The more robust a patient’s social support is, the more likely they are to opt for chemotherapy to treat their advanced colorectal cancer (CRC). Conversely, the less support they have, the less likely they are to choose chemotherapy, which can have dire results in terms of adverse long-term outcomes.

That’s what a team of researchers learned from analyzing data obtained from 1087 patients with stage III colorectal cancer from the Detroit, Michigan, area and the state of Georgia. These research findings were published in JAMA Network Open.

As part of their population-based survey study, the team evaluated 8 risk factors that could affect patients making this kind of decision:

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  • Marital status Never married, separated, divorced, or widowed
  • Employment status Unemployed or disabled
  • Income Annual household income less than $50,000
  • Health insurance Medicaid or no insurance
  • Comorbidities Presence of 2 or more comorbidities
  • Health literacy Marginal or inadequate
  • Adult caregiving Provides care for at least 1 adult who lives in the patient’s home
  • Perceived discrimination Experienced rarely, sometimes, often, or very often

People who reported 3 or more of these factors were significantly less likely to choose chemotherapy than people without any risk factors. The factors most associated with a lower likelihood of choosing chemotherapy were lack of a spouse or partner, lower health literacy, lower household income, and perceived discrimination.

Presence of 7 potential sources of social support for patients also were evaluated, such as a spouse or partner, other family members, friends, healthcare practitioners, coworkers, religious community, and other people with colorectal cancer.

Patients who had 2 or more support sources had higher odds of choosing chemotherapy to treat their advanced colorectal cancer. “The association of cumulative social risk with chemotherapy receipt was mitigated, however, if patients had strong social support during their CRC treatment,” the researchers reported.

When analyzing the participants as a whole, the mean number of social risk factors was 2.46 and the mean number of social support sources was 3.97.

Study limitations included reliance on self-reported data and possible recall bias or participants misremembering the timing of events. The researchers suggested future researchers consider using these findings to create a weighted measure of social risk rather than their version, which assigned equal weight to all social risks, and future studies might also include other forms of social support beyond emotional support.

These findings may help healthcare professionals identify people at higher risk for omitting chemotherapy and providing targeted support to help them.


Davis RE, Trickey AW, Abrahamse P, Kato I, Ward K, Morris AM. Association of cumulative social risk and social support with receipt of chemotherapy among patients with advanced colorectal cancer. JAMA Netw Open. 2021;4(6):e2113533. doi:10.1001/jamanetworkopen.2021.13533