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Should Doctors Consider Marital Status of Male Patients When Planning Palliative Treatment for Bone Metastasis?

DENVER -- Single men are less likely to seek radiation re-treatment for pain caused by prostate cancer that has spread to the bone than married men. That is the conclusion of a Radiation Therapy Oncology Group (RTOG) study presented today at the 47th Annual Meeting of the American Society for Therapeutic Radiology and Oncology in Denver, Colo.

"Patients often experience a great deal of pain if their cancer spreads to the bone," explained Andre Konski, MD, MBA, MA, FACR, director of clinical research in the radiation oncology department at Fox Chase Cancer Center and lead author of the paper on the Radiation Therapy Oncology Group study (RTOG 97-14). "The pain can be alleviated with radiation treatments, but sometimes the treatment has to be repeated to arrest recurrent pain. This study demonstrates that single men are less likely to seek multiple treatments."

The RTOG has previously reported differences in treatment outcomes based upon socioeconomic factors, including marital or live-in status. Three studies showed that married men or men with a live-in partner treated for head and neck cancer had improved local control and overall survival compared to single men. This difference was not seen in women because of the small female sample size seen in these studies.

In this newest study, men and women with symptomatic bone metastases from breast and prostate cancer were randomized to receive 10 radiation treatments at 3 Gy each or one radiation treatment at 8 Gy. The specific aim of this study was to evaluate outcome differences based upon marital status.

"The most significant finding was that men without partners did not seek additional radiation treatment for their pain at the same rate as married men and women who also received only one treatment," said Konski. All of the other sub-groups who received 8 Gy sought re-treatment.

There was no difference in re-treatment rates in single men receiving either 30 Gy or 8 Gy, whereas married and single women and married males who received 8 Gy were more likely to seek re-treatment sooner.

"The lower re-treatment rates observed in single men receiving 8 Gy may be because men without partners don't have the same social support as men with partners and therefore may not seek out additional treatment for their pain," Konski noted. "Clinicians may need to be sensitive to the greater likelihood of negative outcomes in single male patients. Focused strategies, though, will depend on better specification of what aspects of being single are most disadvantageous to men with cancer."

In addition to Konski, other authors of the paper include M. DeSilvio of RTOG Statistical Headquarters, W. Hartsell of Advocate Health, Deborah Watkins Bruner, RN, PhD, of Fox Chase, J. Coyne of the University of Pennsylvania, C. Scarantino of Rex Health and N. Janjan of M. D. Anderson University of Texas Cancer Center.

Fox Chase Cancer Center, part of the Temple University Health System, is one of the leading cancer research and treatment centers in the United States. Founded in 1904 in Philadelphia as one of the nation’s first cancer hospitals, Fox Chase was also among the first institutions to be designated a National Cancer Institute Comprehensive Cancer Center in 1974. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are also routinely recognized in national rankings, and the Center’s nursing program has received the Magnet recognition for excellence four consecutive times. Today, Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research, with special programs in cancer prevention, detection, survivorship, and community outreach.  For more information, call 1-888-FOX CHASE or (1-888-369-2427).

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