What are the unmet supportive care needs of people with cancer? A systematic review

Long-term impact of aerodigestive symptoms on adults with oesophageal cancer: A qualitative study

PURPOSE

The impact of long-term aerodigestive symptoms following oesophageal cancer surgery is still not well understood. This study aimed to qualitatively understand the long-term impact of aerodigestive symptoms on quality of life in adults post-oesophagectomy.

METHOD

Participants who received curative transhiatal/transthoracic surgery for oesophageal cancer in Ireland's National Oesophageal Cancer Centre were invited to attend semi-structured interviews. Surgery had to be completed at least 12 months prior. Reflexive thematic analysis was conducted.

RESULT

Forty participants were interviewed individually face-to-face. Four key themes were identified: (a) isolation, reflecting the reported solitude experienced by oesophageal cancer survivors when attempting to manage their ongoing aerodigestive symptoms; (b) fear, including fear of choking and fear that dysphagia symptoms may indicate recurrence of oesophageal cancer; (c) altered work capacity, caused by ongoing aerodigestive symptoms; and (d) avoidance of social situations involving food, due to the pain, discomfort, and embarrassment caused by these symptoms.

CONCLUSION

Oesophageal cancer treatment can be lifesaving, however, such medical interventions can result in distressing physiological aerodigestive symptoms throughout survivorship, which can significantly impact quality of life. Our findings indicate a need for greater community support to manage aerodigestive symptoms and reduce the impact these have on quality of life.

A multidisciplinary group-based survivorship intervention for those living with multiple myeloma: a feasibility study

BACKGROUND

While multiple myeloma continues to be an incurable cancer, advances in its understanding and management have led to significantly improved survival rates. Survivorship interventions for those living with multiple myeloma remain scarce, despite mounting evidence for multiple unmet support needs among multiple myeloma survivors. The current study aimed to evaluate the feasibility and preliminary effectiveness of a novel multidisciplinary group-based multiple myeloma survivorship intervention.

METHODS

A mixed-method, repeated measures feasibility study was conducted within a routine cancer support service. Seven participants, aged over 18, who had a multiple myeloma diagnosis and were clinically assessed as suitable for the intervention by their haemato-oncologist, attended online for six weekly group sessions of physical exercise and self-management input, completing qualitative, physical and self-report measures at baseline, post-intervention and follow-up.

RESULTS

The intervention was deemed overall feasible, with relatively high uptake, participants describing it as largely acceptable and appropriate and providing recommendations for feasibility-enhancing intervention refinements. Findings regarding the preliminary effectiveness of the intervention were mixed. While qualitative analyses stressed the benefits of the intervention (e.g. peer support, connectedness, improved well-being) and large effect sizes were observed for most physical outcomes, no improvements in self-reported outcomes (i.e. quality of life, fatigue) were reported.

CONCLUSIONS

This study represents the first investigation of a promising novel survivorship intervention for those living with multiple myeloma, highlighting the importance of peer support in particular, on which future clinical trials, aiming to establish the intervention's effectiveness for routine care, will be able to build.

Psychosocial distress after radical prostatectomy, radical cystectomy, or (partial) nephrectomy - a comprehensive analysis of 4,290 German cancer patients during the COVID-19 pandemic

AIM

To evaluate and identify predictors of psychosocial distress (PD) in patients after surgical treatment for prostate cancer (PC), bladder cancer (BC), or kidney cancer (KC) during the COVID-19 pandemic in a large, multi-institutional cohort.

MATERIAL AND METHODS

Patients undergoing inpatient rehabilitation (IR) after radical prostatectomy (RP), radical cystectomy (RC), or (partial) nephrectomy in one IR center in 2021 were included. PD was evaluated by the Questionnaire on Stress in Cancer Patients (QSC-R23) at the beginning (T1) and the end (T2) of IR. Regression analyses were performed to identify disease-specific predictors for high PD.

RESULTS

A total of 4,290 patients (3,413 after RP, 563 after RC, 314 after (partial) nephrectomy) were included in this study. Median PD decreased significantly during IR across all tumor entities (each p < 0.001). The number of PC and BC patients suffering from high PD decreased significantly (each p < 0.001), but not in KC patients (p = 0.310). Younger age independently predicts high PD in all three malignancies, while additionally positive surgical margins (p = 0.016), ileal conduit (IC; p < 0.001), and nephrectomy (p = 0.032) independently predict high PD in PC, BC, and KC patients, respectively. During the Covid-19 pandemic the demand for individual psycho-oncologic counseling increased significantly in PC (p = 0.03) and KC (p = 0.001) patients.

CONCLUSION

Younger age independently predicts high PD in the three main urological malignancies. Positive surgical margins in PCa, IC in BCa, and nephrectomy in KC are disease-specific independent predictors for high PD in the early period after surgical treatment.

IMPLICATIONS FOR CANCER SURVIVORS

Disease-specific predictors for high PD may help clinicians identify patients at risk and may guide timely referrals to psycho-oncologic counseling in the early period after uro-oncologic surgery.

Spanish Society of Medical Oncology recommendations for comprehensive assessment and care of cancer survivors' needs

This article reviews the contemporary and inclusive definition of cancer survivorship, including patients with and without disease who have completed or continue to undergo treatment. The Spanish Society of Medical Oncology (SEOM) describes in this article the needs of these patients and outlines a care model based on an estimation of cancer incidence and identification of patient needs, to enable the provision of practical actions to achieve effective care. The objectives of this review are to identify the main effects of cancer on survivors and to establish appropriate ways of measuring these effects, as well as discussing the management of physical, psychological and social, occupational, financial, and other health-related needs. We suggest a multidisciplinary care model and training programs for the different professionals involved in care, and highlight challenges and the future role of the SEOM and health-care policy in ensuring optimum care of cancer survivors.

Assistive Devices for Addressing Mobility Impairments Linked to Cancer and Cancer Treatment: An Expert Perspective

OBJECTIVES

Cancer survivors often experience mobility impairments that negatively impact their ability to engage in everyday activities. Healthcare providers working with patients in the continuum of cancer care play essential roles in identifying and addressing mobility impairments. The objective of this article is to present common assistive devices valuable in managing cancer and cancer treatment-related mobility impairments.

METHODS

Peer-reviewed scientific publications and expert opinions.

RESULTS

This article highlights assistive devices commonly used in various settings of cancer care and describes how they address different impairments faced by cancer survivors. The information presented can potentially serve as a resource when training clinical staff (eg, oncology nursing staff) on device provision across all settings. The information can also be useful for patients and caregivers to learn about potential functional impairments linked to cancer and treatments and assistive devices that can be useful to improve patients' functional capacity and reduce caregiver burden.

CONCLUSION

It is essential to involve different team members to identify and select the most appropriate assistive devices that match the patient's functional needs and physical capacity and to train them in device use so they can safely carry out their daily routine.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses are one of the first providers to identify mobility impairments in cancer patients. This article will help increase their knowledge in common assistive devices valuable for addressing various mobility impairments associated with cancer and treatments. With additional training on device provision, oncology nurses will be more empowered to collaborate with rehabilitation to identify potential mobility impairments, initiate device provision, and encourage their patients to work with therapy services. Ultimately this could reduce injuries linked to mobility impairments and improve the patient's functional independence and overall quality of life.

Unmet needs in people with high-grade glioma: defining criteria for stepped care intervention

BACKGROUND

We aimed to define levels of unmet supportive care needs in people with primary brain tumor and to reach expert consensus on feasibility of addressing patients' needs in clinical practice.

METHODS

We conducted secondary analysis of a prospective cohort study of people diagnosed with high-grade glioma (n = 116) who completed the Supportive Care Needs Survey-Short Form during adjuvant chemoradiation therapy. Participants were allocated to 1 of 3 categories: no need ("no need" for help on all items), low need ("low need" for help on at least 1 item, but no "moderate" or "high" need), or moderate/high need (at least 1 "moderate" or "high" need indicated). Clinical capacity to respond to the proportion of patients needing to be prioritized was assessed.

RESULTS

Overall, 13% (n = 5) were categorized as no need, 23% (n = 27) low need, and 64% (n = 74) moderate/high need. At least 1 moderate/high need was reported in the physical and daily living domain (42%) and the psychological (34%) domain. In recognition of health system capacity, the moderate/high need category was modified to distinguish between moderate need ("moderate" need indicated for at least 1 item but "high" need was not selected for any item) and high need (at least 1 "high" need indicated). Results revealed 24% (n = 28) moderate need and 40% (n = 46) high need. Those categorized as high need indicated needing assistance navigating the health system and information.

CONCLUSIONS

Using four step allocations resulted in 40% of patients indicating high need. Categories may facilitate appropriate triaging and guide stepped models of healthcare delivery.

Treatment options for patients with pilonidal sinus disease: PITSTOP, a mixed-methods evaluation

Background

There is no consensus on optimal management of pilonidal disease. Surgical practice is varied, and existing literature is mainly single-centre cohort studies of varied disease severity, interventions and outcome assessments.

Objectives

A prospective cohort study to determine: • disease severity and intervention relationship • most valued outcomes and treatment preference by patients • recommendations for policy and future research.

Design

Observational cohort study with nested mixed-methods case study. Discrete choice experiment. Clinician survey. Three-stage Delphi survey for patients and clinicians. Inter-rater reliability of classification system.

Setting

Thirty-one National Health Service trusts.

Participants

Patients aged > 16 years referred for elective surgical treatment of pilonidal disease.

Interventions

Surgery.

Main outcome measures

Pain postoperative days 1 and 7, time to healing and return to normal activities, complications, recurrence. Outcomes compared between major and minor procedures using regression modelling, propensity score-based approaches and augmented inverse probability weighting to account for measured potential confounding features.

Results

Clinician survey: There was significant heterogeneity in surgeon practice preference. Limited training opportunities may impede efforts to improve practice. Cohort study: Over half of patients (60%; N = 667) had a major procedure. For these procedures, pain was greater on day 1 and day 7 (mean difference day 1 pain 1.58 points, 95% confidence interval 1.14 to 2.01 points, n = 536; mean difference day 7 pain 1.53 points, 95% confidence interval 1.12 to 1.95 points, n = 512). There were higher complication rates (adjusted risk difference 17.5%, 95% confidence interval 9.1 to 25.9%, n = 579), lower recurrence (adjusted risk difference -10.1%, 95% confidence interval -18.1 to -2.1%, n = 575), and longer time to healing (>34 days estimated difference) and time to return to normal activities (difference 25.9 days, 95% confidence interval 18.4 to 33.4 days). Mixed-methods analysis: Patient decision-making was influenced by prior experience of disease and anticipated recovery time. The burden involved in wound care and the gap between expected and actual time for recovery were the principal reasons given for decision regret. Discrete choice experiment: The strongest predictors of patient treatment choice were risk of infection/persistence (attribute importance 70%), and shorter recovery time (attribute importance 30%). Patients were willing to trade off these attributes. Those aged over 30 years had a higher risk tolerance (22.35-34.67%) for treatment failure if they could experience rapid recovery. There was no strong evidence that younger patients were willing to accept higher risk of treatment failure in exchange for a faster recovery. Patients were uniform in rejecting excision-and-leave-open because of the protracted nursing care it entailed. Wysocki classification analysis: There was acceptable inter-rater agreement (κ = 0.52, 95% confidence interval 0.42 to 0.61). Consensus exercise: Five research and practice priorities were identified. The top research priority was that a comparative trial should broadly group interventions. The top practice priority was that any interventions should be less disruptive than the disease itself.

Limitations

Incomplete recruitment and follow-up data were an issue, particularly given the multiple interventions. Assumptions were made regarding risk adjustment.

Conclusions and future work

Results suggest the burden of pilonidal surgery is greater than reported previously. This can be mitigated with better selection of intervention according to disease type and patient desired goals. Results indicate a framework for future higher-quality trials that stratify disease and utilise broad groupings of common interventions with development of a patient-centred core outcome set.

Trial registration

This trial is registered as ISRCTN95551898.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/17/02) and is published in full in Health Technology Assessment; Vol. 28, No. 33. See the NIHR Funding and Awards website for further award information.

Needs of breast cancer survivors: a systematic review of quantitative data

This systematic review aimed to update the perceived needs of individuals with breast cancer (BC). Databases were searched for studies reporting quantitative data collected through validated assessment tools. Needs of adults with BC were reported by survivorship phase. The post-diagnosis and the post-surgery phases revealed the most needs; health system and information needs represented the greatest concern, with average Supportive Care Needs Survey-Short Form (SCNS-SF34) scores ranging from 62.0 to 75.8 post-diagnosis and from 45.0 to 67.8 post-surgery. Needs then seemed to decrease or remain stable up to within one year from diagnosis, when needs in all domains increased again; health system and information needs remained a priority. Younger age, side effects, type of treatment, and advanced stage were associated with the occurrence of unmet needs. The needs of BC survivors vary over the course of their cancer experience. This knowledge can assist the planning of appropriate assessments.

What is the economic and social return on investment for telephone cancer information and support services in Australia? An evaluative social return on investment study protocol

INTRODUCTION

Over 50% of people affected by cancer report unmet support needs. To address unmet information and psychological needs, non-government organisations such as Cancer Councils (Australia) have developed state-based telephone cancer information and support services. Due to competing demands, evidence of the value of these services is needed to ensure that future investment makes the best use of scarce resources. This research aims to determine the costs and broader economic and social value of a telephone support service, to inform future funding and service provision.

METHODS AND ANALYSIS

A codesigned, evaluative social return on investment analysis (SROI) will be conducted to estimate and compare the costs and monetised benefits of Cancer Council Victoria's (CCV) telephone support line, 13 11 20, over 1-year and 3-year benefit periods. Nine studies will empirically estimate the parameters to inform the SROI and calculate the ratio (economic and social value to value invested): step 1 mapping outcomes (in-depth analysis of CCV's 13 11 20 recorded call data; focus groups and interviews); step 2 providing evidence of outcomes (comparative survey of people affected by cancer who do and do not call CCV's 13 11 20; general public survey); step 3 valuing the outcomes (financial proxies, value games); step 4 establishing the impact (Delphi); step 5 calculating the net benefit and step 6 service improvement (discrete choice experiment (DCE), 'what if' analysis). Qualitative (focus groups, interviews) and quantitative studies (natural language processing, cross-sectional studies, Delphi) and economic techniques (willingness-to-pay, financial proxies, value games, DCE) will be applied.

ETHICS AND DISSEMINATION

Ethics approval for each of the studies will be sought independently as the project progresses. So far, ethics approval has been granted for the first two studies. As each study analysis is completed, results will be disseminated through presentation, conferences, publications and reports to the partner organisations.

Exploring the Role of Artificial Intelligence Chatbots in Preoperative Counseling for Head and Neck Cancer Surgery

OBJECTIVE

To evaluate the potential use of artificial intelligence (AI) chatbots, such as ChatGPT, in preoperative counseling for patients undergoing head and neck cancer surgery.

STUDY DESIGN

Cross-Sectional Survey Study.

SETTING

Single institution tertiary care center.

METHODS

ChatGPT was used to generate presurgical educational information including indications, risks, and recovery time for five common head and neck surgeries. Chatbot-generated information was compared with information gathered from a simple browser search (first publicly available website excluding scholarly articles). The accuracy of the information, readability, thoroughness, and number of errors were compared by five experienced head and neck surgeons in a blinded fashion. Each surgeon then chose a preference between the two information sources for each surgery.

RESULTS

With the exception of total word count, ChatGPT-generated pre-surgical information has similar readability, content of knowledge, accuracy, thoroughness, and numbers of medical errors when compared to publicly available websites. Additionally, ChatGPT was preferred 48% of the time by experienced head and neck surgeons.

CONCLUSION

Head and neck surgeons rated ChatGPT-generated and readily available online educational materials similarly. Further refinement in AI technology may soon open more avenues for patient counseling. Future investigations into the medical safety of AI counseling and exploring patients' perspectives would be of strong interest.

LEVEL OF EVIDENCE

N/A. Laryngoscope, 134:2757-2761, 2024.

Telephone consultation for cancer survivors with unclarified need for rehabilitation in a primary healthcare setting: a mixed methods process evaluation

PURPOSE

To evaluate the implementation of telephone consultations to assess cancer patients' needs for rehabilitation, with focus on patients' acceptance, health professionals' experience and contextual factors.

METHODS

A mixed methods process evaluation was conducted at a primary healthcare rehabilitation clinic. Cancer survivors above 18 years of age with an unclarified rehabilitation need at discharge from hospital, was offered a telephone consultation provided by health professionals. Data on implementation and acceptability were collected using medical records systems, data collection forms and semi-structured interviews with six patients and two health professionals.

RESULTS

Eighty-one cancer survivors were referred to the intervention, and 54% continued to further rehabilitation. The telephone consultations were executed approximately eight days after referral and took on average 44 min to deliver. Overall, the patients found that the telephone consultation addressed what they considered the most important topics, and the health professionals found the intervention to be acceptable. Both patients and health professionals reported challenges regarding the referral process.

CONCLUSION

Patient acceptance of the intervention was high, and the telephone consultation was implemented to a high degree, resulting in more than half of the patients continuing to further rehabilitation. Patients' and health professionals' perspectives provided valuable insights about contextual factors.

Supportive care needs among older Mexican adults with metastatic cancer

INTRODUCTION

Supportive care needs may vary according to age. The purpose of this research is to describe and compare supportive care needs between older adults with metastatic cancer (age ≥ 65 years) and their younger counterparts.

MATERIALS AND METHODS

We conducted a retrospective secondary analysis of a cohort of patients with newly diagnosed metastatic solid tumors. Supportive care needs were assessed at baseline and at a three-month follow-up. Patients were divided into two groups (aged ≥65/<65 years). Differences in clinical characteristics and supportive care needs were compared utilizing descriptive statistics. Multivariate logistic regression models were employed to identify patient characteristics associated with specific supportive care needs.

RESULTS

Between 2018 and 2022, 375 patients were enrolled. Median age was 66 years (interquartile range 19-94). At baseline, older adults had a higher number of supportive care needs (4.8 vs. 4.2, p = 0.01) and were at higher risk of malnutrition (75 vs. 65%, p = 0.05). Increasing age (odds ratio [OR] 1.02 (95% confidence interval [CI] 1.0-1.04, p = 0.03) and an estimated life expectancy <6 months (OR 3.0, 95%CI 1.5-6.1; p < 0.01) were associated with higher odds of malnutrition, while a higher educational level was associated with decreased odds (OR 0.68, 95%CI 0.5-0.8; p < 0.01). At three-month follow-up, older adults still had a higher number of supportive care needs (3.8 vs.2.6, p < 0.01) and were more likely to have fatigue (62 vs. 47%, p = 0.02). An estimated life expectancy of <6 months was associated with increased odds of fatigue (OR 3.0, 95%CI 1.5-6.3; p < 0.01).

DISCUSSION

Older adults reported significantly more supportive care needs, particularly risk of malnutrition and fatigue. This information can help in the creation of supportive care services tailored to the needs of older individuals.

Exploring Health Information-Seeking Behavior and Information Source Preferences Among a Diverse Sample of Cancer Survivors: Implications for Patient Education

This study examined health information-seeking behavior among cancer survivors, including informational sources used and the factors correlated with information-seeking across different racial/ethnic groups. We used data from the Health Information National Trends Survey (2017-2022). Adjusted logistic regression was conducted to identify the predictors of information-seeking by race/ethnicity. Predicting variables were organized into demographic (age, education, race, income, and comorbidity), enabling (having health insurance, having a regular provider, and frequency of care visits), predisposing (quality of care, self-efficacy, and confidence in one's ability to get information), and reinforcing (patient-centered communication, ease of getting information, and confusing information available) factors based on the PRECEDE-PROCEED Model. We included 4723 cancer survivors, of which 15.41% have breast cancer, 17.50% have skin cancer, and 11.11% have prostate cancer. A majority (75.08%) had sought health information. Healthcare providers were the most preferred sources of information across demographic groups, followed by the Internet. Health insurance, a regular provider, and frequent visits were enabling factors that positively influenced information-seeking behavior. Confidence in getting information when needed and self-efficacy were predisposing factors positively associated with the information-seeking behavior. Finally, reinforcing factors (ease of getting information and non-confusion of the information available) were also positively associated with information-seeking. Study findings suggest that one-fourth of cancer survivors had not sought cancer-related information. The results have implications for identifying patients at increased risk for unmet information needs. They also contribute to our understanding of critical racial differences and similarities. Further, findings can help guide interventions to assist in information seeking based on patient preferences.

A couple-based unmet supportive care needs intervention for colorectal cancer couples: A preliminary feasibility study

PURPOSE

To support colorectal cancer couples cope with cancer, we developed a couple-based unmet supportive care needs intervention program guided by the Supportive Care Needs Framework and examined the feasibility, acceptability, and initial effects of the unmet supportive care needs program.

METHODS

The design of a pre-and post-intervention study was conducted among Chinese colorectal cancer couples. The intervention was delivered in five sessions through in-person and telephone interventions combined. To measure program feasibility through recruitment and retention rates, and to test program acceptability through quantitative and qualitative post-intervention program assessments. The complete data (N = 20 pairs) were used to calculate effect sizes to assess the initial intervention effect.

RESULTS

There was evidence of the feasibility of the intervention program in terms of recruitment (66.7%) and retention (83.3%) rates. Participants' satisfaction with the program also attested to its acceptability. The intervention (Cohen's = 0.15-0.56) had a small-moderate effect size in improving unmet supportive care needs and most cancer-adapted outcomes for colorectal cancer couples, validating the initial effect of the program.

CONCLUSIONS

The unmet supportive care needs program is feasible, acceptable, and preliminarily effective in supporting Chinese colorectal cancer couples to improve unmet supportive care needs and cancer adaptability, as provided by this study.

Lessons learned from COVID-19: improving breast cancer care post-pandemic from the patient perspective

BACKGROUND

Since the onset of the pandemic, breast cancer (BC) services have been disrupted in most countries. The purpose of this qualitative study is to explore the unmet needs, patient-priorities, and recommendations for improving BC healthcare post-pandemic for women with BC and to understand how they may vary based on social determinants of health (SDH), in particular socio-economic status (SES).

METHODS

Thirty-seven women, who were purposively sampled based on SDH and previously interviewed about the impact of COVID-19 on BC, were invited to take part in follow-up semi-structured qualitative interviews in early 2023. The interviews explored their perspectives of BC care since the easing of COVID-19 government restrictions, including unmet needs, patient-priorities, and recommendations specific to BC care. Thematic analysis was conducted to synthesize each topic narratively with corresponding sub-themes. Additionally, variation by SDH was analyzed within each sub-theme.

RESULTS

Twenty-eight women (mean age = 61.7 years, standard deviation (SD) = 12.3) participated in interviews (response rate = 76%). Thirty-nine percent (n = 11) of women were categorized as high-SES, while 61% (n = 17) of women were categorized as low-SES. Women expressed unmet needs in their BC care including routine care and mental and physical well-being care, as well as a lack of financial support to access BC care. Patient priorities included the following: developing cohesion between different aspects of BC care; communication with and between healthcare professionals; and patient empowerment within BC care. Recommendations moving forward post-pandemic included improving the transition from active to post-treatment, enhancing support resources, and implementing telemedicine where appropriate. Overall, women of low-SES experienced more severe unmet needs, which in turn resulted in varied patient priorities and recommendations.

CONCLUSION

As health systems are recovering from the COVID-19 pandemic, the emphasis should be on restoring access to BC care and improving the quality of BC care, with a particular consideration given to those women from low-SES, to reduce health inequalities post-pandemic.

Implementing a Clinical Pathway for Needs Assessment and Supportive Care Interventions

Despite advances in clinical cancer care, cancer survivors frequently report a range of persisting issues, unmet needs, and concerns that limit their ability to participate in life roles and reduce quality of life. Needs assessment is recognized as an important component of cancer care delivery, ideally beginning during active treatment to connect patients with supportive services that address these issues in a timely manner. Despite the recognized importance of this process, many health care systems have struggled to implement a feasible and sustainable needs assessment and management system. This article uses an implementation science framework to guide pragmatic implementation of a needs assessment clinical system in cancer care. According to this framework, successful implementation requires four steps including (1) choosing a needs assessment tool; (2) carefully considering the provider level, clinic level, and health care system-level strengths and barriers to implementation and creating a pilot system that addresses these factors; (3) making the assessment system actionable by matching needs with clinical workflow; and (4) demonstrating the value of the system to support sustainability.

The psychosocial needs of head and neck cancer patients: a multicenter study

INTRODUCTION

Cancer is among the most frequent pathologies and a major cause of death and disability. Scientific research and surgeons focus mainly on aspects relating to etiopathogenesis, diagnosis, and treatment, but often neglect the psychological needs of patients and related social factors. The aim of this study is to investigate the psychological and social needs of patients affected by head and neck cancer to improve patient management and achieve more empathetic care.

MATERIALS AND METHODS

The Need Evaluation Questionnaire (NEQ) was administered to adult patients who had to undergo surgery in 4 Italian tertiary head and neck cancer centers the day before the operation.

RESULTS

188 patients affected by stage I-IV head and neck tumors were enrolled. The main needs expressed by patients fall under the categories of either "information and dialogue", (64.3% more information about future conditions, 50% more information about treatments, 45% more information about the diagnosis, 44% more reassurance) or "spiritual support" (50% need to talk to someone who had the same experience as them).

CONCLUSIONS

Common methods of explaining diagnosis, treatment, and prognosis have proven unsatisfactory to patients and most also require more psychosocial support. This highlights the need to implement interventions and activities that are increasingly geared toward supporting the psychological and relational aspects of the care journey.

[Patient concerns and palliative psychology interventions within an inpatient palliative care service]

BACKGROUND

Multi-professional inpatient palliative care services are increasingly complementing palliative care in hospitals alongside palliative care units. The present study aims to investigate the nature and frequency of patient concerns and palliative psychological interventions in the context of palliative psychological work, as well as the perceived quality of outcomes in an inpatient palliative service.

METHODS

Palliative psychological interventions for terminally ill patients at the inpatient palliative care service at Leipzig University Hospital were investigated in a prospective follow-up evaluation study. Psychological distress (distress thermometer) as well as the perceived quality of the results of the palliative psychological support (from the therapist`s perspective) were recorded. Patient concerns and psychological conversation topics and interventions were recorded. Descriptive and regression analytic procedures were used.

RESULTS

Over a year, 355 patients in the inpatient palliative care service received psychological support, 304 participated in the study (mean age 63.8 years, 55% male, 89% oncological disease). An average of 3 palliative psychological interviews were conducted; 64% of patients reported high psychological distress (M=6.5). The most common patient concerns and topics within the interviews were dealing with emotions (87%), resources (83%), conflicting care and autonomy issues (77%) and hope (76%); significantly less common were spiritual concerns (2%) or the patient's legacy (9%). The most frequently used palliative psychological interventions included: support in illness processing and acceptance (74%) or in emotional-relieving interventions (98%) as in normalisation (75%), active listening (97%) or emotional containment (95%). Regression analysis showed that an oncological (vs. non-oncological) disease, a high number of palliative psychological interviews and interventions, comprehensive information regarding the palliative dimension of the diagnosis as well as undisturbed contact in the initial interview had a positive effect on the perceived outcome quality.

CONCLUSION

The study results show that palliative psychologists play an important role in inpatient palliative care teams and should be involved as early as possible in the course of the disease. There is a need for improvement, especially in the palliative psychological care of non-oncological patients.

Examining patient-reported late toxicity and its association with quality of life and unmet need for symptom management among nasopharyngeal cancer survivors: a cross-sectional survey

Introduction

Alongside the improved survival of nasopharyngeal cancer (NPC), late radiation toxicities are alarmingly hampering survivors' quality of life. A patient-reported symptom burden survey is lacking to address the unmet need for symptom management among local NPC survivors.

Methods

A single-center cross-sectional survey was conducted on 211 NPC survivors who had completed radiation therapy for three to 120 months. We employed the Chinese version M. D. Anderson Symptom Inventory - Head & Neck Module (MDASI-HN-C), Functional Assessment of Cancer Therapy - Head & Neck (FACT-HN-C), and a question extracted from the Cancer Survivors' Unmet Needs Measure (CaSUN).

Results

Two hundred valid responses were collected. Participants suffered from at least four moderate to severe symptoms (mean = 4.84, SD = 4.99). The top five severe symptoms were dry mouth, mucus problems, difficulty swallowing or chewing, teeth or gum problems, and memory problems. MDASI-HN-C subscales were negatively correlated with the physical, emotional, functional, and HN-specific domains of the FACT-HN-C. The unmet need for symptom management was positively associated with symptom burden, either general symptoms (Adjusted odds ratio [ORadj] = 1.566, 95% CI = 1.282 - 1.914, p < 0.001) or top-5 symptoms (ORadj = 1.379, 95% CI = 1.185 - 1.604, p < 0.001), while negatively associated with post-RT time (ORadj = 0.981, 95% CI [0.972, 0.991], p < 0.001).

Conclusion

Virtually all NPC survivors suffer from late toxicities, which interplay with survivors' perceptions intricately to affect their unmet needs for symptom management. Personalized supportive care strategies with regular assessments and stratifications are warranted.

Validation of the Standardized Needs Evaluation Questionnaire in Polish Cancer Patients

BACKGROUND

Cancer influences various aspects of patients' functioning. Cancer patients face not only medical problems but also organizational, socio-psychological, and spiritual problems. Their needs often seem to be unrecognized because patients do not express their concerns and clinicians do not ask appropriate questions. Unmet needs impact patients' quality of life. The aim of this study was to select, adapt, validate, and introduce a simple instrument for estimating cancer patients' unmet needs in Poland.

METHODS

The Needs Evaluation Questionnaire (NEQ) was chosen for validation in a Polish population. The Polish version of the NEQ was developed with a back-translation procedure, as approved by a psycho-oncologist and a public health specialist. The psychometric properties of the NEQ (content analysis, reliability, construct validity, comprehensibility, and acceptability) were measured.

RESULTS

This study was performed on a group of 121 cancer patients. The median time of completion for the NEQ was 10 min. The form, length, and font size of the NEQ were accepted by the respondents. Overall, the meaning of the questions was well understood, with only a few cases of discreetly heterogeneous interpretation of the content. The questionnaire showed good reliability and internal factor structure validity.

CONCLUSION

The NEQ is a simple, easy-to-administer instrument with good psychometric properties and seems to be useful in assessing the unexpressed needs of cancer patients.

Group-based trajectory modeling for fear of cancer recurrence in cancer survivors: a systematic review

PURPOSE

We aimed to systematically review studies that used a group-based trajectory modeling approach to explore the categories of fear of cancer recurrence (FCR) trajectories and their predictors in cancer survivors.

METHODS

MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science were searched. Three authors independently reviewed the literature for predefined eligibility criteria. The Joanna Briggs Institute critical appraisal tools for Cohort Studies and the Guidelines for Reporting on Latent Trajectory Studies were used to assess the quality of included studies. A qualitative synthesis of the included studies was performed.

RESULTS

Ninety-eight studies were retrieved after removing duplicates, and 11 studies met the criteria for inclusion. There are four types of FCR trajectories: stable, decreasing, increasing, and stable-then-decreasing-then-increasing. The following factors were considered significant predictors of FCR trajectory category in at least one of the included studies: age, race, income, education, employment, cancer stage, physical symptoms, depression, anxiety, satisfaction with medical care, and selected cognitive and behavioral factors.

CONCLUSIONS

There was considerable heterogeneity among the studies included in study design and FCR trajectory results. Factors that significantly predicted FCR trajectory categories mostly focused on psychological characteristics. The correlation of sociodemographic and disease-related predictors with FCR trajectory categories was not consistent among the included studies.

IMPLICATIONS FOR CANCER SURVIVORS

We suggest that future scholars should incorporate more psychological factors when identifying cancer survivors who persistently maintain a high level of FCR and developing FCR mitigation measures.

Understanding quality of life's challenges in sarcoma patients: A mixed-methods study

PURPOSE

Sarcoma, a highly aggressive form of cancer, profoundly affects patients both physically and psychologically. This study aimed to assess sarcoma patients' health-related quality of life and explore their experiences of living with the disease and their specific care requirements.

METHODS

This research employed a convergent parallel mixed-methods design. Fifty-two sarcoma patients completed the European Portuguese version of the EORTC QLQ-C30 questionnaire, and seven of them participated in semi-structured interviews. Descriptive measures, Cronbach alpha for internal consistency, t-teste-Anova and stepwise regression were employed in the quantitative analysis. Qualitative data was analysed thematically.

RESULTS

The most affected Quality of life (QoL) dimensions were role functioning and global health, areas of functioning that were also described as impacted in patients' experiences. Symptoms like insomnia, pain, and fatigue were frequently reported. Symptoms such as fatigue, pain, and financial difficulty explain QoL variance. No significant differences in QoL were found according to the different forms of treatment. Analysis of the interviews revealed three overarching themes: (1) disruption of daily life, (2) adaptation to life with sarcoma, and (3) the demand for more personalized care, allowing to gain a deeper understanding of living with sarcoma.

CONCLUSION

The results underscore the significance of delivering care that enhances the quality of life for sarcoma patients, addressing both their physical and psychosocial needs, and providing personalized support throughout all stages of the disease.

Cancer survivorship in urban people living with cancer following primary treatment: A secondary analysis of qualitative interview data

PURPOSE

Urban cancer survivors have been shown to have better opportunities for recovery of health and wellbeing than their rural counterparts. Whilst there is a considerable body of evidence that explores urban people with cancers' experiences and outcomes, there is a dearth of research that explicitly explores 'urban cancer survivorship' in its own right. This study aimed to explore cancer survivorship in urban people living with cancer who have completed primary treatment.

METHODS

Secondary analysis of in-depth interview data (n = 18) with adults living with cancer who resided in urban parts of the UK. Data were drawn from a broader study on self-management of people living with cancer. An adapted version of Foster and Fenlon's recovery of health and wellbeing in cancer survivorship framework was used to inform the analysis of the data.

RESULTS

Recovery of health and wellbeing was impacted by a variety of contributory factors, which had a largely positive impact. Access to amenities, social support, travel, and healthcare factors were opportunities for urban cancer survivors, whilst pollution, traffic and a lack of green spaces acted as challenges for health management.

CONCLUSION

This study demonstrated how urban residency acted as both a barrier and a facilitator to recovery of health and wellbeing in urban cancer survivors following the completion of primary treatment. Area of residence should be taken into account by health providers and policymakers supporting cancer survivorship and the views of those with lived experiences should be included in informing future practice.

[Implementation of pharmaceutical consultations in digestive oncology in a teaching hospital: one-year outcomes]

INTRODUCTION

The announcement of a cancer diagnosis is traumatic for the patient. In France, an announcement system has been in place, providing medical time for announcement and treatment proposal, nursing time for support, without including the pharmacist. In order to improve management of patients treated with intravenous anticancer drugs, we set up introductory pharmaceutical consultations in digestive oncology. The aims were to assess the situation one year after the introduction of these consultations, and to assess their contribution.

METHODS

When a patient was diagnosed with digestive cancer and receiving intravenous treatment, a pharmaceutical initiation consultation was scheduled. Indicators of activity (number of consultations, average duration, average preparation time and various delays) and results (number and type of pharmaceutical interventions, patient satisfaction) were collected in order to assess activity.

RESULTS

Forty-seven pharmaceutical initiation consultations were carried out. The average duration of the consultations was 39.3minutes. Consultations were carried out on average 12.1 days after the medical consultation and 9.6 days before the first chemotherapy treatment. Twenty-nine patients responded to the satisfaction questionnaire. All were satisfied, and the majority of patients said they had improved their knowledge of cancer treatment.

DISCUSSION

This activity enables us to review with patients essential aspects of their care, such as implanting an implantable chamber catheter, anti-cancer treatment and managing potential side effects and improve their self-care skills.

Inclusion of Social Work in Comprehensive Palliative Care to Address Psychosocial Needs of Advanced Cancer Patients in Vietnam

The need for psychosocial care among patients with serious illnesses and available social work services continues to be great, especially in low- and middle-income countries. To evaluate the specific needs of Vietnamese cancer patients' quality of life (QOL), prevalence and severity of symptoms including depression and anxiety, and caregiver burden were assessed. Data on QOL, mood, caregiver burden, and other parameters were collected through face-to-face and phone- interviews. The QOL assessed by European Quality of Life scale version 5D (EQ5D) was poor but consistent with other studies of cancer patients. Assessed by the Hospital Anxiety and depression Scale (HADS), borderline or severe anxiety and depression were prevalent. Caregiver burden was high for one third of study participants. These results confirm the need among cancer patients for psycho-social support services that currently are rarely available in Vietnam. In light of this need, a comprehensive palliative care (CPC) service, including social work, was created to improve the quality of life (QOL) of Vietnamese cancer patients.

The Relationship Between Cancer Patients' Supportive Care Needs and Their Attitudes Toward Complementary and Alternative Medicine

BACKGROUND

Cancer patients have high supportive care needs related to the nature of the disease and treatment methods. To meet these needs or reduce symptoms, patients can be expected to resort to alternative treatment methods.

AIM

To examine the relationship between the supportive care needs of cancer patients and their attitudes toward complementary and alternative medicine (CAM).

METHODS

This was a cross-sectional study involving 289 cancer patients at the Oncology Hospital in east of Turkey. Short-Form Supportive Care Needs Survey Questionnaire (SCNS-SF 29) and Holistic Complementary and Alternative Medicine Questionnaire (HCAMQ) were standard instruments used for data collection. The association between supportive care needs and attitude toward CAM was determined.

RESULTS

The mean age of the study participants was 56.7 ± 12.7 years. There were 180 females (62.3%) and 109 males (37.7%). The mean score of the SCNS-SF 29 of the study participant was 101.19 ± 33.97. It was found that the patients' psychological needs were the highest, followed by health services and information, daily life, and sexuality needs, respectively. The mean score of the HCAMQ was 27.16 ± 9.54. There was a weak, significant negative correlation between HCAM and psychological supportive care needs (r: -0.240, P: 0.003). However, there was no significant relationship between needs related to health services information, daily life sexuality, and attitudes toward CAM.

CONCLUSIONS

Cancer patients have high supportive care requirements. Those with high psychological needs have a positive attitude toward HCAM. Incorporation of HCAM in the care of cancer patients may improve their quality of care.

Is There a Difference in Unmet Supportive Care Needs Between Older and Younger Outpatients Receiving Chemotherapy?

Objective: This study investigated whether there was a difference in unmet supportive care needs between older and younger cancer patients who receive chemotherapy. Background: Physiological, physical, cognitive, and social functions, which play a key role in coping with cancer, are impaired due to aging. Age-related physiological changes and psychosocial factors and comorbid medical conditions make some of the needs of older cancer patients unique and complex. At the heart of meeting these needs lies the concept of supportive care. First step of meeting their needs is to determine these needs. Study Design and Methods: The study was conducted in the Daytime Treatment Unit of the oncology hospital of a university in Ankara, Turkey. The study sample consisted of 93 patients aged 65 years or older and 93 patients under 65 years of age. Both groups were similar in terms of sex, cancer type, and chemotherapy protocols. Data were collected using a Patient Information Form and Supportive Care Needs Scale-Short Turkish Version and analyzed using descriptive statistics, Mann-Whitney U test, Kruskal-Wallis H test, and Bonferroni correction. Results: Participants had a median total score of 1.92. Their "daily life needs" and "sexuality needs" subscale scores were highest and lowest, respectively. Older patients had lower median total scores than younger patients. Younger patients had higher median "health care and information needs" and "sexuality needs" subscale scores than older patients. Conclusion: Elderly patients reported fewer unmet needs than younger patients. This may be due to age-related cultural factors as they may have difficulty expressing their needs. Implications: Results suggest to focus on the fact that patients' needs change with age and that they have difficulty expressing their needs.

Self-care advice for patients after surgery for oesophageal cancer - a mixed-methods systematic review

PURPOSE

The aim of the literature review was to identify and synthesise research on self-care advice for oesophageal cancer survivors.

METHODS

A mixed-methods systematic review and synthesis of existing literature on the topic. Five databases were searched for studies providing information on self-care advice for survivorship after oesophageal cancer surgery, in English, with no time filter. The Critical Appraisal Skills Program was used to assess the risk of bias. Data were presented by textual descriptions and grouping of data.

RESULTS

Among the 13 studies included in the review, five pieces of self-care advice were identified; reconstructing eating habits, bed-head elevation, health-promoting advice, monitoring symptoms and body functions, and involving family and friends. The self-care advice was experienced to be hard work, but worth the effort. They also provided reassurance and an increased understanding of bodily changes and social consequences of the disease and treatment.

CONCLUSIONS

There are is little evidence-based self-care advice for oesophageal cancer survivors. However, the existing self-care advice was appreciated and contributed to an increased understanding of the situation. Comprehensible and easy-to-follow recommendations should be provided to all oesophageal cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Evidence-based self-care advice helpful for the individual oesophageal cancer survivor may be imperative to cope with the consequences of oesophagectomy after hospital discharge.

Needs of amyloidosis patients and their care providers: design & first results of the AMY-NEEDS research and care program

BACKGROUND

Amyloidosis represents a rare yet heterogeneous multi-system disorder associated with a grave prognosis and an enormous psycho-emotional strain on patients, relatives, and caregivers. We here present the overall study design and first results of AMY-NEEDS, a research program aiming to systematically assess the needs of patients suffering from amyloidosis, their relatives and health care professionals (HCPs), and develop an amyloidosis-specific care approach.

METHODS

AMY-NEEDS uses a mixed-methods approach including focus groups (step 1), a questionnaire-based broad evaluation within the local amyloidosis patient collective (step 2), and the development of a needs-adapted care concept (step 3).

RESULTS

Seven patients, six relatives and five HCPs participated in the focus groups (step 1). At the time of diagnosis, patients expressed the need of a smooth diagnostic process, possibly enhanced through improved awareness and better education of local HCPs. There was a strong wish to receive well-founded information and comprehensive support including companionship during medical visits, experience the feeling of being understood, find trust in that "everything possible" is being done, and have effortless access to centre staff. In the course of the disease, patients favoured that the specialized centre should manage treatment coordination, monitoring and psychosocial support. The interface between centre and local HCPs was regarded of particular importance, requiring further investigation into its optimal design.

CONCLUSIONS

Patients with amyloidosis express particular needs that should appropriately be considered in specifically tailored care concepts.

An Integrative Medicine Educational Program for Radiation Oncology Patients: Patient-Reported Outcomes

Purpose

Complementary health approaches (CHAs) equip patients to self-manage radiation therapy (RT)-related symptoms and fulfill unmet needs, but few disclose CHA use to their radiation oncologist. An integrative medicine educational program (IMEP) was developed to assess its ability to improve patient self-efficacy for symptom management and CHA use disclosure.

Methods and Materials

The IMEP included 4 1-hour sessions covering topics of (1) meditation, (2) yoga, (3) massage therapy, and (4) nutrition. Individuals over age 18 years and actively receiving RT were administered presession and postsession surveys. The primary outcomes were intention to disclose CHA use and self-efficacy. Qualitative data were assessed with a thematic approach.

Results

Overall, 23 patients attended 1 or more sessions, yielding 43 completed surveys. Compared with 35.9% of participants who had disclosed CHA use before the session, 67.4% intended to disclose after the session. Of the 5 self-efficacy statements, there were significant improvements in "I have ownership over my health" (increase of 0.42; 95% CI, 0.07-0.77; P = .01), "I have tools to manage my disease on my own" (1.14; 95% CI, 0.42-1.87; P = .001), and "I have control over my cancer" (0.96; 95% CI, 0.39-1.53; P < .001). Barriers to involvement included transportation, timing relative to RT appointment, and poor performance status.

Conclusions

A radiation-specific IMEP resulted in a high rate of intention to disclose CHA use and improvements in patients' reported self-efficacy to manage radiation-related symptoms. However, substantial resources were needed to deliver the IMEP. Future work must focus on increasing accessibility through telehealth and flexible timing.

A prospective evaluation of quality of life, psychosocial distress, and functional outcomes two years after radical cystectomy and urinary diversion in 842 German bladder cancer patients

PURPOSE

This study aims to evaluate survival, health-related quality of life (HRQoL), psychosocial distress, and functional outcomes after radical cystectomy (RC) and urinary diversion for ileal neobladder (INB) or ileal conduit (IC) in a contemporary German cohort of bladder cancer patients.

METHODS

Patients undergoing inpatient rehabilitation after RC between April 2018 and December 2019 in one high-volume rehabilitation center were surveyed regarding HRQoL, psychosocial distress, and functional outcomes until two years after RC.

RESULTS

Eight-hundred forty-two patients (683 male, 159 female; 395 INB, 447 IC) were included. Patients with an IC suffered more often from locally advanced disease (≥ pT3; 41.4% vs. 24.1%, p < 0.001) and lymph node metastases (19.9% vs. 11.8%, p = 0.002), resulting in worse probability of survival (p < 0.001). Global HRQoL improved steadily during follow-up, but significant differences in subscales persisted between cohorts. Multivariable regression analysis identified IC, male sex, and patient age ≤ 59 years as independent predictors for persistent high psychosocial distress. Almost 42% of female patients reported severe urinary incontinence two years after RC. Most men reported severely diminished erectile function, even after nerve-sparing surgery.

CONCLUSION

Global HRQoL two years after RC is comparable to the general German population. Female patients should be informed about worse continence rates. Conversely, men should be educated about erectile dysfunction. Aftercare should include psycho-oncologic counseling, especially for patients at risk.

IMPLICATIONS FOR CANCER SURVIVORS

Patients should be counseled on long-term functional outcomes and persistent psychosocial distress after RC. Closer cooperation between urologists and psycho-oncologists is needed.

The Perspective of Cancer Patients in Palliative Care on Unmet Needs: A Qualitative Synthesis Using Meta-Ethnography

BACKGROUND

As cancer patients approach the end of life, their needs become more complex, increasing the demand for palliative care. Advanced-stage cancer patients encounter increasing unmet psychological, physical, autonomy, and communication needs, reflecting the difference between patients' perceived requirements and the support from health care professionals. The objective of this study was to synthesize qualitative evidence on unmet needs in palliative cancer care among inpatient and outpatient adults.

METHODS

We conducted a meta-ethnographic review according to Noblit and Hare's framework and the operationalized guidelines developed by Sattar. The eMERGe Reporting Guidance was followed. A literature search was conducted in Cinahl, Embase, Medline, Scopus, Web of Science, PsycINFO and Google Scholar for gray literature. For all the studies, direct quotes from the participants and authors' results were identified, coded and analyzed in NVivo 1.7.1 and extracted as I and II order constructs from which higher third-order themes originated.

RESULTS

Eight studies were included. Four new themes emerged, representing areas where palliative cancer care patients expressed a need for help: the need for comprehensive, patient-centered care, the need for maintaining a sense of autonomy and dignity, the need for attentive support to patients' soul and the need for accessible and timely care.

CONCLUSIONS

Palliative care patients require a secure, suffering-free end-of-life journey with informed decision-making and team support. Ensuring continuity of care, validating their suffering, and allocating sufficient time are crucial aspects of care. This involves maintaining a consistent care plan, respecting patients' emotions and experiences, and providing services tailored to individual needs.

Availability of cancer survivorship support services across the National Cancer Institute Community Oncology Research Program network

BACKGROUND

National cancer organizations recommend provision of nutrition, physical activity, and mental health supportive services to cancer survivors. However, the availability of these services across diverse community oncology settings remains unclear.

METHODS

The National Cancer Institute Community Oncology Research Program (NCORP) is a national network of community oncology practices engaged in cancer research. The 2022 NCORP Landscape Assessment (5UG1CA189824) assessed individual practices' establishment of survivorship clinics and nutrition, physical activity, and mental health services, resources, and/or referrals. Descriptive statistics summarized and logistic regression quantified the association between services, practice, and patient characteristics.

RESULTS

Of 46 NCORP community sites, 45 (98%) responded to the survey, representing 259 adult practice groups. A total of 41% had a survivorship clinic; 96% offered mental health, 94% nutrition, and 53% physical activity services, resources, and/or referrals. All 3 services were offered in various formats (eg, in-house, referrals, education) by 51% and in-house only by 25% of practices. Practices with advanced practice providers were more likely to have a survivorship clinic (odds ratio [OR] = 3.19, 95% confidence interval [CI] = 1.04 to 9.76). Practices with at least 30% Medicare patients (OR = 2.54, 95% CI = 1.39 to 4.66) and more oncology providers (OR = 1.02, 95% CI = 1.01 to 1.04) were more likely to have all 3 services in any format. Practices with at least 30% Medicare patients (OR = 3.41, 95% CI = 1.50 to 7.77) and a survivorship clinic (OR = 2.84, 95% CI = 1.57 to 5.14) were more likely to have all 3 services in-house.

CONCLUSIONS

Larger oncology practices and those caring for more survivors on Medicare provided more supportive services, resources, and/or referrals. Smaller practices and those without survivorship clinics may need strategies to address potential gaps in supportive services.

Supportive care needs in predicting the acceptance of illness among gynecological cancer patients undergoing therapy: a cross-sectional study

PURPOSE

This study aimed to examine the effect of supportive care needs and related factors in the acceptance of illness by gynecological cancer patients undergoing therapy.

METHODS

A cross-sectional design was adopted. The study included 190 gynecologic cancer patients by convenience sampling method. The personal information form, Acceptance of Illness Scale, and Supportive Care Needs a Survey-Short Form were used for data collection. ANOVA, t-test, Pearson's correlation test, and hierarchical regression analysis were used for analyzing the data.

RESULTS

Most participants (72.6%) had moderate acceptance of illness, and the Supportive Care Needs a Survey-Short Form total score was a moderate level, at 84.93 ± 18.86. All the patients stated that their need for supportive care had caused them much concern, thus needing additional help. The acceptance of illness was negatively related to unmet supportive care needs (r =-0.515, p = 0.001) and all its subscales [health care service and informing, psychology, sexuality, daily life, (r = -0.343, r = -0.447, r = -0.341, r = -0.408, respectively; p < 0.05)]. Hierarchical regression analyses indicated unmet psychology (β = -0.305), daily life (β = -0.205) and sexuality needs (β = -0.167), perceived income (β = 0.290), and occupation (β = -0.167), explaining 45% of the acceptance of illness.

CONCLUSIONS

Acceptance of illness of gynecological cancer patients undergoing therapy needs to be improved. Perceived income and occupation are positive predictors, and unmet psychology, daily life, and sexuality needs are negative predictors of acceptance of illness.

Silent suffering: the impact of sexual health challenges on patient-clinician communication and adherence to adjuvant endocrine therapy among Black women with early-stage breast cancer

PURPOSE

Adjuvant endocrine therapy (AET) increases sexual health challenges for women with early-stage breast cancer. Black women are more likely than women of other racial/ethnic groups to report adverse symptoms and least likely to initiate and maintain AET. Little is known about how sexual health challenges influence patient-clinician communication and treatment adherence. This study explores facilitators of and barriers to patient-clinician communication about sexual health and how those factors might affect AET adherence among Black women with early-stage breast cancer.

METHODS

We conducted 32 semi-structured, in-depth interviews among Black women with early-stage breast cancer in the U.S. Mid-South region. Participants completed an online questionnaire prior to interviews. Data were analyzed using thematic analysis.

RESULTS

Participants' median age was 59 (range 40-78 years, SD = 9.0). Adverse sexual symptoms hindered participants' AET adherence. Facilitators of patient-clinician communication about sexual health included female clinicians and peer support. Barriers included perceptions of male oncologists' disinterest in Black women's sexual health, perceptions of male oncologists' biased beliefs about sexual activity among older Black women, cultural norms of sexual silence among Southern Black women, and medical mistrust.

CONCLUSIONS

Adverse sexual symptoms and poor patient-clinician communication about sexual health contribute to lower AET adherence among Black women with early-stage breast cancer. New interventions using peer support models and female clinicians trained to discuss sexual health could ameliorate communication barriers and improve treatment adherence.

IMPLICATIONS FOR CANCER SURVIVORS

Black women with early-stage breast cancer in the U.S. Mid-South may require additional resources to address sociocultural and psychosocial implications of cancer survivorship to enable candid discussions with oncologists.

Chronic myeloid leukaemia: A qualitative interview study exploring disease impact from patient and practitioner perspectives

PURPOSE

Improvements in chronic myeloid leukaemia treatment mean it is now relevant to examine the experiences of living with this cancer over a lifetime. This qualitative study aimed to investigate the impact of chronic myeloid leukaemia, from patient and healthcare practitioner perspectives.

METHODS

The research was set within the UK's Haematological Malignancy Research Network; a population-based cohort of patients newly diagnosed with blood cancer, treated at one of fourteen hospitals. Purposive sampling led to interviews with seventeen patients and thirteen health care practitioners. Data were analysed using thematic analysis.

RESULTS

Two analytical themes, "Significant impact of disease and treatment" and "Mediators of the impact of disease and treatment", and six sub-themes, were derived from patient interviews and supported with data from practitioners. Chronic myeloid leukaemia was described by patients as having significant widespread impact, which could be mediated by their knowledge, social support, and the quality of healthcare systems. Practitioners reflected patient accounts, but could underestimate the impact of this cancer. They generally viewed chronic myeloid leukaemia as less complex, severe and impactful than acute blood cancers; a message that reassured patients at diagnosis, but could later unintentionally contribute to difficulties discussing side effects and struggles to cope.

CONCLUSION

Chronic myeloid leukaemia may significantly impact individuals, particularly as it is experienced over the lifetime. Greater understanding and discussion of the breadth and extent to which patients are affected, including potential mediators, could enhance clinical care.

Psychological interventions during breast cancer rehabilitation: a randomized controlled trial comparing structured short-term psychotherapy versus non-specific group discussion

PURPOSE

Psycho-oncological treatment is recommended in cancer rehabilitation as it improves fatigue, anxiety, depression, and quality of life in breast cancer patients. The aim of our study was to compare a structured short-term psychotherapy and a non-specific group discussion provided during breast cancer rehabilitation.

METHODS

Breast cancer patients were randomly assigned to structured group short-term psychotherapy or a non-specific group discussion during breast cancer rehabilitation. The patients completed questionnaires at the beginning and end of rehabilitation and three months after rehabilitation. The primary outcome was anxiety. Secondary outcomes were depression, distress, fatigue and health-related quality of life domains.

RESULTS

In total, 160 patients (80 in both groups) were recruited and included in the analysis. There was no significant difference between both groups in the primary outcome anxiety at the end of rehabilitation (difference = -0.2; 95% CI -1.2 to 0.7) and three months after rehabilitation (difference = 0.2; 95% CI -0.9 to 1.3) and in any secondary outcome. Patients in the short-term psychotherapy group with high anxiety levels at baseline reported fewer depressive symptoms at the end of rehabilitation.

CONCLUSIONS

Our study showed no difference between structured short-term psychotherapy and a non-specific group discussion. Patients with high baseline anxiety levels were more likely to benefit from short-term structured psychotherapy. Early identification of this subgroup and symptoms of mental illness should occur after initial treatment in breast cancer patients in order to offer a structured treatment for anxiety and depressive symptoms during rehabilitation.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS00017571; 08/07/2019).

Prevalence of unmet supportive care needs reported by individuals ever diagnosed with cancer in Australia: a systematic review to support service prioritisation

PURPOSE

Improved health outcomes for individuals ever diagnosed with cancer require comprehensive, coordinated care that addresses their supportive care needs. Implementing interventions to address these is confounded by a lack of evidence on population needs and a large pool of potential interventions. This systematic review estimates the point prevalence of different supportive care needs stratified by the tool used to measure needs and cancer type in Australia.

METHODS

We searched MEDLINE, Embase, and Scopus from 2010 to April 2023 to identify relevant studies published on the prevalence of supportive care needs in Australia.

RESULTS

We identified 35 studies that met the inclusion criteria. The highest prevalent unmet need across all cancers was 'fear of cancer spreading' (20.7%) from the Supportive Care Needs Survey Short-Form 34 (SCNS-SF34), ranging from 9.4% for individuals ever diagnosed with haematological cancer to 36.3% for individuals ever diagnosed with gynaecological cancer, and 'concerns about cancer coming back' (17.9%) from the Cancer Survivors' Unmet Needs (CaSUN), ranging from 9.7% for individuals ever diagnosed with prostate cancer to 37.8% for individuals ever diagnosed with breast cancer. Two studies assessed needs in Aboriginal and Torres Strait Islander populations, reporting the highest needs for financial worries (21.1%).

CONCLUSIONS

Point prevalence estimates presented here, combined with estimates of the costs and effects of potential interventions, can be used within economic evaluations to inform evidence-based local service provision to address the supportive care needs of individuals ever diagnosed with cancer.

IMPLICATIONS FOR CANCER SURVIVORS

Local health services can use local evidence to prioritise the implementation of interventions targeted at unmet needs.

A Double Whammy? Psychosocial Disadvantages of Dementia Caregivers with Cancer Histories

Guided by the Diathesis-Stress model, this study examined how cancer history interacted with caregiving status to determine the psychosocial functioning of dementia caregivers. This study assessed a set of indicators for psychological health and social connections among 85 spousal caregivers of persons with Alzheimer's disease and 86 age- and gender-matched spouses of healthy controls at study entry and 15-18 months later. Results showed that dementia caregivers with cancer histories reported lower social connections relative to caregivers without cancer histories or non-caregivers with or without cancer histories, and reported lower psychological health relative to non-caregivers with and without cancer histories at two time points. The findings highlight that a history of cancer is a predisposing vulnerability factor for psychosocial dysfunctions among dementia caregivers and address gaps in knowledge about the psychosocial adjustment of cancer survivors as caregivers.

Types of Social Support That Colorectal Cancer Survivors Need by Treatment Phase: A Text-Mining Analysis

BACKGROUND

Evaluating the needs of colorectal cancer survivors is critical for developing and providing effective supportive services; however, little is known about the specific needs of the survivors.

OBJECTIVES

The aim of this study was to examine the types of social support that colorectal cancer survivors need at each treatment phase.

METHODS

Data were extracted using text-mining analysis from posts on an online self-help group for colorectal cancer survivors in Korea from 2011 to 2020. Classification analysis was performed based on the frequency of terms posted, and word clouds were created.

RESULTS

In the pretreatment phase, support for pain and diagnostic testing were needed. In the treatment phase, needing support for colorectal cancer treatment and managing subsequent adverse events were frequently mentioned. In the posttreatment phase, informational interventions providing information on adjusting to changes in bowel functions and preventing cancer recurrence were needed.

CONCLUSIONS

There were differences in the types of social support and the number of words frequently used across phases of treatment, highlighting the need for phase-specific supportive interventions. The highest identified needs, including colorectal cancer treatment and adverse events in the treatment phase, suggest that colorectal cancer survivors need additional information about treatment within the healthcare system.

IMPLICATIONS FOR PRACTICE

Colorectal cancer survivors have specific needs that vary by their treatment stage. Supportive services that reflect the needs of each treatment phase are needed to improve the physical and mental health and quality of life of colorectal cancer survivors.

Patient and carer experiences of lung cancer referral pathway in a regional health service: a qualitative study

BACKGROUND

Lung cancer referral pathways aim to reduce delays and improve referral patterns of people with suspected lung cancer.

AIM

As part of implementing a lung cancer referral pathway at a regional Australian hospital, this study aimed to explore the experiences and perceptions of people with lung cancer and their carers.

METHODS

In-depth interviews were used to elicit data for thematic analysis in this cross-sectional descriptive qualitative study. Patients with newly diagnosed lung cancer and their carers at a regional academic cancer centre were invited to participate in interviews. Five interviews were conducted face-to-face, and 14 interviews were conducted by telephone (as per interviewee preference). Interviews were audiorecorded, transcribed and qualitatively analysed. Descriptive phrases were used to generate initial inductive codes and themes.

RESULTS

Nineteen participants approached agreed to take part in the study. Factors that positively impacted the care experience were good communication, timeliness and patient advocacy and support. Improper communication, long waiting times for investigations and appointments, uncertainty about the process and inconsistent advice from providers negatively impacted the care experience. Participants preferred face-to-face or video-linked consultations over telephone consultations.

CONCLUSIONS

Understanding the experiences of rural and regional patients and carers with the lung cancer referral pathway is important to improve quality of care. Implementing changes to the referral pathway to improve patient and carer experiences needs to be an ongoing quality improvement exercise.

Is there a need for change in cancer survivorship care? A qualitative exploration of survivor experiences and needs at the Sydney Cancer Survivorship Centre Clinic

PURPOSE

Effective cancer survivorship care is contingent on a comprehensive understanding and management of the dynamic needs of cancer survivors. The Sydney Cancer Survivorship Centre (SCSC) clinic established a holistic, multidisciplinary model of survivorship care. We aimed to explore survivors' experiences and perceptions of the clinic, and to identify their unmet needs.

METHODS

Semi-structured focus groups (FGs) involving participants recruited from the SCSC clinic were conducted by an experienced facilitator and observer using a guide covering: survivor perceptions of first SCSC clinic visit, services accessed, ongoing unmet needs, and how needs changed over time. FGs were audio-recorded and transcribed. Interpretive description using a Framework approach was undertaken and participant characteristics summarised descriptively.

RESULTS

Eight FGs were conducted involving a total of 26 participants (mean age: 60), most were female (n = 20), born in Australia (n = 14), and with breast cancer diagnoses (n = 16). Four overarching themes were identified: (i) perceptions of the SCSC clinic; (ii) patient-centred care; (iii) adjustment to illness; and (iv) external supports and resources. Participants valued the centralisation of multidisciplinary survivorship care at the SCSC clinic, which helped their recovery. Mitigating ongoing treatment sequelae, reassurance of good-health, normalisation of survivorship experiences, and handling caregiver stress represent some needs identified.

CONCLUSIONS

The SCSC clinic offers holistic, specialised care and reassurance to cancer survivors. Adjustment to the survivorship journey, inter-survivor shared experiences, and management of physical treatment sequelae were perceived as important in their recovery. Managing survivor needs is integral to improving long-term survivorship care.

Understanding colorectal cancer patient follow-up: a qualitative interview study

PURPOSE

There are increasing numbers of patients who have been treated for colorectal cancer (CRC) who struggle with ongoing physical and psychological symptoms. 'Cancer survivor' is often used to describe these patients but this terminology remains controversial. This study sought to understand the follow-up experience of CRC patients in the UK and identify the terminology they prefer following diagnosis and treatment.

METHODS

Purposeful sampling of patients from specialist CRC follow-up clinics was performed until data saturation was achieved. Two 1:1 semi-structured qualitative interviews were performed for each participant. Data were analysed thematically.

RESULTS

Seventeen participants, median age = 62, 53% male were interviewed. Several themes were identified. Of note, fear of cancer recurrence dominates patients' agendas at follow-up appointments. There are also clinical and administrative barriers to discussing symptoms including being embarrassed, feeling that their symptoms were not relevant or not having enough time to discuss issues. However, there are several methods which may improve this, such as through the use of video consultations and questionnaires. In addition, patients identified inadequate holistic support despite significant psychological and social distress. Our data suggest that labelling a diverse group of patients as 'cancer survivors' can be problematic.

CONCLUSION

It is important that clinicians systematically screen patients for symptoms that are known to occur following treatment. Clinicians and patients should have routine access to pathways and programmes that can support patients in navigating their life after cancer therapy.

"It Becomes a Family I'm a Part of…We Get to Carry Each Other": Themes from Qualitative Interview of Patients Enrolled in an Inpatient Palliative Care Support Program for Adolescents and Young Adults

Background: The pediatric palliative care literature provides little evidence regarding the lived experiences of adolescents and young adults (AYAs). Objectives: We sought to evaluate the aspects of a palliative care peer support program, which were most helpful to patients, and identify areas for improvement to better address their psychosocial needs. Design: This was a retrospective, cross-sectional study, which described self-reported Streetlight program evaluation using thematic analysis of interviews with AYAs. A total of 10 interviews was completed. Setting/Subjects: Thirty-three current and former Streetlight participants (13-30), enrolled in the Streetlight program for at least six months, were recruited during hospital admissions and clinic visits at UF Health Shands Hospital in the United States. Of the 33, 2 participants died before interviews could be conducted. A total of 10 interviews were conducted. Results: Thematic analysis of the 10 individuals identified 5 themes. They were (1) normalization of life in hospital, (2) mental health and instillation of hope, (3) companionship and connection, (4) diversity of volunteers, and (5) gratitude. Conclusions: Results suggest that AYAs who participated in a peer support, palliative care program benefitted from their exposure to volunteer social support. Addressing the need for continued study of this population provides opportunities to expand peer support, pediatric palliative care programs to other hospitals and care facilities.

Do cancer centres and palliative care wards routinely measure patients' quality of life? An international cross-sectional survey study

PURPOSE

Routinely assessing quality of life (QoL) of patients with cancer is crucial for improving patient-centred cancer care. However, little is known about whether or how cancer centres assess QoL for clinical practice or for research purposes. Therefore, our study aimed to investigate if QoL data is collected and if so, how and for what purposes.

METHOD

We conducted a cross-sectional survey study among 32 cancer centres in Europe and Canada. Centre representatives identified persons who they judged to have sufficient insight into QoL data collections in their wards to complete the survey. Descriptive statistics were used to summarise the information on QoL assessment and documentation.

RESULTS

There were 20 (62.5%) responding cancer centres. In total, 30 questionnaires were completed, of which 13 were completed for cancer wards and 17 for palliative care wards. We found that 23.1% and 38.5% of the cancer wards routinely assessed QoL among inpatients and outpatients with cancer, respectively, whereas, in palliative care wards, 52.9% assessed QoL for outpatients with cancer and 70.6% for the inpatients. Wide variabilities were observed between the cancer centres in how, how often, when and which instruments they used to assess QoL.

CONCLUSION

A sizable proportion of the cancer wards, especially, and palliative care wards apparently does not routinely assess patients' QoL, and we found wide variabilities between the cancer centres in how they do it. To promote routine assessment of patients' QoL, we proposed several actions, such as addressing barriers to implementing patient-reported outcome measures through innovative e-health platforms.

The Perception of Spirituality and Its Assessment among Those with Different Health Statuses in Saudi Arabia

This study compares the perception of spirituality among individuals with different health statuses. It also describes the spiritual services and religious support in the healthcare system that are recommended by the community. A cross-sectional comparative study was conducted in Riyadh during the year 2021. A face-to-face questionnaire was used to obtain data from seriously ill inpatients (N = 132), chronically ill outpatients (N = 202), and healthy individuals (N = 283), which is an assessment tool designed by the investigators to meet the purpose of the study. This study was conducted in two tertiary hospitals and in the community. Participants were randomly selected using a stratified random sampling technique. The study was performed on 635 participants. A significant number of the participants agreed that the provision of spiritual services has a positive effect on patient condition. The rural population had a higher mean value on limiting the concept of spirituality to religious aspects. There is a clear tendency from all categories toward religious services. The majority of the participants support the provision of psychological services, especially if it is provided by specialized and expert spiritual care providers. The positive perception of participants about spiritual care has been reflected on the tendency toward providing spiritual services. The provision of spiritual care in healthcare systems is expected to be a necessity and not a luxury.

Unmet supportive care needs of breast cancer survivors: a systematic scoping review

BACKGROUND

Breast cancer is the most common type of cancer in women worldwide. Though improved treatments and prolonged overall survival, breast cancer survivors (BCSs) persistently suffer from various unmet supportive care needs (USCNs) throughout the disease. This scoping review aims to synthesize current literature regarding USCNs among BCSs.

METHODS

This study followed a scoping review framework. Articles were retrieved from Cochrane Library, PubMed, Embase, Web of Science, and Medline from inception through June 2023, as well as reference lists of relevant literature. Peer-reviewed journal articles were included if USCNs among BCSs were reported. Inclusion/exclusion criteria were adopted to screen articles' titles and abstracts as well as to entirely assess any potentially pertinent records by two independent researchers. Methodological quality was independently appraised following Joanna Briggs Institute (JBI) critical appraisal tools. Content analytic approach and meta-analysis were performed for qualitative and quantitative studies respectively. Results were reported according to the PRISMA extension for scoping reviews.

RESULTS

A total of 10,574 records were retrieved and 77 studies were included finally. The overall risk of bias was low to moderate. The self-made questionnaire was the most used instrument, followed by The Short-form Supportive Care Needs Survey questionnaire (SCNS-SF34). A total of 16 domains of USCNs were finally identified. Social support (74%), daily activity (54%), sexual/intimacy (52%), fear of cancer recurrence/ spreading (50%), and information support (45%) were the top unmet supportive care needs. Information needs and psychological/emotional needs appeared most frequently. The USCNs was found to be significantly associated with demographic factors, disease factors, and psychological factors.

CONCLUSION

BCSs are experiencing a large number of USCNs in fearing of cancer recurrence, daily activity, sexual/intimacy, psychology and information, with proportions ranging from 45% to 74%. Substantial heterogeneity in study populations and assessment tools was observed. There is a need for further research to identify a standard evaluation tool targeted to USCNs on BCSs. Effective interventions based on guidelines should be formulated and conducted to decrease USCNs among BCSs in the future.

Living with prostate cancer: a mixed-method evaluation of group therapy intervention to alleviate psychological distress in a Canadian setting

PURPOSE

To assess the effects of group therapy focused on the experience of living with prostate cancer (PC) on depression and mental well-being among men with the disease and to explore participant experiences of a guided opportunity to 'speak the unspeakable' as it pertains to living with PC.

METHODS

We used a mixed-method convergent design. Participants completed four validated self-report questionnaires at baseline, immediately after the final session, and at three, six, and 12 months follow-up. A repeated measures mixed-effect model examined the effects of the program on depression, mental well-being, and masculinity. Seven focus groups (n = 37) and 39 semi-structured individual interviews explored participant reactions at follow-up.

RESULTS

Thirty-nine (93%) participants completed the questionnaires at all follow-ups. Responses indicated improved mental well-being up to three months (p < 0.01) and a decrease in depressive symptoms to 12 months (p < 0.05). Qualitative analysis revealed how the cohesive group environment alleviated psychological stress, enabled participants to identify significant issues and concerns in their lives, and improved communication and relationship skills that were of value in the group as well as with family and friends. The facilitation was essential to guiding participants to 'speak the unspeakable.'

CONCLUSION

Men with PC who speak of their experience in a group setting with a guided process incorporating features of a life review appear to gain insight into the impact of PC in their lives, experience diminished features of depression and isolation, and enhance their communication skills within the groups as well as with family members and friends.

Supportive Care Needs Trajectories in Patients With Advanced Non-Small-Cell Lung Cancer Receiving Chemotherapy: A Longitudinal Study

BACKGROUND

The supportive care needs trajectories in patients with advanced non-small-cell lung cancer (NSCLC) during chemotherapy and the related factors have yet to be explored or addressed in the literature.

PURPOSE

This study was designed to investigate supportive care needs trajectories in patients with advanced NSCLC receiving chemotherapy and the association between the sociodemographic and disease characteristics of these patients over the four cycles of chemotherapy.

METHODS

For this longitudinal study, 95 patients with advanced NSCLC were recruited using convenience sampling at a medical center in Taiwan. The supportive care needs of the participants were assessed in each of the four chemotherapy cycles using the Needs Evaluation Questionnaire-Chinese version (NEQ-C) with 23 dichotomous items on the day before and the seventh day after the end of each cycle. Group-based trajectory modeling was applied to identify the classes of supportive care needs trajectories, whereas chi-square tests were used to examine the factors related to these classes.

RESULTS

Seventy-one participants completed all eight questionnaire sessions across the four cycles. The mean NEQ-C scores for these participants ranged between 14.4 and 14.6. Three classes of supportive care needs trajectories (low, moderate, and high) were identified for the entire NEQ-C and for each domain. Marital status was found to be associated with the classes of trajectories related to supportive care and assistance/care needs, spouse as the primary caregiver was found to be associated with the classes of trajectories related to information needs, and educational level was found to be associated with the classes of trajectories related to psychoemotional support needs.

CONCLUSIONS

The results of this study indicate that marital status and spouse as primary caregiver relate significantly to supportive care needs trajectories in patients with advanced NSCLC during chemotherapy. Healthcare professionals should provide continuous, tailored supportive care interventions that address the needs of patients and their spouses/partners.

Factors Associated With Unmet Supportive Care Needs and Emergency Department Visits and Hospitalizations in Ambulatory Oncology

Importance

Patients with cancer experience multiple supportive care needs (eg, coping and financial counseling) that, if not addressed, may result in poor clinical outcomes. Limited work has assessed the factors associated with unmet needs in large and diverse samples of ambulatory oncology patients.

Objective

To characterize the factors associated with unmet supportive care needs among ambulatory oncology patients and to assess whether such needs were associated with emergency department (ED) visits and hospitalizations.

Design, Setting, and Participants

Between October 1, 2019, and June 30, 2022, cross-sectional retrospective analyses were performed in a large and diverse ambulatory cancer population via My Wellness Check, an electronic health record (EHR)-based supportive care needs and patient-reported outcomes (PROs) screening and referral program.

Main Outcomes and Measures

Demographic characteristics, clinical characteristics, and clinical outcomes were extracted from EHRs. Data on PROs (ie, anxiety, depression, fatigue, pain, and physical function), health-related quality of life (HRQOL), and supportive care needs were also collected. Logistic regressions examined factors associated with unmet needs. Cumulative incidence of ED visits and hospitalizations were assessed by Cox proportional hazards regression models adjusting for covariates.

Results

The 5236 patients in the study had a mean (SD) age of 62.6 (13.1) years and included 2949 women (56.3%), 2506 Hispanic or Latino patients (47.9%), and 4618 White patients (88.2%); 1370 patients (26.2%) indicated Spanish as their preferred language, according to their EHR. A total of 940 patients (18.0%) reported 1 or more unmet needs. Black race (adjusted odds ratio [AOR], 1.97 [95% CI, 1.49-2.60]), Hispanic ethnicity (AOR, 1.31 [95% CI, 1.10-1.55]), 1 to 5 years after diagnosis (AOR, 0.64 [95% CI, 0.54-0.77]), more than 5 years after diagnosis (AOR, 0.60 [95% CI, 0.48-0.76]), anxiety (AOR, 2.25 [95% CI, 1.71-2.95]), depression (AOR, 2.07 [95% CI, 1.58-2.70]), poor physical function (AOR, 1.38 [95% CI, 1.07-1.79]), and low HRQOL scores (AOR, 1.89 [95% CI, 1.50-2.39]) were associated with greater unmet needs. Patients with unmet needs had a significantly higher risk of ED visits (adjusted hazard ratio [AHR], 1.45 [95% CI, 1.20-1.74]) and hospitalizations (AHR, 1.36 [95% CI, 1.13-1.63]) relative to patients without unmet needs.

Conclusions and Relevance

In this cohort study of ambulatory oncology patients, unmet supportive care needs were associated with worse clinical outcomes. Patients from racial and ethnic minority groups and those with greater emotional or physical burden were more likely to have 1 or more unmet needs. Results suggest that addressing unmet supportive care needs may be crucial for improving clinical outcomes, and targeted efforts should focus on specific populations.