Prevalence, predictors, and correlates of supportive care needs among women 3–5 years after a diagnosis of endometrial cancer

Symptoms, distress, finances, social support, resource utilization, and unmet care needs of patients with gynecological cancer

PURPOSE

This study explored the unmet care needs of gynecological cancer patients, including overall and subdomain needs (i.e., physical and daily living needs, psychological and emotional needs, care and support needs, and health-system and information needs), and related factors.

METHODS

In this cross-sectional study, gynecological cancer patients treated at a medical center in northern Taiwan were recruited. Data on demographics, symptoms, distress, finances, social support, resource utilization, and care needs were collected. Spearman's correlation and the Mann-Whitney U test were used for analysis.

RESULTS

This study of 118 cancer patients found that 73% had unmet psychological and emotional needs, followed by 54% with unmet health system and information needs. The most common physical symptoms were insomnia, fatigue, and pain, with 51.7% experiencing moderate or high levels of distress. Overall, the patients received considerable social support, both instrumental and emotional, primarily through medical information booklets (39.0%), cancer information websites (28.8%), and rehabilitative resources (20.3%). Factors associated with unmet care needs included younger age, non-ovarian cancer, symptoms (pain, fatigue, appetite loss, insomnia, dyspnea, nausea, and vomiting), distress, finances, social support, and the use of cancer information websites.

CONCLUSION

Psychological and emotional unmet needs is prevalent among patients with gynecological cancer; psychological support is crucial. Younger patients and those with non-ovarian cancer had more unmet care needs. These needs are linked to severe symptoms, distress, financial difficulties, limited social support, and low use of cancer information websites. Enhancing support for this population through targeted interventions is necessary.

Patient-initiated follow-up in women with early-stage endometrial cancer: A long-term follow-up of the OPAL trial

OBJECTIVE

A long-term follow-up of the OPAL trial to compare the effect of patient-initiated (PIFU) versus hospital-based (HBFU) follow-up on fear of cancer recurrence (FCR), quality of life (QoL) and healthcare use after 34 months of follow-up.

DESIGN

Pragmatic, multicentre randomised trial.

SETTING

Four Danish departments of gynaecology between May 2013 and May 2016.

POPULATION

212 women diagnosed with stage I low-intermediate risk endometrial carcinoma.

METHODS

The control group attended HBFU with regular outpatient visits (i.e., 8) for 3 years after primary treatment. The intervention group underwent PIFU with no prescheduled visits but with instructions about alarm symptoms and options of self-referral.

MAIN OUTCOME MEASURES

The endpoints were FCR as measured by the Fear of Cancer Recurrence Inventory (FCRI) and QoL as measured by the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire C-30 (EORTC QLQ C-30), and healthcare use as measured by questionnaires and chart reviews after 34 months of follow-up.

RESULTS

FCR decreased from baseline to 34 months in both groups and no difference was found between allocations (difference -6.31 [95% confidence interval -14.24 to 1.63]). QoL remained stable with no difference in any domains between the two arms at 34 months using a linear mixed model analysis. The use of healthcare was significantly lower in the PIFU group (P < 0.01).

CONCLUSION

Patient-initiated follow-up is a valid alternative to hospital-based follow-up for people who have been treated for endometrial cancer and have low risk of recurrence.

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.

Changes in unmet care needs, social support and distress from initial diagnosis to post-surgery in patients with gynecological cancer: A longitudinal study

PURPOSE

This study aimed to explore the changes in unmet care needs, perceived social support, and levels of distress experienced by newly diagnosed Greek patients with gynecological cancer during the phase after diagnosis and before surgical treatment (T0), and 4 months after surgical treatment at the first postoperative follow-up visit (T1).

METHODS

This was a prospective, longitudinal, descriptive study based on the framework of stress and coping theory. The Needs Evaluation Questionnaire, Depression, Anxiety and Stress Scale (DASS-21), Multidimensional Scale of Perceived Social Support (MSPSS), and a demographic and clinical data questionnaire were distributed to a convenience sample of 86 patients.

RESULTS

A convenience sample of 86 patients newly diagnoised with gynecological cancer participated in the study. The mean age of the participants was 60.7 years (SD = 10.9 years) while 57.6% of them were married. Overall, patients' needs and social support had significantly decreased at T1 compared to T0 (p = 0.005 and p = 0.029, respectively). DASS-21 subscale scores did not change significantly at T1, whereas anxiety levels were significantly lower at follow-up (p = 0.048). Changes in anxiety levels were associated with changes in needs related to family (p < 0.001), need for assistance/care (p = 0.013) and support (p = 0.004), and total needs (p = 0.004).

CONCLUSION

The phase following cancer diagnosis and awaiting surgery is a high-risk period for the mental health of women with gynecological cancer, and one that requires special attention from healthcare professionals. By identifying unmet needs, addressing anxiety and providing appropriate social support, healthcare professional can contribute significantly to improving patients' quality of life throughout their cancer journey.

Psychometric properties of the Slovenian version of the Cancer Survivors’ Unmet Needs (CaSUN-SL) measure in post-treatment cancer survivors

Background

As the number of cancer survivors is growing, valid instruments for assessing cancer survivors' needs are required. Thus, the aim of this study was to translate and validate the Cancer Survivors Unmet Needs (CaSUN) scale.

Methods

Cancer survivors were recruited from 30 family medicine practices and separated into two samples (sample 1, n = 147; sample 2, n = 148). Factor structure was explored with an exploratory analysis in sample 1 and determined with a confirmatory analysis in sample 2. Psychometric properties were assessed with internal consistency, test–retest reliability and construct validity.

Results

A translation and cultural adaptation of the CaSUN scale resulted in 34 items being included in the final version. The factor structure confirmed the five-factors solution of the CaSUN-SL. Cronbach’s alpha was 0.94 for the CaSUN-SL and ranged from 0.71–0.88 for specific domains. Test–retest reliability showed moderate-high stability over time. The CaSUN-SL significantly and positively correlated with anxiety (r = 0.49), depression (r = 0.44), health-related quality of life (r = 0.36), and negatively with self-perceived health (r =  − 0.36) and resilience (r =  − 0.47), which confirms the construct validity. In addition, we found a significant correlation between unmet needs and age (r =  − 0.29), gender (r = 0.14), cancer stage (r = 0.20), cancer type (r = 0.19), and time since treatment (r =  − 0.20).

Conclusions

Results indicate that CaSUN-SL is a valid and reliable measure to assess the Slovenian cancer survivors’ unmet, met and total needs and can be used for further prospective studies.

Trial Registration: No. 0120-25/2019/6.

Factors associated with a high level of unmet needs and their prevalence in the breast cancer survivors 1-5 years after post local treatment and (neo)adjuvant chemotherapy during the COVID-19: A cross-sectional study

Objective

To assess the prevalence of unmet needs in post-treatment breast cancer survivors and identify sociodemographic, clinical, and psychosocial variables associated with reported unmet needs during the COVID-19 pandemic.

Materials and methods

In this cross-sectional study, 430 post-treatment breast cancer survivors, ranging between 1 and 5 years after the procedure, completed the Cancer Survivors' Unmet Needs (CaSUN) questionnaire from September 2021 and January 2022. The multivariate logistic analysis identified factors associated with at least one reported unmet need in the total CaSUN scale and specific domains.

Results

A total of 67% of survivors reported at least one unmet need. The most frequently reported unmet needs were the lack of accessible hospital parking (43%) and recurrence concerns (39.5%). The majority of reported unmet needs relate to comprehensive care (44%), followed by the psychological and emotional support domain (35.3%). Younger age (OR = 0.95, 95% CI = 0.92-0.99; p < 0.001), three or more comorbidities (OR = 0.27, 95% CI = 0.11-0.71, p < 0.01), a lower quality of life (OR = 0.06, 95% CI = 0.01-0.47, p < 0.01) and low resilience (OR = 0.95, 95% CI = 0.93-0.99) were associated with a high level of unmet needs in the multivariate regression model. Results are presented for factors associated with a high level of unmet needs for comprehensive cancer care and psychological and emotional support domain.

Conclusion

A high prevalence found in our study could be attributed to the COVID-19 pandemic, where patients may have missed adequate follow-up care, although comparing to studies done in non-pandemic time is difficult. Family physicians should be more attentive toward younger cancer survivors and those with more comorbidities as both characteristics can be easily recognized in the family practice.

The needs of gynecological cancer survivors at the end of primary treatment: A scoping review and proposed model to guide clinical discussions

OBJECTIVE

Gynecological cancer (GC) survivors have unmet needs when they complete primary cancer treatment. Despite this, no known research has summarized these needs and survivors' suggestions to address them. We conducted a scoping review to fill these gaps and develop a model useful to guide clinical discussions and/or interventions.

METHODS

English, full length, and accessible primary studies describing the needs of GC survivors were included. No restrictions on date nor country of publication were applied. Two reviewers screened and extracted data, which was verified by a third reviewer.

RESULTS

Seventy-one studies met the inclusion criteria for data extraction. Results were thematically grouped into seven dimensions: physical needs, sexuality-related concerns, altered self-image, psychological wellbeing, social support needs, supporting the return to work, and healthcare challenges and preferences. After consulting with a stakeholder group (a GC survivor, clinicians, and researchers), the dimensions were summarized into a proposed model to guide clinical assessments and/or interventions.

CONCLUSION

Results illuminate the diverse needs of GC survivors as they complete primary cancer treatment and their recommendations for care to meet these needs.

PRACTICE IMPLICATIONS

The resulting model can be used to guide assessments, discussions and/or interventions to optimally prepare GC survivors for transition out of primary cancer treatment.

Weight and weight control behaviors during long-term endometrial cancer survivorship: Results of the Laparoscopic Approach to Cancer of the Endometrium long-term follow-up study

BACKGROUND

Overweight or obesity is common in endometrial cancer (EC). This study aimed to examine sociodemographic, clinical, and psychosocial characteristics associated with being discontent with current weight and use of weight control methods among long-term EC survivors.

METHODS

Women diagnosed with early-stage EC who participated in the Laparoscopic Approach to Cancer of the Endometrium (LACE) trial (n = 516) were invited to complete a long-term follow-up survey at least 4.5 years after treatment. Chi-square test and multivariate logistic regression models adjusted for time since surgery were used to determine factors associated with being discontent with current weight.

RESULTS

On average 9 years after surgery, 190/259 (73%) of participants were currently discontent with their weight, and 146 (56%) had used one or more weight loss methods during the past 12 months. Women who were discontent with their weight were more likely to be younger than 70 years (p < 0.000), and used one or more weight loss methods ever or during the past 12 months (p < 0.000). Among the weight loss methods used, exercise (40.1%), meal reductions (52.7%), or fat/sugar reductions (48.5%) were much more commonly reported than fasting (2.6%) or designated weight loss programs (2.3%).

CONCLUSIONS

Our study provides evidence that the majority of long-term EC survivors in this clinical trial population are discontent with their weight and over half continue to use multiple methods to lose weight each year. These data indicate that health professionals and lifestyle educators need to assess weight issues, and develop a tailored plan to address the specific needs of long-term survivors to assist them become content with their weight after treatment for EC.

Cultural adaptation and validation of the Survivor Unmet Needs Survey Short-Form among cancer patients in China

AIM

Cancer patients have long been found to have multiple types of unmet needs during their survivorship. Composite psychological instruments are essential for measuring the unmet needs of cancer patients. The objective of this study was to evaluate the psychometric properties of the Short-Form Survivor Unmet Needs Survey (SF-SUNS)-Chinese version.

DESIGN

A cross-sectional survey.

METHODS

The Chinese version was developed using the standard Functional Assessment of Chronic Illness Therapy (FACIT) translation methodology and 428 Chinese cancer patients participated in the survey between 2016-2017. Inter-rater reliability, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were calculated.

RESULTS

Confirmatory factor analysis supported the four-factor structure with good model fit. Cronbach's alpha of 0.894 for the overall scale and intra-class correlation coefficients (0.869-0.884) indicated that reliability was satisfactory. The EFA extracted four factors with eigenvalues greater than 1 and these factors explained 50.68% of the total variance. The Chinese version of SF-SUNS was confirmed to have the potential to become a useful and valid instrument. It could contribute to the assessment of unmet needs among Chinese cancer patients with accuracy and with respect to Chinese culture and context. This measurement of unmet needs may help promote cancer management and nursing quality. Clinical nurses and researchers could use the simple assessment tool to target the individual needs of Chinese cancer patients and then provide more personalized care efficiently.

"There should be some kind of checklist for the soul"- A qualitative interview study of support needs after end of treatment for gynecologic cancer in young women

PURPOSE

Young women diagnosed with a gynecologic cancer face the risk of significant physical and mental health problems after end of treatment. Still, there is a lack of knowledge regarding specific support needs in this population, and supportive care services provided to young women with a gynecologic cancer have been reported to be insufficient. The aim of this study was therefore to identify support needs experienced by women diagnosed with a gynecologic cancer before the age of 40.

METHOD

Qualitative semi-structured interviews were conducted with participants (n = 10). Interviews were analyzed using content analysis with an inductive approach.

RESULTS

Eight categories and two themes were identified. The themes described if these needs were related to how women wanted the support to be provided, or to what the support should contain, i.e., 'Form' and 'Content', respectively. The categories related to 'Form' included: Outreach support; Long-term specialized support; Support for the whole family; and Peer-support, whereas categories related to 'Content' included needs for: Support for psychological reactions; Support related to reproduction, sexuality, and family life; Information regarding late effects; and Support tailored to younger women.

CONCLUSION

Women diagnosed with a gynecologic cancer during young adulthood report several specific support needs. The results provide important guidance to clinicians and health care providers by outlining these needs both in terms of form and content.

Long-term quality of life outcomes of women treated for early-stage endometrial cancer

OBJECTIVE

To compare long-term quality of life in women treated for early-stage endometrial cancer with population norms, and to compare quality of life outcomes of patients who had total laparoscopic or total abdominal hysterectomy.

METHODS

Once the last enrolled patient had completed 4.5 years of follow-up after surgery, participants in the Laparoscopic Approach to Cancer of the Endometrium (LACE) clinical trial were asked to complete a self-administered questionnaire. Two instruments-EuroQol 5 Dimension 3-level (EQ-5D-3L) and the Functional Assessment of Cancer Treatment-General Population (FACT-GP)-were used to determine quality of life. The mean computed EQ-5D-3L index scores for LACE participants at different age categories were compared with Australian normative scores; and the FACT-GP scores were compared between patients treated with surgical treatments.

RESULTS

Of 760 women originally enrolled in the LACE trial, 259 (50.2%) of 516 women consented to provide long-term follow-up data at a median of 9 years (range 6-12) after surgery. On the EQ-5D-3L, long-term endometrial cancer survivors reported higher prevalence of anxiety/depression than normative levels across all age groups (55-64 years, 30% vs 14.9%; 65-74 years, 30.1% vs 15.8%; ≥75 years, 25.9% vs 10.7%). For women ≥75 years of age, the prevalence of impairment in mobility (57.6% vs 43.3%) and usual activities (58.8% vs 37.9%) was also higher than for population norms. For the FACT-GP, the physical (effect size: -0.28, p<0.028) and functional (effect size: -0.30, p<0.015) well-being sub-scale favored the total laparoscopic hysterectomy compared with total abdominal hysterectomy recipients.

CONCLUSION

Compared with population-based norms, long-term endometrial cancer survivors reported higher prevalence of anxiety/depression across all age groups, and deficits in mobility and usual activities for women aged ≥75 years. Physical and functional well-being were better among women who were treated with total laparoscopic hysterectomy than among those receiving total abdominal hysterectomy.

Unmet needs from the first diagnosis of cancer until the end of medical treatment: A longitudinal study

OBJECTIVE

This study aimed to examine (1) The courses of Chinese cancer patients' unmet supportive care needs (psychological, physical and daily living, health system and information, patient care and support, and sexual) from the first cancer diagnosis until the end of medical treatment; (2) The predictive role of socio-demographic and medical characteristics (i.e., age, gender, and cancer stage) in the courses of unmet needs; and (3) The associations of courses of unmet needs with courses of depressive and anxiety symptoms.

METHODS

A longitudinal study was performed at Shaanxi Provincial Tumour Hospital in Xi'an, China. A total of 153 heterogeneous cancer patients were assessed after the first diagnosis (T1), at the beginning (T2) and the end (T3) of the receipt of medical treatment. Latent growth curve models were used to examine the research questions.

RESULTS

Psychological needs and health system and information needs showed a decrease over time, whereas physical needs, patient care needs and sexual needs remained stable. Younger and female patients tended to report higher levels of unmet psychological needs at T1 and experienced slower decreases from T1 to T3. Only the courses of unmet psychological needs were associated with the courses of depressive and anxiety symptoms from T1 to T3.

CONCLUSIONS

More attention can be given to young and female cancer patients, as they were more likely to suffer from high unmet psychological needs over the disease trajectory. Future research may focus more on addressing unmet needs reported by Chinese cancer patients.

Gaining insight into the supportive care needs of women experiencing gynaecological cancer: A qualitative study

AIM AND OBJECTIVES

To gain insight into the supportive care needs of Western Australian women experiencing gynaecological cancer.

BACKGROUND

Meeting the supportive care needs of people living with cancer is becoming increasingly important as advances in cancer treatment contribute to growing numbers of survivors. International evidence suggests between 24%-56% of women with gynaecological cancer have unmet supportive care needs and that psychological challenges, information provision and holistic care are priorities. No qualitative investigation has previously explored women's journey of gynaecological cancer within the Australian setting.

DESIGN

A qualitative descriptive design was used.

METHODS

Women treated for gynaecological cancer were recruited from a tertiary public women's hospital in Western Australia. Thematic analysis was conducted on qualitative data collected from 190 women over 12 months through written open-ended survey responses and telephone interviews. The COnsolidated criteria for REporting Qualitative research (COREQ) guided presentation of results.

RESULTS

Analysis yielded five themes and four subthemes: (a) Communication style directs the experience (subthemes: feeling supported; absence of empathy); (b) It's not just about the disease (subthemes: life has changed; holistic care); (c) A desire for information; (d) Drawing upon resilience; and (e) Navigating the system.

DISCUSSION

Exploration of the women's needs leads to the discussion of three concepts. Communication styles, harnessing women's resilience and alternative models of care are evaluated for their capacity to improve care and women's quality of life into survivorship. Recommendations are made for further research and possible interventions that can be translated into the clinical setting.

CONCLUSION

Women with gynaecological cancer described complex often unmet supportive care needs and interactions with the healthcare system. Insight gained directs suggestions for improved service provision.

RELEVANCE TO CLINICAL PRACTICE

Improved patient-centred communication, harnessing resilience as a resource and alternative models of care for follow-up are encouraged as areas of improvement for clinicians and care services.

Unmet supportive care needs of Indonesian gynecological cancer survivors

OBJECTIVE

This study aimed to assess the unmet supportive care needs of gynecological cancer patients in Indonesia.

METHOD

A quantitative descriptive cross-sectional study using survey was used. We recruited 298 gynecological cancer survivors from three hospitals in different provinces in Indonesia, i.e., Soetomo Hospital in East Java; Sardjito Hospital in Yogyakarta; and Dharmais Cancer Hospital in Jakarta. Demographic and clinical characteristic and the Cancer Survivor Unmet Needs (CaSUN) questionnaires were given to measure supportive care needs (i.e. comprehensive care need, existential need, quality of life need, relationship need, and informational need). Descriptive statistics including frequency, percentage, and mean were used to analyze the demographic and clinical characteristics and unmet supportive care needs of participants.

RESULTS

98% of the survivors reported at least one supportive care need. The highest percentage of unmet supportive care need was an informational need (37.8%) followed by comprehensive care need (37.3%), quality of life need (36.1%), existential need (31.5%), and relationship need (23.9%). However, the highest mean of unmet needs was existential survivorship need 6.4 (5.7).

CONCLUSIONS

Gynecological cancer survivors in Indonesia marked various unmet needs. Nurses should identify the supportive care needs of the women diagnosed with gynecological cancer early in cancer trajectory and also at the critical points of cancer care such as after including primary treatment.

Identifying the most prevalent unmet needs of cancer survivors in Australia: A systematic review

Understanding the unmet needs of cancer survivors is crucial to inform health service planning and optimize survivorship care. This systematic review sought to identify the most prevalent unmet needs of cancer survivors in Australia, and to determine personal, disease, and treatment-related variables correlated with unmet needs. Seventeen studies were included in the review. Substantial heterogeneity across the included studies precluded statistical pooling of the data; narrative synthesis and vote counting were used to synthesize results. Unmet needs were ranked by the number of endorsements (n) each item received. The most frequently reported unmet needs of Australian cancer survivors are for help with psychosocial issues, including fear of cancer recurrence (n = 14; 14-42%), uncertainty about the future (n = 9; 12-26%), worry about partners, friends, and families (n = 8; 12-26%), help to reduce stress (n = 8; 12-34%), and sexual changes (n = 7; 11-29%). Survivors also needed more help with physical issues, including fatigue (n = 7; 10-27%) and usual activities (n = 6; 13-27%), and expressed supportive care unmet needs, including for affordable hospital car parking (n = 7; 12-26%), information about available services (n = 7; 11-33%), and peer support (n = 6; 13-26%). Anxiety, depression, and lower overall and physical quality of life were significantly correlated with greater unmet needs, as were younger age and more advanced disease.

Prevalence and risk factors associated with the comprehensive needs of cancer patients in China

Background

The incidence and mortality rates of cancer have been increasing in developing countries, particularly in Asia. Therefore to provide optimal comprehensive care to the cancer patients, the care plan must focus on the comprehensive needs of cancer patients. The purpose of this study was to investigate the comprehensive needs of cancer patients, and explore the associated factors.

Methods

In a cross-sectional questionnaire study, a total of 200 cancer patient-caregiver dyads were selected and interviewed in Mainland China by convenient sampling method. Patients’ comprehensive needs were assessed with Comprehensive Needs Assessment Tool in cancer for Patients (CNAT), including seven domains (Information, Psychological Problems, Health Care Staffs, Physical Symptoms, Hospital Facilities and Services, Social/Religious/Spiritual Support and Practical Support). Both cancer patients and caregivers completed the sociodemographic survey. The mean differences in domain scores for different characteristics groups were compared by one-way ANOVA or non-parametric analyses, and influencing factors defined with multivariate regression analysis.

Results

The cancer patients’ need for Health Care Staffs (78.35 ± 13.08) was the highest among the seven domains, followed by the need for Information (71.18 ± 17.39) and the need for Hospital Facilities and Services (52.65 ± 13.35). The lowest score was the need for Physical Symptoms (35.12 ± 16.68). Patients who were female, with low family monthly income, at their own expense, and with highly educated caregivers had higher score of CNAT. Also sociodemographic characteristics were associated with each domain need of cancer patients.

Conclusion

This study shows that cancer patients experience high levels of needs for health-care staff and information, and the different needs are closely related to their sociological characteristics. The provision of health care can be adapted to meet the different needs of cancer patients of different epidemiological characteristics at different times during the course of treatment.

Prevalence and factors associated with unmet needs in post-treatment cancer survivors: A systematic review

Cancer survivors may experience unmet needs beyond the end of their treatment. This paper aimed to explore the prevalence and most frequently found unmet needs and to identify factors associated with higher levels of total unmet needs and with each domain separately. Five databases were searched using the keywords neoplasms, survivors, needs assessment, health services' needs and demands. The results were presented based on the strength of the evidence (strong, moderate and weak association) and the categorisation of the pooled prevalence of at least one unmet need (high, moderate, low). Twenty-six studies were included in the review. A higher prevalence of at least one reported unmet need was observed in survivors with less time since treatment and in women with breast cancer. The most frequently reported unmet needs were fear of cancer recurrence and requesting up to date information. Strong evidence was found for an association between a higher number of unmet needs and younger age, higher anxiety and poorer quality of life. Future studies on unmet needs should report how unmet needs are associated with each domain separately. This might solve the inconclusive evidence found for the stage of the disease at diagnosis and depression.

Supportive care needs and quality of life in patients with breast and gynecological cancer attending inpatient rehabilitation. A prospective study

BACKGROUND

Among patients with breast or gynecological cancer, supportive care needs are both highly prevalent and enduring. However, little is known about whether meeting patients' needs is accompanied by increased quality of life (QoL). We aimed to explore patients' supportive care needs reported at the beginning of inpatient rehabilitation and examined whether meeting these needs resulted in improved QoL.

MATERIAL AND METHODS

In a multicenter, prospective cohort study with 2 measurement occasions (beginning and end of inpatient rehabilitation), 292 patients with breast and gynecological cancer (mean age 55 years; 71% breast cancer) were enrolled. In 73%, time since diagnosis was longer than 6 months. We obtained self-reports of supportive care needs in 12 domains and measured QoL using the EORTC QLQ-C30 functioning subscales.

RESULTS

At the beginning of inpatient rehabilitation, top-ranking severe supportive care needs concerned coordination of care (48%), medical information (45%), alleviation of physical symptoms (42%) and support with improving health behaviors (36%). At the end of inpatient rehabilitation, all needs assessed declined significantly, although many patients still expressed strong needs in some domains. However, meeting patients' needs was accompanied by improvements in all functioning subscales.

CONCLUSIONS

This is the first study to show that meeting breast and gynecological cancer patients' supportive care needs during inpatient rehabilitation resulted in improved QoL. Given the considerable proportions of patients still reporting unmet needs at the end of their stay, stronger and continuing efforts seem warranted to meet these needs and thus further increase QoL.

The supportive care needs of women experiencing gynaecological cancer: a Western Australian cross-sectional study

Background

Women diagnosed with gynaecological cancer experience supportive care needs that require care provision to reduce the impact on their lives. International evidence suggests supportive care needs of women with gynaecological cancer are not being met and provision of holistic care is a priority area for action. Knowledge on gynaecological cancer supportive care needs is limited, specifically comparison of needs and cancer gynaecological subtype.

Our aim was to identify supportive care needs of Western Australian women experiencing gynaecological cancer, their satisfaction with help and explore associations between participant’s demographic characteristics and identified needs.

Methods

A cross-sectional design incorporating a modified version of the Supportive Care Needs Survey – short form (SCNS-SF34) assessed 37 supportive care needs under five domains in conjunction with demographic data. Three hundred and forty three women with gynaecological cancer attending a tertiary public referral hospital completed the survey over 12 months. Statistical analysis was performed using the R environment for statistical computing. A linear regression model was fitted with factor scores for each domain and demographic characteristics as explanatory variables.

Results

Three hundred and three women (83%) identified at least one moderate or high level supportive care need. The five highest ranked needs were, ‘being informed about your test results as soon as feasible’ (54.8%), ‘fears about cancer spreading’ (53.7%), ‘being treated like a person not just another case’ (51.9%), ‘being informed about cancer which is under control or diminishing (that is, remission)’ (50.7%), and ‘being adequately informed about the benefits and side-effects of treatments before you choose to have them’ (49.9%). Eight of the top ten needs were from the ‘health system and information’ domain. Associations between supportive care items and demographic variables revealed ‘cancer type’, and ‘time since completion of treatment’ had no impact on level of perceived need for any domain.

Conclusions

Western Australian women with gynaecological cancer identified a high level of supportive care needs. The implementation of a supportive care screening tool is recommended to ensure needs are identified and care is patient-centred. Early identification and management of needs may help to reduce the burden on health system resources for managing ongoing needs.

Electronic supplementary material

The online version of this article (10.1186/s12885-018-4812-9) contains supplementary material, which is available to authorized users.

A conversation approach based on shared goal-setting and shared decision-making for nurses in cancer aftercare: A developmental study

PURPOSE

This study aimed to develop and pretest a systematic conversation approach for nurses to tailor aftercare to oncology patient's goals, unmet needs and wishes.

METHODS

We used an iterative developmental process for complex interventions: 1. Identifying problems 2. Identifying overall objectives 3. Designing the intervention 4. Pretesting and adapting the intervention.

RESULTS

The main results of the problem identification were: non-systematic and incomplete screening of potential issues, caveats in providing information, and shared decision-making. The overall objective formulated was: To develop a model for aftercare conversations based on shared goal-setting and decision-making. The conversation approach consists of four phases: 1. Preparation of the consultation including a questionnaire, 2. Shared goal-setting by means of a tool visualizing domains of life, and 3. Shared care planning by means of an overview of possible choices in aftercare, a database with health care professionals and a cancer survivorship care plan. 4.

EVALUATION

The results of the pretest revealed that the conversation approach needs to be flexible and tailored to the patient and practice setting, and embedded in the care processes. The conversation approach was perceived as enhancing patient-centeredness and leading to more in-depth consultations.

CONCLUSION

The conversation approach was developed in co-creation with stakeholders. The results of the pretest revealed important implications and suggestions for implementation in routine care. The aftercare conversation approach can be used by nurses to provide tailored patient-centered evidence-based aftercare. Tailored aftercare should support oncology patient's goals, unmet needs and wishes. Further tailoring is needed.

Psychometric properties of the Dutch extended Cancer Survivors' Unmet Needs measure (CaSUN-NL)

Information and support needs increase emotional distress and can impede cancer survivors’ adjustment. To investigate the information and support needs of Dutch cancer survivors, the Cancer Survivors’ Unmet Needs measure (CaSUN) was translated into Dutch and applied in two Dutch studies with cancer survivors (N = 255; N = 467). The CaSUN‐NL entailed the original five CaSUN scales, extended with respectively a returning to work and lifestyle scale. This study aimed to determine the psychometric properties of the CaSUN‐NL. To assess validity, a maximum likelihood factor analysis was employed. Construct validity was analysed using Pearson's and Spearman's correlation coefficients. To assess reliability, test–retest (Kappa coefficient) and internal consistency (Cronbach's alpha) values were determined. Factor analysis revealed the original five factors. Test–retest reliability was low (r ≤ .15, 93% retest response). Internal consistency values were high (Cronbach's alpha = 0.92–0.94), except for lifestyle. Significant correlations were found between total number of unmet needs with anxiety (r = .55), depression (r = .49), negative adjustment (r = .50), quality of life (r = −.52) and age (r = −.24). The CaSUN‐NL is valid and reliable to investigate the unmet information and support needs of Dutch cancer survivors.

Unmet needs for information and psychosocial support in relation to quality of life and emotional distress: A comparison between gynecological and breast cancer patients

OBJECTIVE

We compared gynecological and breast cancer patients regarding their needs for information and psychosocial support, quality of life (QoL), and emotional distress and the relationship among these constructs.

METHODS

In a multicenter, cross-sectional study in Germany, we evaluated 1214 female cancer patients (317 with gynecological cancer, 897 with breast cancer). We obtained self-reports of unmet needs, using a self-developed measure. We measured QoL with the EORTC QLQ-C30, symptoms of depression with the Patient Health Questionnaire (PHQ-9), and symptoms of anxiety with the Generalized Anxiety Disorder Scale (GAD-7).

RESULTS

Compared to breast cancer patients, gynecological cancer patients felt less informed about several aspects of their disease, particularly regarding psychological support (p<0.001), tended to have more unmet information needs, and reported lower QoL levels. Lower emotional functioning, but higher physical functioning were independent correlates of the level of unmet information needs. Depressive symptoms and higher physical functioning (only in breast cancer) were independent correlates of higher needs for psychosocial support.

CONCLUSION

Compared to breast cancer, gynecological cancer patients were less satisfied with the information received and reported lower levels of QoL.

PRACTICE IMPLICATIONS

Both clinicians and policy makers should take efforts to address the higher needs of gynecological cancer patients.

Lymphadenectomy in Early-Stage Intermediate-/High-Risk Endometrioid Endometrial Cancer: Clinical Characteristics and Outcomes in an Australian Cohort

Objective

The role of lymphadenectomy (LND) in early-stage endometrial cancer (EC) remains controversial. Previous studies have included low-risk patients and nonendometrioid histologies for which LND may not be beneficial, whereas long-term morbidity after LND is unclear. In a large Australian cohort of women with clinical early-stage intermediate-/high-risk endometrioid EC, we analyzed the association of LND with clinicopathological characteristics, adjuvant treatment, survival, patterns of disease recurrence, and morbidity.

Materials and Methods

From a larger prospective study (Australian National Endometrial Cancer Study), we analyzed data from 328 women with stage IA grade 3 (n = 63), stage IB grade 1 to 3 (n = 160), stage II grade 1 to 3 (n = 71), and stage IIIC1/2 grade 1 to 3 (n = 31/3) endometrioid EC. Overall survival (OS) was estimated using Kaplan-Meier methods. The association of LND with OS was assessed using Cox regression analysis adjusted for age, stage, grade, and adjuvant treatment. The association with risk of recurrent disease was analyzed using logistic regression adjusted for age, stage, and grade. Morbidity data were analyzed using χ2 tests.

Results

Median follow-up was 45.8 months. Overall survival at 3 years was 93%. Lymphadenectomy was performed in 217 women (66%), 16% of this group having positive nodes. Median node count was 12. There were no significant differences in OS between LND and no LND groups, or by number of nodes removed. After excluding stage IB grade 1/2 tumors, there was no association between LND and OS among a “high-risk” group of 190 women with a positive node rate of 24%. However, a similar cohort (n = 71) of serous EC in the Australian National Endometrial Cancer Study had improved survival after LND. Women who underwent LND had significantly higher rates of critical events (5% vs 0%, P = 0.02) and lymphoedema (23% vs 4%, P < 0.0001).

Conclusions

In this cohort with early-stage intermediate-/high-risk endometrioid EC, LND did not improve survival but was associated with significantly increased morbidity.

Defining cancer survivors, their needs, and perspectives on survivorship health care in the USA

More people are living after a diagnosis of cancer than ever before and now account for around 5% of the US population. The specialty of cancer survivorship has been developing and growing since the mid-1980s, but the term survivor is open to debate by people living with cancer and those caring for them. Regardless of the term used, many ongoing physical, psychological, and social needs affect quality of life for people who are living with cancer and those who have survived the disease. Survivors prefer to have these needs addressed by their oncologist but also want their primary care provider to have a role. However, survivors also believe there are communication and coordination barriers between care providers. The existing method for delivering cancer care is becoming unsustainable and is not adequately configured to deliver high-quality cancer care to this growing population in the USA, especially when confronted with projected health-care shortages by 2020. In this Series paper, we define the term cancer survivor, discuss survivors' ongoing needs and preferences for care over time, and consider the implications for delivering coordinated cancer care in the USA.

Unmet needs of non-Hodgkin lymphoma survivors in Korea: prevalence, correlates, and associations with health-related quality of life

OBJECTIVE

We aimed to describe the prevalence and correlates of unmet needs among non-Hodgkin lymphoma (NHL) survivors in Korea and to identify their association with health-related quality of life (HRQOL).

METHODS

Participants were 826 NHL survivors from three hospitals in South Korea diagnosed at least 24 months prior to participating (mean, 6.3 years; range, 2.1-20.9 years). We used self-reported questionnaires, including the Need Scale for Cancer Patients Undergoing Follow-up Care (NS-C) developed in Korea and the EORTC QLQ-C30. We defined an unmet need as a moderate to high level of unmet need in the NS-C response scale.

RESULTS

Among six domains, unmet need prevalence ranged from 1.7% to 38.3%. Most commonly reported domains with unmet needs were 'treatment and prognosis' (38.3%) and 'keeping mind under control' (30.5%). The three most frequently reported individual unmet needs were 'being informed about prevention of recurrence' (50.7%), 'being informed about prevention of metastasis' (49.7%), and 'having self-confidence of overcoming cancer' (42.7%). Multivariate logistic analyses revealed that younger age, being unmarried, and low monthly income were associated with unmet needs of multiple domains. Participants with unmet needs demonstrated significantly poorer HRQOL, and the most clinically meaningful differences were found in social function and emotional function.

CONCLUSIONS

Korean NHL survivors have substantial unmet needs, especially those who are younger, unmarried, and have a lower income. Initiating supportive care programs for meeting unmet needs may enhance their HRQOL. Copyright © 2016 John Wiley & Sons, Ltd.

Survivorship care experiences, information, and support needs of patients with oral and oropharyngeal cancer

BACKGROUND

There is little research documenting the posttreatment experiences and needs of oral/oropharyngeal cancer survivors.

METHODS

In this cross-sectional study, 92 patients with oral/oropharyngeal cancer diagnosed between 2 and 5 years prior completed a survey about oral cancer information and support needs.

RESULTS

About half retrospectively reported that they did not receive a written treatment summary. The desire for more oral cancer information was common; one-third or more desired more information about long-term effects, recommended follow-up, and symptoms that should prompt contacting a doctor. Support needs were less common; only a lack of energy was rated as a significant support need. Patients who had a recurrence, did not drink alcohol, and had a greater recurrence fear desired more information. Smokers and more distressed patients reported more support needs.

CONCLUSION

Survivors reported the desire for more oral cancer information. A desire for assistance was less common. © 2016 Wiley Periodicals, Inc. Head Neck 38: E1935-E1946, 2016.

Supportive care needs among Indigenous cancer patients in Queensland, Australia: less comorbidity is associated with greater practical and cultural unmet need

Little is known about the supportive care needs (SCN) of Australian Indigenous cancer patients. This cross-sectional study investigated the association between comorbidity and SCN among newly diagnosed Indigenous cancer patients in Queensland. Comorbidity was ascertained from medical chart review using the Charlson Comorbidity Index (CCI) and SCN were measured using the Supportive Care Needs Assessment Tool for Indigenous Peoples (SCNAT-IP). Of 183 participants, 76 (42%) had no comorbidity (CCI = 0), 60 (33%) had had a CCI score of 1 and 47 (26%) had a CCI of two or more, with the most common condition being diabetes (30%). The most common moderate-high unmet need items varied between comorbidity groups, although all patients most frequently reported moderate-high unmet need in the Physical and Psychological and the Practical and Cultural needs domains. Patients with the greatest comorbidity (CCI ≥ 2) had significantly more reduced odds of practical and cultural needs than patients without comorbidity (OR 0.28, 95% CI 0.11-0.75). This appeared to be partially explained by time since diagnosis, age, whether they were receiving current treatment and residential remoteness. Patients' experience of chronic disease, hospitals and the healthcare system may better prepare them for the practical and cultural aspects of their cancer journey.