Effect of Marital Status on Longer Time from Diagnosis to External Beam Radiation Therapy in High-Risk Prostate Cancer Patients According to Race/Ethnicity.

INTRODUCTION

Unmarried men may be at a disadvantage in various healthcare scenarios. We tested whether unmarried status may predispose to longer time between diagnosis and external beam radiation therapy (TT-EBRT) in high-risk prostate cancer (PCa) and whether this relationship may apply differently according to race/ethnicity.

METHODS

Within the Surveillance, Epidemiology, and End Results (SEER) database (2010-2021), 21,129 high-risk PCa patients receiving EBRT were identified. Multivariable logistic regression (MLR) models were fitted to test the association between unmarried status and TT-EBRT > 3, >4, > 5 and > 6 months, according to race/ethnicity (Caucasian, African American, Hispanic, Asian/Pacific Islander). Interaction analysis was performed to assess whether the association between unmarried status and longer TT-EBRT varied according to race/ethnicity.

RESULTS

Numbers and proportions of unmarried high-risk PCa patients were 3,841 (27.0%) Caucasians; 1,670 (47.0%) African Americans; 624 (28.0%) Hispanics and 230 (18.0%) Asians/Pacific Islanders. Numbers and proportions of unmarried high-risk PCa patients with TT-EBRT > 3, >4, > 5 and > 6 months were highest in Caucasians and African Americans, intermediate in Hispanics and lowest in Asians/Pacific Islanders. At MLR models, unmarried status independently predicted higher rates of TT-EBRT > 3 in Caucasians and Africans Americans, but not in Hispanics or Asians/Pacific Islanders, and higher rates of TT-EBRT > 4, >5 and > 6 months in equally strong fashion in Caucasians, African Americans and Hispanics, but not in Asians/Pacific Islanders. Interaction analysis demonstrated that the association between unmarried status and longer TT-EBRT varied significantly according to race/ethnicity.

CONCLUSION

Unmarried status appears to predispose to longer TT-EBRT in Caucasians, African Americans and Hispanics high-risk PCa patients, in whom unmarried rates are highest. Conversely, in Asians/Pacific Islanders in whom unmarried rates are the lowest, unmarried status does not affect the proportion of men in whom TT-EBRT is longer than average.