1 Department of Surgery, University of Michigan, Ann Arbor, Michigan2 Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, Michigan3 Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford University School of Medicine, Stanford, California4 School of Public Health, University of Michigan, Ann Arbor, Michigan5 Department of Medicine, University of Michigan, Ann Arbor, Michigan
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BACKGROUND:Multidisciplinary care is critical for the successful treatment of stage III colorectal cancer, yet receipt of adjuvant chemotherapy remains unacceptably low. Peer support, or exposure to others treated for colorectal cancer, has been proposed as a means to improve patient acceptance of cancer care.OBJECTIVE:The purpose of our study was to evaluate the effect of peer support on the attitudes of patients with colorectal cancer toward chemotherapy and their adherence to it.DESIGN:We conducted a population-based survey of patients with sage III colorectal cancer and compared demographics and adjuvant chemotherapy adherence after patient-reported exposure to peer support.SETTINGS:Patients were identified by using Surveillance, Epidemiology, and End Results Program cancer registries and were recruited 3 to 12 months after cancer resection.PATIENTS:All patients with stage III colorectal cancer who underwent colorectal resection between 2011 and 2013 and were located in the Detroit and Georgia regions were included.MAIN OUTCOME MEASURES:The main outcome measure was adjuvant chemotherapy adherence. Exposure to peer support was an intermediate outcome.RESULTS:Among 1301 patient respondents (68% response rate), 48% reported exposure to peer support. Exposure to peer support was associated with younger age, higher income, and having a spouse or domestic partner. Exposure to peer support was significantly associated with receipt of adjuvant chemotherapy (OR, 2.94; 95% CI, 1.89–4.55). Those exposed to peer support reported positive effects on attitudes toward chemotherapy.LIMITATIONS:This study has limitations inherent to survey research including the potential lack of generalizability and responses that are subject to recall bias. Additionally, the survey results do not allow for determination of the temporal relationship between peer support exposure and receipt of chemotherapy.CONCLUSION:Our study demonstrates that exposure to peer support is associated with higher adjuvant chemotherapy adherence. These data suggest that facilitated peer support programs could positively influence patient expectations and coping with diagnosis and treatment, thereby affecting the uptake of postoperative chemotherapy. See Video Abstract at http://links.lww.com/DCR/A587.