Doctors Seem To Be Biased Against Unmarried Cancer Patients, Offer Them Less Effective Treatment

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Doctors may be unintentionally biased against single patients, a study out of University of Delaware has found.

After Joan DelFattore, a professor emerita of English and legal studies, was diagnosed with cancer, she had an unpleasant experience with one of her doctors. It made her interested in uncovering if doctors tend to have a bias against their single patients. So, she combined her research skills with her experience as an unmarried cancer patient and dove into analyzing data from the US National Cancer Institute database.

What she found was that single patients are less likely than their married peers to have life-saving surgery and radiation.

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Her peer-reviewed article, titled “Death by Stereotype? Cancer Treatment in Unmarried Patients,” was published in The New England Journal of Medicine. DelFattore pored through 84 medical articles found in the National Cancer Institute database to reach her conclusion.

“The statistics definitely show a connection between marital status and the treatment patients receive,” she said. “There are people getting sick and getting second-best treatment.”

When doctors ask about the marital status of a patient, they may assume that because the patient is single, they have no strong relationships to speak of. This, in turn, can lead to less effective and less aggressive treatment for them versus married patients.

DelFattore posits that the reason for this disparity is because doctors are equating “support” with “spouse” and disregarding any other social relationships that could function in a similar role. Support is important, definitely — but the psychological and sociological studies that the authors of the 84 medical articles cite don’t even mention words like “marriage” when underscoring social support. Rather, social support is complex and varied, and can’t be reduced to a single person.

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When DelFattore was diagnosed with stage IV gallbladder that had spread to her liver, she wanted to treat it aggressively. Her surgeon at Memorial Sloan Kettering Cancer Center agreed, and when DelFattore said she had a support network to help her through it, he accepted that.

Her post-surgery doctor in charge of her chemotherapy disagreed. When he asked DelFattore about her marital status and she again stated she had a support network, he was concerned. Because of that, he would only recommend a mild course of treatment — even after she tried to explain in detail that she had strong relationships in her life.

“He wouldn’t risk serious side effects [of the more aggressive treatment] with, as he put it, ‘someone in your situation,'” she said.

DelFattore got a second opinion, and that doctor agreed to a more rigorous course of chemotherapy, which she completed.

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Delfattore isn’t surprised by what she found in her research — nor is she the first person to discover this discrepancy.

“This is not shocking news,” she said. “What’s shocking is that it’s been buried in the fine print of academic journals and footnotes for over 30 years.”

She hopes that her findings will prompt other researchers to look into the issue, and that medical schools will teach about this type of unintentional bias, like they already do with unintentional racial and gender bias.

“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.”

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C. Dixon likes to read, sing, eat, drink, write, and other verbs. She enjoys cavorting around the country to visit loved ones and experience new places, but especially likes to be at home with her husband, son, and dog.
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