clinic implemented universal screening of patients with cancer, no significant association between depression and marital status was found.”
The link between getting married and being less depressed also turns out to be suspect in studies of the general population. Social support is what matters, and that can come from people other than a spouse. As noted in a “Living Single” article:
“People who said that they could open up to friends and family, and rely on them when they had a problem, were less depressed than those who did not have social support from friends and family.”
Do Doctors Assume Single People “Don’t Have Anyone” and Therefore Recommend Less Aggressive Treatment?
If cancer patients who are not married rarely refuse doctor-recommended treatments, and if they are no more depressed than married cancer patients, then why are they being undertreated? Perhaps, Professor DelFattore suggests, doctors believe the stereotype that single people “don’t have anyone.” They think that if a person does not have a spouse, then that person has no social support at all. Then, on the assumption that there will be no one available to help, the doctors are less aggressive in their treatment recommendations.
In her close reading of the articles in medical journals, DelFattore found that the literature “overwhelmingly equates the absence of a spouse with a lack of social support, which is then proposed as an explanation for lower rates of surgery and radiotherapy.”
As an example, she points to this claim in a research report: “People who are married receive better social support, which subsequently promotes health and survival.” For evidence, the authors cite a review article. When DelFattore studied that review article for herself, she found that it “does not even mention the words “marriage,” “marital,” or “spouse.” The author instead offered a sophisticated perspective, shared by leading social support researchers, that social support can come from friends, relatives, and community networks and not just from a spouse.
The irony of the assumption that single people don’t have anyone is that dozens of studies show that in important ways, just the opposite is true. Single people have more friends and bigger social networks than married people do. They also get more psychological and emotional fulfillment from their relatives and friends. Single people value “the ones” instead of “The One.” When they need help, they often find that those people are there for them.
Another Way of Thinking About Different Rates of Surviving Cancer
Studies sometimes find that people who are married are more likely to survive cancer than people who are not married. Those investigations do not show that married people do better because they are married. Rather, the studies are plagued by methodological shortcomings and the results are open to important alternative explanations, as explained here.
In her article in the New England Journal of Medicine, Professor DelFattore makes a compelling case for the disturbing possibility that married people do in fact have an advantage when it comes to surviving cancer—because they, more than single people, are getting the treatments they should be getting.
