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Assessment of Attitudes Toward Initiation of Immediate Adjuvant Chemotherapy for Colon Cancer

Published:November 28, 2022DOI:https://doi.org/10.1016/j.jss.2022.11.024

      Abstract

      Introduction

      Early initiation of chemotherapy after surgery for colon cancer has survival benefits. Immediate adjuvant chemotherapy (IAC) involves giving chemotherapy during surgical resection and immediately postoperatively. This novel approach has been shown to be safe, eliminating delays in adjuvant treatment that could increase the risk of micro-metastatic spread. The aim of this study was to assess the willingness of the general public to accept IAC.

      Materials and methods

      Between March and April 2021, 800 telephone interviews were conducted with a sample of adult New York State residents. The Survey Research Institute of Cornell University conducted all surveys. Kruskal–Wallis, chi-squared, and Fisher’s tests were conducted using R 4.0.2.

      Results

      Three scenarios were presented: (1) receiving IAC resulting in improved survival and quality of life, (2) finishing chemotherapy earlier without survival impact, and (3) finishing chemotherapy earlier but with possible side effects. Respondents with higher education were more likely to accept (1) & (2), males were more likely to accept (2) & (3), higher income respondents were more likely to accept (1) & (3), and those with more work hours were more likely to accept (2). Lastly, 16% responded they would be very or extremely likely, and 52% respondents would be somewhat likely or likely to accept intraoperative chemotherapy, even if it may not be necessary.

      Conclusions

      Respondents were likely to accept IAC if offered. Given the known risk of delayed adjuvant chemotherapy (AC) in colon cancer, further research is warranted to determine the survival and quality of life (QOL) benefits of IAC.

      Keywords

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      References

        • Benson A.B.
        • Venook A.P.
        • Al-Hawary M.M.
        • et al.
        NCCN guidelines insights: colon cancer, version 2.
        J Natl Compr Canc Netw. 2018; 16: 359-369
        • Kim Y.W.
        • Choi E.H.
        • Kim B.R.
        • Ko W.-A.
        • Do Y.-M.
        • Kim I.Y.
        The impact of delayed commencement of adjuvant chemotherapy (eight or more weeks) on survival in stage II and III colon cancer: a national population-based cohort study.
        Oncotarget. 2017; 8: 80061-80072
        • Kim I.Y.
        • Kim B.R.
        • Kim Y.W.
        Factors affecting use and delay (≥8 Weeks) of adjuvant chemotherapy after colorectal cancer surgery and the impact of chemotherapy-use and delay on oncologic outcomes.
        PLoS One. 2015; 10e0138720
        • Biagi J.J.
        • Raphael M.J.
        • Mackillop W.J.
        • Kong W.
        • King W.D.
        • Booth C.M.
        Association between time to initiation of adjuvant chemotherapy and survival in colorectal cancer: a systematic review and meta-analysis.
        JAMA. 2011; 305: 2335-2342
        • Hershman D.
        • Hall M.J.
        • Wang X.
        • et al.
        Timing of adjuvant chemotherapy initiation after surgery for stage III colon cancer.
        Cancer. 2006; 107: 2581-2588
        • Bos A.C.R.K.
        • van Erning F.N.
        • van Gestel Y.R.B.M.
        • et al.
        Timing of adjuvant chemotherapy and its relation to survival among patients with stage III colon cancer.
        Eur J Cancer. 2015; 51: 2553-2561
        • Klein M.
        • Azaquoun N.
        • Jensen B.V.
        • Gögenur I.
        Improved survival with early adjuvant chemotherapy after colonic resection for stage III colonic cancer: a nationwide study.
        J Surg Oncol. 2015; 112: 538-543
        • Jones L.A.
        • Ferrans C.E.
        • Polite B.N.
        • et al.
        Examining racial disparities in colon cancer clinical delay in the Colon Cancer Patterns of Care in Chicago study.
        Ann Epidemiol. 2017; 27: 731-738.e1
        • Potosky A.L.
        • Harlan L.C.
        • Kaplan R.S.
        • Johnson K.A.
        • Lynch C.F.
        Age, sex, and racial differences in the use of standard adjuvant therapy for colorectal cancer.
        J Clin Oncol. 2002; 20: 1192-1202
        • Sargent D.J.
        • Wieand H.S.
        • Haller D.G.
        • et al.
        Disease-free survival versus overall survival as a primary end point for adjuvant colon cancer studies: individual patient data from 20,898 patients on 18 randomized trials.
        J Clin Oncol. 2005; 23: 8664-8670
        • Böckelman C.
        • Engelmann B.E.
        • Kaprio T.
        • Hansen T.F.
        • Glimelius B.
        Risk of recurrence in patients with colon cancer stage II and III: a systematic review and meta-analysis of recent literature.
        Acta Oncol. 2015; 54: 5-16
        • Lu H.
        • Ouyang W.
        • Huang C.
        Inflammation, a key event in cancer development.
        Mol Cancer Res. 2006; 4: 221-233
        • Mantovani A.
        • Allavena P.
        • Sica A.
        • Balkwill F.
        Cancer-related inflammation.
        Nature. 2008; 454: 436-444
        • Okada F.
        Inflammation and free radicals in tumor development and progression.
        Redox Rep. 2002; 7: 357-368
        • van der Bij G.J.
        • Oosterling S.J.
        • Beelen R.H.J.
        • Meijer S.
        • Coffey J.C.
        • van Egmond M.
        The perioperative period is an underutilized window of therapeutic opportunity in patients with colorectal cancer.
        Ann Surg. 2009; 249: 727-734
        • Jafari M.D.
        • Carmichael J.C.
        • Dayyani F.
        • et al.
        Immediate adjuvant chemotherapy in non-metastatic colon cancer: phase I trial evaluating a novel treatment protocol.
        Clin Colorectal Cancer. 2021; 21: 114-121
        • Armstrong K.
        • Ravenell K.L.
        • McMurphy S.
        • Putt M.
        Racial/ethnic differences in physician distrust in the United States.
        Am J Public Health. 2007; 97: 1283-1289
        • Shavers V.L.
        • Lynch C.F.
        • Burmeister L.F.
        Racial differences in factors that influence the willingness to participate in medical research studies.
        Ann Epidemiol. 2002; 12: 248-256
        • Mitchell K.-A.R.
        • Brassil K.J.
        • Osborne M.L.
        • Lu Q.
        • Brown R.F.
        Understanding racial-ethnic differences in patient-centered care (PCC) in oncology through a critical race theory lens: a qualitative comparison of PCC among Black, Hispanic, and White cancer patients.
        Patient Educ Couns. 2022; 105: 2346-2354
      1. Localised colon cancer | clinical practice guidelines.
        • Des Guetz G.
        • Nicolas P.
        • Perret G.-Y.
        • Morere J.-F.
        • Uzzan B.
        Does delaying adjuvant chemotherapy after curative surgery for colorectal cancer impair survival? A meta-analysis.
        Eur J Cancer. 2010; 46: 1049-1055
        • Du C.-Z.
        Effect of multidisciplinary team treatment on outcomes of patients with gastrointestinal malignancy.
        WJG. 2011; 17: 2013-2018
        • Richardson B.
        • Preskitt J.
        • Lichliter W.
        • et al.
        The effect of multidisciplinary teams for rectal cancer on delivery of care and patient outcome: has the use of multidisciplinary teams for rectal cancer affected the utilization of available resources, proportion of patients meeting the standard of care, and does this translate into changes in patient outcome?.
        Am J Surg. 2016; 211: 46-52
        • Burton S.
        • Brown G.
        • Daniels I.R.
        • et al.
        MRI directed multidisciplinary team preoperative treatment strategy: the way to eliminate positive circumferential margins?.
        Br J Cancer. 2006; 94: 351-357
        • Gabel M.
        • Hilton N.E.
        • Nathanson S.D.
        Multidisciplinary breast cancer clinics. Do they work?.
        Cancer. 1997; 79: 2380-2384
        • Chang J.H.
        • Vines E.
        • Bertsch H.
        • et al.
        The impact of a multidisciplinary breast cancer center on recommendations for patient management: the University of Pennsylvania experience.
        Cancer. 2001; 91: 1231-1237
        • Ortiz H.
        • Wibe A.
        • Ciga M.A.
        • et al.
        Impact of a multidisciplinary team training programme on rectal cancer outcomes in Spain.
        Colorectal Dis. 2013; 15: 544-551
        • Palmer G.
        • Martling A.
        • Cedermark B.
        • Holm T.
        Preoperative tumour staging with multidisciplinary team assessment improves the outcome in locally advanced primary rectal cancer.
        Colorectal Dis. 2011; 13: 1361-1369
        • Stephens M.R.
        • Lewis W.G.
        • Brewster A.E.
        • et al.
        Multidisciplinary team management is associated with improved outcomes after surgery for esophageal cancer.
        Dis Esophagus. 2006; 19: 164-171
        • Coory M.
        • Gkolia P.
        • Yang I.A.
        • Bowman R.V.
        • Fong K.M.
        Systematic review of multidisciplinary teams in the management of lung cancer.
        Lung Cancer. 2008; 60: 14-21
      2. Is It Worth Reorganising Cancer Services On The Basis... - Google Scholar.

        • Jafari M.D.
        • Brouwer J.
        • Mesiti A.
        • et al.
        Attitudes of physicians and patients toward the timing of adjuvant treatment in colon cancer.
        J Clin Orthod. 2022; 40: e15596
        • Cheung W.Y.
        • Neville B.A.
        • Earle C.C.
        Etiology of delays in the initiation of adjuvant chemotherapy and their impact on outcomes for Stage II and III rectal cancer.
        Dis Colon Rectum. 2009; 52: 1054-1063
        • Midura E.F.
        • Hanseman D.
        • Davis B.R.
        • et al.
        Risk factors and consequences of anastomotic leak after colectomy: a national analysis.
        Dis Colon Rectum. 2015; 58: 333-338
        • Kawada K.
        • Hasegawa S.
        • Hida K.
        • et al.
        Risk factors for anastomotic leakage after laparoscopic low anterior resection with DST anastomosis.
        Surg Endosc. 2014; 28: 2988-2995
        • Akiyoshi T.
        • Ueno M.
        • Fukunaga Y.
        • et al.
        Incidence of and risk factors for anastomotic leakage after laparoscopic anterior resection with intracorporeal rectal transection and double-stapling technique anastomosis for rectal cancer.
        Am J Surg. 2011; 202: 259-264