DelFattore is part of that population, and when she was diagnosed in
2011 with advanced gallbladder cancer, she relied on her network of
friends, colleagues, neighbors and extended family to help her. As she
recounts in the journal article, her surgeon at Memorial Sloan Kettering
Cancer Center accepted her description of her friend-based support
network without question.
At the time, she didn’t realize that his acceptance couldn’t be taken
for granted, but when she went for post-surgery chemotherapy, the first
doctor she saw asked about her marital status and continued to focus on
that subject. Even after she tried to explain the support she had
available, the oncologist recommended a milder course of treatment that
DelFattore knew was not the most effective.
“He wouldn’t risk serious side effects [of the more aggressive
treatment] with, as he put it, ‘someone in your situation,’” she writes.
She changed doctors and was given the harsher, more effective
chemotherapy by an oncologist who accepted that she had the necessary
DelFattore is concerned that doctors might rely on medical
researchers who, in turn, are citing sociological and psychological
studies that don’t say what the researchers assume they say.
“Even if medical researchers mean to recommend what’s best for
patients, as they presumably do, their reliance on stereotypes about
unmarried adults is misleading, especially when they misinterpret
sociological and psychological studies that do not, in fact, support
those stereotypes,” DelFattore said.
For example, she said, almost all authors in the 84 articles she
reviewed equate marriage with social support, “but the psychological and
sociological studies they cite to support that claim don’t even mention
the words ‘marriage,’ ‘marital’ or ‘spouse,’” she said. Instead, those
studies talk about social support as a complex web of connections that
can’t be reduced to a single element.
Consistent with longstanding social stereotypes, DelFattore said,
doctors may use the question about marital status as a kind of shorthand
way to ask about social support. Once they hear the word “unmarried,”
they may stop there.
DelFattore is quick to point out that she’s not the person who
discovered the differences in treatment between married and unmarried
patients. Based on her review of articles, it’s been known since at
least 1987 that cancer patients with a current spouse are more likely to
get surgery or radiotherapy than those who are divorced, separated,
widowed or never married, she said.
“This is not shocking news,” she said of the disparity. “What’s
shocking is that it’s been buried in the fine print of academic journals
and footnotes for over 30 years.”
Now, she said, she hopes her journal article will raise awareness and
spur additional research. She also hopes that, just as medical schools
now teach about the dangers of unintentional racial and gender bias in
treating patients, they’ll also start discussing marital status.
“I’m not writing about this and advocating for change out of anger or
outrage,” she said. “It’s not about blame. It’s about asking people to
examine their assumptions—in this case, with respect to potentially
life-or-death decisions. Medicine has to evolve, not only in science and
technology, but also with respect to an evolving society.”
Article by Ann Manser; illustration by Jeffrey C. Chase
Published Sept. 19, 2019