Associations between marital quality and the prognosis of breast cancer in young Chinese women: 10.3-year median follow-up.

BACKGROUND: Some evidence has revealed that marital status is an important predictor of breast cancer (BC) prognosis. However, what role marital quality plays in the effect of marital status on BC prognosis remains unclear.

METHODS: We conducted a prospective cohort study of women aged 20-50 years with stage I-III BC treated in accordance with a standard treatment protocol. The following three categories of marital quality were assessed: marital satisfaction, sexual relationship, and couple communication. The log-rank test was used to compare survival. Cox proportional hazards models were used to estimate hazard ratio (HR) and 95% confidence interval (CI) for recurrence and metastasis, BC-specific mortality, and overall mortality, adjusting for clinical variables.

RESULTS: A total of 1,043 married women were initially recruited in the study. Forty-five (4.3%) patients refused to participate in this study and 141 (13.5%) were excluded from the analysis. Among 857 participants, there were 59 deaths, including 57 from BC. Multivariate Cox regression analysis showed that patients with poor marital satisfaction had significantly higher risks of recurrence and metastasis (HR 3.942, 95% CI: 1.903-8.167), BC-specific mortality (HR 3.931, 95% CI: 1.896-8.150), and overall mortality (HR 3.916, 95% CI: 1.936-7.924). Those with poor sexual relationship had significantly higher risks of recurrence and metastasis (HR 5.763, 95% CI: 3.012-11.027), BC-specific mortality (HR 5.724, 95% CI: 2.992-10.949), and overall mortality (HR 5.653, 95% CI: 2.993-10.680).

CONCLUSIONS: Our results identified a subset of BC patients who have a poor prognosis, namely, those with poor marital quality. Early screening for marital quality and applying necessary social support interventions are helpful in improving the prognosis of patients with poor marital quality.