We appreciate Johnson and Master's refined statistical analysis addressing cancer-specific survival, which also incorporated additional important covariates. We note that these additional analyses are consistent with our overall findings. We agree further research is needed to examine the biological basis of these differences in survival. Prospective studies would permit collection of immune biomarkers and measures of psychosocial stress/support at time of diagnosis and at periodic, follow-up intervals. Such data will be important to confirm causal pathways relating marital status and survival.

Gwen C. Sprehn PhD*, Joanna E. Chambers MD*, Peter A. S. Johnstone MD*, * Department of Neurology Indiana University School of Medicine Indianapolis, Indiana.