Swedish Men Living Alone Have Later Stage at Diagnosis and Worse Survival in Cutaneous Malignant Melanoma
In a population-based study reported in the Journal of Clinical Oncology, Eriksson et al found that Swedish men with cutaneous malignant melanoma have more advanced stage at diagnosis and worse disease-specific survival if they live alone. Women living alone did not have worse disease-specific survival.
Study Details
The study included 27,235 patients from the Swedish Melanoma Register with primary invasive cutaneous malignant melanoma diagnosed between 1990 and 2007 and with data linked to nationwide population-based registers followed through 2012. Of 13,390 men, 3,814 lived alone. Of 13,845 women, 6,052 lived alone.
Later Stage at Diagnosis
After adjustment for age at diagnosis, level of education, living area, period of diagnosis, and tumor site, the odds ratios (ORs) of higher stage at diagnosis were significantly increased among men living alone vs with a partner for stage II vs stage I disease (1.42, 95% confidence interval [CI] =1.29–1.57) and for stage III or IV vs stage I disease (1.43, 95% CI = 1.14–1.79). Risk of stage II vs stage I disease at diagnosis was also increased among women living alone (OR = 1.15, 95% CI =1.04–1.28), whereas risk of stage III or IV vs I was not (OR = 1.04, 95% CI = 0.79–1.37).
Increased Disease-Specific Mortality
After adjustment for the same potential confounders, risk for cutaneous malignant melanoma-specific mortality was significantly increased in men living alone (hazard ratio [HR] = 1.48, P < .001), but not in women living alone (HR = 1.11, 95% CI = 0.97–1.27). After adjustment for the same factors plus other risk factors including clinical stage, histogenetic type, tumor ulceration, tumor thickness, and Clark level of invasion, risk of disease-specific mortality remained significantly greater in men living alone (HR = 1.31, P < .001), with no difference in risk for women living alone (HR = 1.01, 95% CI = 0.88–1.16). Risk of disease-specific mortality was increased for men in all age at diagnosis groups (15–54, 55–69, and ≥ 70 years) in both the initial model adjusting for confounders (HRs = 1.44–1.50) and the fully adjusted model (HRs = 1.23–1.41).
The investigators concluded, “In all age groups among men, living alone is significantly associated with reduced [cutaneous malignant melanoma]-specific survival, partially attributed to a more advanced stage at diagnosis. This emphasizes the need for improved prevention and early detection strategies for this group.
Hanna Eriksson, MD, PhD, of the Karolinska Institutet, Stockholm, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by the Swedish Cancer Society, Radiumhemmet Research Funds, Sigurd and Elsa Goljes Memorial Foundation, and Stockholm County Council. The study authors reported no potential conflicts of interest.
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