Marital and partnership status and functional and work limitations among U.S. cancer survivors, 1997-2023

Functional limitations (FL) and activity limitations (AL) represent persistent challenges for cancer survivors and are important determinants of long-term health and quality of life. While marital status is a well-recognized social determinant of survival, its role in shaping disability patterns among survivors remains not well defined.

The National Health Interview Survey (1997-2023), a nationally representative sample of US adults, was used to compare the prevalence of AL and FL among cancer survivors and the general population stratified by marital and partnership status (i.e., married, living with a partner, divorced/separated, widowed, never married). Models were additionally fitted within survivors alone, using married survivors as the reference category. Multivariable survey-weighted logistic and linear regression models were used to estimate adjusted odds ratios (OR) and adjusted mean differences, controlling for sociodemographic and clinical factors.

Among 72,687 cancer survivors and 725,691 adults in the general population, survivors reported a higher weighted prevalence of AL (33.9 vs 14.0%) and FL (61.1 vs 31.3%) (both p<0.001). Within survivors, the adjusted prevalence of AL was lowest among married individuals (29.5%, 95% CI 28.8-30.2) and higher among individuals divorced or separated (39.6%, 38.4-40.8), widowed (37.7%, 36.5-38.8), living with a partner (36.9%, 34.1-39.7), and never married (35.3%, 33.4-37.2). In models restricted to survivors with married survivors as the reference, the adjusted odds of AL were elevated among divorced or separated (AOR 1.73, 1.60-1.86), widowed (1.56, 1.46-1.68), cohabiting (1.50, 1.28-1.76), and never-married (1.38, 1.24-1.54) survivors. Divorced or separated survivors had the highest odds of any work limitation (1.53, 1.42-1.65) and of being unable to work (1.56, 1.43-1.71). On multivariable analysis, cancer survivors had 44% higher odds of AL (AOR 1.44, 95% CI 1.39-1.49) and 61% higher odds of FL (AOR 1.61, 1.56-1.66) compared with the general US population. The association between partnership status and AL differed by sex (p for interaction=0.005) and by age group (p=0.007).

Cancer survivors experience a substantially higher burden of AL and FL than the general US population, with divorced and widowed survivors facing the greatest challenges across physical, social, and vocational domains. Cohabiting survivors resembled unmarried rather than married survivors, indicating that legal marital status alone does not capture the relevant exposure. Survivors without a co-resident spouse as a group had more functional and vocational burden and may warrant prioritization in the design and prospective evaluation of survivorship pathways incorporating functional screening and rehabilitation.