Why It's Important to Have a Partner in Cancer Therapy
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Study finds that married or partnered patients are more likely to receive and complete guidelines-concordant cancer
Whether or not a patient is married is an understood predictor in clinical outcomes, including in patients with cancer. While researchers know that partnered patients have better overall survival than unmarried patients, it is unknown exactly why.
To further investigate this issue, Christine M. Veenstra, MD, MSHP, a medical oncologist at University of Michigan Comprehensive Cancer Center, set out to study outcomes among patients with stage III colon cancer, comparing the treatment and outcomes of patients who were married or partnered against those who were not.
Veenstra was a 2015 recipient of the NCCN Foundation® Young Investigator Award, which funds promising researchers early in their careers.
The partnered patient population
Veenstra and colleagues examined medical records for nearly 400 patients within the Michigan Cancer Research Consortium with stage III colon cancer, noting their partnered status, and compared the treatment that the patients received to the recommendations from the National Comprehensive Cancer Network® (NCCN®) as outlined in the 2015 version of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Colon Cancer.
According to Veenstra, because the NCCN Guidelines® for stage III resected colon cancer are clear, comprehensive, and evidence-based, they provide an excellent case for investigating concordance. The protocol outlined in the 2015 Guidelines included surgery, followed by six months of adjuvant chemotherapy, preferably two-drug combination chemotherapy.
While 85% of the patients studied received either combination or single-agent chemotherapy, partnered patients were far more likely to complete the six-month course, perhaps also increasing their likelihood of overall survival.
“We found that patients who had a partner were almost twice as likely to complete the full six months of chemotherapy. This finding is important as it points to a possible mechanism for improved outcomes that we had not recognized earlier,” said Veenstra.
Although the state of partnership does not change the physical characteristics of one’s cancer or the likelihood of his or her response to treatment, there are theories for this disparity. Regarding the specific treatments outlined in this study, the most common side effect and reason patients give for stopping treatment was neuropathy.
“Partners may help patients manage and cope with the physical side effects of treatment, as well as provide important encouragement and positive support that unpartnered patients do not necessarily have,” explained Veenstra. She also noted that general support could be a factor, such as someone to provide transportation or fill prescriptions at the pharmacy.
Bridging the gap
Now that Veenstra has identified a mechanism behind improved outcomes for a particular patient population, work can immediately be done to improve adherence to NCCN Guidelines-concordant care in unpartnered patients. One way to do this, Veenstra says, is to train clinicians to recognize and be aware of the risks facing unpartnered patients.
“The unpartnered patient population is at risk of not completing or receiving recommended care. We must work to ensure that support systems are in place so that patients are able to stay the course of treatment,” Veenstra. These support systems can include extended family and friends, as well as local support groups and patient advocacy organizations.
Veenstra acknowledges that there are a few more steps to her research. Next, she plans to work directly with patients and their partners.
“I am interviewing patients and their partners about the role that the partners play and its impact on the patient -- I want to be able to look at this from the couple’s perspective -- in their own words,” said Veenstra.
She also plans to extend her research across the cancer care continuum, particularly surveillance of high-risk survivors and their partners, to better understand how clinicians can intervene to improve quality of care.
Advancing the care of patients with cancer
In 2015, Veenstra was one of five grant recipients through the NCCN Foundation Young Investigator Award program, which funded her research for this project. The NCCN Young Investigator Awards provide vital funding to some of the nation’s top next-generation cancer researchers guiding the course of treatment innovation and advancement. Moreover, the program makes it possible for junior faculty to develop the unique skillset necessary in a today’s competitive research environment by enabling them to balance research and clinical duties early in their careers, as well as introducing them to a network of senior investigators from leading cancer centers.
Through the grant program, young investigators, like Veenstra, are nominated by leaders at NCCN Member Institutions for their dedication to discovering cutting-edge breakthroughs and interventions in cancer care.
“The NCCN Foundation Young Investigator Award has been critical in this early point in my research career. It has provided the support for the study, as well as protected my time as a researcher to build my research program in this area so that I can grow to become an independent researcher,” said Veenstra.
Veenstra notes that funding from the NCCN Foundation allowed her to advance her research, and she has since received a National Cancer Institute Cancer Prevention, Control, Behavioral Sciences, and Population Sciences Career Development Award (K07), which is supporting the aforementioned interview trial.
“It is important at an early stage of a research career to have the opportunity to grow and attain grants to build and expand studies. It’s the Young Investigator Award that protects this time for me,” said Veenstra.
Dr. Veenstra’s study, Partnered Status & Receipt of NCCN Guideline-Concordant Colon Cancer Care, was presented at the General Poster Session during the NCCN 22nd Annual Conference in March 2017.
More information is available at JNCCN.org.
About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 27 leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The primary goal of all NCCN initiatives is to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives. For more information, visit NCCN.org.