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

Palliative Care for Patients With End-Stage Renal Disease: An Examination of Unmet Needs and Experiencing Problems

Patients with end-stage renal disease face numerous physical, emotional, and financial burdens, necessitating palliative care (PC) interventions. This cross-sectional study assessed the problems and unmet needs of 129 patients under renal dialysis from 6 hospitals. Findings revealed that 64.7% of participants experienced significant challenges, primarily financial difficulties (78.5%), autonomy concerns (68.8%), and a need for information (68.0%). More than half (51.9%) reported needing PC, particularly for managing fatigue (78.3%), pain (79.8%), and depression (72.9%). Unmet needs were common (47.6%), with the most notable gaps in financial support (52.5%) and information provision (50%). Correlation analysis demonstrated strong positive associations between reported problems, care needs, and unmet needs ( r > 0.90, P < .001). Significant differences were observed by dialysis access type ( F = 5.71, P = .001), with arteriovenous fistula patients reporting higher problems and unmet needs. Increased dialysis frequency was linked to more problems and unmet needs ( F = 7.24, P < .001). In addition, patients with comorbidities experienced significantly higher problems, care needs, and unmet needs (all P s < .001). These findings underscored the urgent need for tailored PC interventions for end-stage renal disease patients, particularly in addressing symptom management, psychosocial and spiritual support, financial support, and information deficits, to enhance their quality of life.

Family Resilience in Adult Oncology: A Systematic Review and Meta-Analysis

PROBLEM IDENTIFICATION

This systematic review and meta-analysis assessed the state of the science to determine relationships among adult patient- and family member-perceived family resilience, individual resilience and perceived family resilience, and perceived family resilience and psychosocial outcomes.

LITERATURE SEARCH

PubMed®, CINAHL®, PsycINFO®, Sociological Abstracts, and Cochrane Library databases were searched. Random effects models were performed to calculate pooled effect sizes, and meta-analyses were conducted.

DATA EVALUATION

Two authors assessed risk of bias using the Appraisal tool for Cross-Sectional Studies and the Mixed Methods Appraisal Tool. Study heterogeneity was assessed using Cochran's Q test and the I2 statistic. Publication bias was evaluated.

SYNTHESIS

Patient-perceived family resilience and family member-perceived family resilience were positively correlated. Family resilience was positively related to patient and family member individual resilience. Higher family resilience was associated with patients' reduced symptom burden and perceived stress and improved affect and quality of life, and family members' reduced caregiver burden and stress and higher social support and quality of life.

IMPLICATIONS FOR NURSING

Investigations employing a longitudinal design are needed to understand any causal relationships between family resilience and psychosocial outcomes for the dyad.

Effects of exercise-based interventions on health-related quality of life in adults after cancer: A systematic review and meta-analysis

BACKGROUND

Due to the lack of available knowledge in the current literature, this systematic review and meta-analysis was aimed to assess the effectiveness of exercise-based lifestyle interventions, including healthy diet and/or psychological well-being on mental, physical and global health-related quality of life (HRQoL) in adults after cancer treatment.

METHODS

MEDLINE (via PubMed) and Web of Science databases were searched for randomised controlled trials (RCTs) published until August 2024 evaluating exercise-based lifestyle interventions, including healthy diet and/or psychological well-being, which assessed mental, physical and global HRQoL.

RESULTS

Of 6193 screened studies, 32 RCTs met the criteria. The total sample comprised 5528 participants (3003 intervention and 2525 control). There was a small effect size in a pooled analysis that found exercise-based lifestyle interventions improve mental HRQoL (d 0.11, 95 % CI 0.05 to 0.18). These effects were greater in those studies that combined exercise with psychological well-being (d = 0.19, P = 0.004), and with moderate-to-high intensity aerobic exercise (moderate intensity; d = 0.11, P = 0.02, high intensity; d = 0.16, P = 0.02, aerobic exercise; d = 0.16, P = 0.26).

CONCLUSIONS

Exercise-based lifestyle interventions do not enhance physical nor global HRQoL, yet those combined with psychological well-being seem to improve mental HRQoL in individuals after cancer treatment.

PROSPERO REGISTRATION NUMBER

CRD42022369169.

Quantifying the Influence of Psychosocial Characteristics, Supportive Care Needs and Quality of Life on Breast Cancer Survival

OBJECTIVE

To identify the contribution of psychosocial characteristics, supportive care needs, or quality of life on breast cancer survival outcomes.

METHODS

This study used data from a population-based longitudinal study involving women diagnosed with invasive breast cancer (n = 3326, response rate = 71%) in Queensland, Australia, 2010-2013, and followed up to 2020. Flexible parametric survival models were used to identify which factors were associated with survival outcomes. Model fit was assessed using D andR D 2 ${R}_{D}^{2}$ statistics.

RESULTS

Unmet physical and daily living needs, social support, age, stage at diagnosis, tumour grade, clinical subtype and mode of detection explained 39% of survival variability (R D 2 ${R}_{D}^{2}$ 0.39; 95% CI 0.33-0.44), with a Harrell's C statistic of 0.84 (95% CI 0.81-0.86). Unmet physical and daily living needs and social support, which fall under the categories of supportive care needs and psychosocial characteristics respectively, were identified as key factors that predict breast cancer survival, explaining 3% of survival variability. When compared to women who had less unmet physical needs and adequate social support (5-year survival: 96.6%, 95% CI 92%-99%), those who had more unmet physical needs and limited social support had poorer breast cancer-specific survival (5-year survival: 86.8%, 95% CI 72%-95%).

CONCLUSION

The study found that unmet physical and daily living needs and social support play a marginal but significant role in influencing breast cancer outcomes. The findings enhance the current literature regarding the impact of psychosocial characteristics and supportive care needs on breast cancer survival and suggest that integrating psychosocial support and interventions alongside medical treatment may further improve the survival outcomes for women diagnosed with breast cancer.

Patterns in Symptoms Preceding Acute Care in Patients With Cancer

Importance

Patients with cancer frequently experience unplanned acute care with emergency department visits and hospitalization due to disease or treatment complications, which impacts outcomes, quality of life, and health care costs. There remains a knowledge gap in understanding patterns of symptoms that precede acute care events. Natural language processing (NLP) may enable greater understanding of the symptoms and identify differences across patient and cancer characteristics.

Objective

To characterize symptoms preceding acute care in patients with cancer and quantify differences in symptom documentation across sociodemographic and cancer histologic subgroups.

Design, Setting, and Participants

A cohort study in a single tertiary-care institution, including all acute care (emergency department and hospitalization) encounters for patients aged 18 years or older with a primary cancer diagnosis identified between January 1, 2013, and December 31, 2023.

Main Outcomes and Measures

Natural language processing was used to identify routine clinical documentation to characterize symptoms documented in the 30 days preceding acute care. Logistic regression analyses was used to examine the possible association between sex, age, race and ethnicity, insurance coverage, cancer histologic characteristics, and reported symptoms.

Results

Overall, 28 708 patients with cancer had 70 606 acute care visits with 854 830 associated preceding documented symptoms. Median age was 61 (IQR, 48-70) years. Men (37 861 encounters [53.62%]) and patients of White race (39 989 encounters [56.64%]) accounted for most acute care encounters. Pain (7.54% of documented symptoms), nausea (6.74%), and vomiting (5.79%) were the most frequently documented symptoms. Acute care encounters with patients who were female (adjusted odds ratio [AOR], 1.14; 95% CI, 1.10-1.18; P < .001), Asian (AOR, 1.22; 1.17-1.28; P < .001), Black (AOR, 1.17; 95% CI, 1.10-1.25; P < .001), American Indian or Alaska Native (AOR, 1.21; 95% CI, 1.01-1.44; P = .04), or Medicaid-insured (AOR, 1.10; 95% CI, 1.05-1.14; P < .001) were associated with a high documented symptom burden (>10 unique symptoms) preceding acute care visits. Patients aged 65 years or older (AOR, 0.96; 95% CI, 0.92-1.00; P = .04) or uninsured (AOR, 0.58; 95% CI, 0.45-0.76; P < .001) were less likely to have a high symptom burden documented before acute care events.

Conclusions and Relevance

The findings of this study highlight common symptoms preceding acute care as well as the need for further research on interventions to reduce patient burden, improve quality of life, and reduce the use of acute care in patients with cancer.

Usability, Acceptability, and Barriers to Implementation of a Collaborative Agenda-Setting Intervention (CASI) to Promote Person-Centered Ovarian Cancer Care: Development Study

Background

People with advanced ovarian cancer and their caregivers report unmet supportive care needs. We developed a Collaborative Agenda-Setting Intervention (CASI) to elicit patients' and caregivers' needs through the patient portal before a clinic visit and to communicate these needs to clinicians using the electronic health record.

Objective

We aimed to assess the usability and acceptability of the CASI and identify barriers to and facilitators of its implementation.

Methods

We recruited English- and Spanish-speaking patients, caregivers, and clinicians from the gynecologic oncology program at a comprehensive cancer center. Participants used the CASI prototype and then completed individual cognitive interviews and surveys. We assessed usability with the System Usability Scale (scores range 0-100, scores ≥70 indicate acceptable usability) and acceptability with the Acceptability of Intervention Measure and Intervention Appropriateness Measure (scores for both measures range from 1 to 5, higher scores indicate greater acceptability). Interviews were audio recorded, transcribed, and analyzed using directed content analysis. Domains and constructs from the Consolidated Framework for Implementation Research comprised the initial codebook. We analyzed survey data using descriptive statistics and compared usability and acceptability scores across patients, caregivers, and clinicians using analyses of variance.

Results

We enrolled 15 participants (5 patients, 5 caregivers, and 5 clinicians). The mean System Usability Scale score was 72 (SD 16). The mean Acceptability of Intervention Measure and Intervention Appropriateness Measure scores were 3.9 (SD 1.0) and 4.1 (SD 0.8), respectively. Participants viewed the CASI content and format positively overall. Several participants appreciated the CASI's integration into the clinical workflow and its potential to increase attention to psychosocial concerns. Suggestions to refine the CASI included removing redundant items, simplifying item language, and adding options to request a conversation or opt out of supportive care referrals. Key barriers to implementing the CASI include its complexity and limited resources available to address patients' and caregivers' needs.

Conclusions

The CASI is usable and acceptable to patients with advanced ovarian cancer, caregivers, and clinicians. We identified several barriers to and facilitators of implementing the CASI. In future research, we will apply these insights to a pilot randomized controlled trial to assess the feasibility of comparing the CASI to usual care in a parallel group-randomized efficacy trial.

Quality Improvement of Single-Institution Craniofacial Center Multidisciplinary Meetings Using Standardized Meeting Guides

Objectives

The American Cleft Palate Association-Craniofacial Association (ACPA-CPF) recommends regular multidisciplinary team meetings for comprehensive craniofacial patient care, yet standardized meeting guidelines are lacking. Lack of standardization may result in varying quality of care within and between institutions, as well as difficulty in creation of new multidisciplinary craniofacial teams at institutions without one. This study sought to assess craniofacial multidisciplinary team meetings and determine the utility of a meeting guidance tool in such meetings. It was set in a single institution's craniofacial center, and participants included multidisciplinary team members.

Methods

This project used the Plan-Do-Study-Act quality improvement method, completed in two phases. In the project's first phase, craniofacial team members assessed their current meetings with an evaluation instrument previously created. The evaluation results identified areas needing improvement, and a new meeting guide was created and implemented over four meetings. Team members also completed a survey comparing historical versus new meeting structures.

Results

Initial meeting quality was perceived positively, but evaluation with a standardized instrument revealed deficiencies, particularly in case presentation topics. Implementing a custom guide improved the provision of current and historical patient information and treatment plan summarization, although excessive repetition persisted. Adjustments to the custom meeting guide led to further quality enhancement, particularly in case presentation efficiency and meeting effectiveness.

Conclusion

Multidisciplinary team meetings are vital for comprehensive craniofacial care, but ensuring consistent quality is challenging. Our study demonstrates the value of utilizing standardized meeting guides to evaluate and create custom guides leading to quality improvement. Ongoing refinement is essential to address persisting issues and optimize patient outcomes.

Level of Evidence

5.

Care needs and cancer-related post traumatic stress (CR-PTS) in patients with early-stage lung cancer three months after surgery

PURPOSE

Lung cancer is one of the life-threatening diseases. The purposes of this study were to explore (1) the levels of unmet care needs, cancer-related post-traumatic stress (CR-PTS), and symptoms, and (2) factors related to unmet care needs in newly diagnosed early-stage lung cancer (LC) patients three months after surgery.

METHODS

A cross-sectional study with consecutive sampling was conducted in the thoracic outpatient clinic of a medical centre in Taiwan to recruit early-stage (I-IIIA) LC patients. Patients were assessed of their care needs (Supportive Care Needs Survey Screening Tool [SCNS-ST9]), CR-PTS (Impact of Events Scale Revised [IES-R], including intrusion, avoidance, hyperarousal subscales), symptom severity, and background information.

RESULTS

Of the 130 participants enrolled in this study, 62.3% of subjects reported to have overall unmet care needs and 28.5% were at risk of CR-PTS. The levels of unmet care needs are generally in moderate level, with health system and information needs being the highest. Mild to moderate CR-PTS levels were noted, with avoidance, intrusion, and hyperarousal in descending order. Logistic regression identified lower education, higher symptom severity, and higher CR-PTS as the most robust factors related to unmet care needs.

CONCLUSION

The findings of this study highlight the importance of assessing care needs and psychological distress status of patients with early-stage LC. Developing appropriate interventions for this vulnerable patient population and examining their effects on improving care needs and psychological health are urgently needed.

Childhood Cancer-Connect: Identifying solutions to elevating the cancer experience for adolescents and young adults with cancer

Adolescents and young adults with cancer (aged 15-39 years) experience unique challenges because of their developmental life stage, and many have limited access to support and resources. Childhood Cancer (CC)-Connect, the patient assistance component of the White House Cancer Moonshot Childhood Cancer-Data Integration for Research, Education, Care, and Clinical Trials initiative that aims to help childhood cancer families find the best care for their child, undertook a multipronged effort to identify key strategies for addressing the unique needs of adolescents and young adults with cancer. This article describes the 4 strategies that emerged to form a comprehensive framework for addressing the unmet needs of adolescents and young adults with cancer, which can improve outcomes and enhance the cancer care experience for this vulnerable population.

Effects of a culturally tailored patient navigation program on unmet supportive care needs in Hispanic/Latino cancer survivors: A randomized controlled trial

BACKGROUND

Patient navigation (PN) is a promising yet underused approach to address Hispanic/Latino (H/L) cancer survivors' unmet supportive care needs. The authors conducted a randomized trial to evaluate the effect of a culturally tailored PN program with the LIVESTRONG Foundation's Cancer Navigation Services (PN-LCNS) on reducing unmet needs in H/L survivors.

METHODS

From 2012 to 2015 at two US sites, 288 H/L survivors diagnosed with breast, prostate, or colorectal cancer were randomized to a PN-LCNS program or to standard PN. Participants assigned to the PN-LCNS program received 3-month PN services; access to phone-based, bilingual, one-on-one support; and additional resources (i.e., guidebook, health journal, and care plan). Participants completed assessments at baseline and at 3, 9, and 15 months post-baseline. The Supportive Care Needs Survey was used to assess unmet needs across five domains: psychological, health system and information, physical and daily living, patient care and support, and sexuality. Intervention effects were tested by using separate multilevel growth models for women and men.

RESULTS

Women randomized to the PN-LCNS program, relative to those who received standard PN, had a statistically significant reduction in unmet needs (i.e., overall and for the health systems and information, physical and daily living, and patient care and support domains). Among men, younger age was associated with greater unmet needs at baseline. Prostate cancer survivors reported greater unmet sexual health needs compared with colorectal cancer survivors. There was no significant change in unmet needs among H/L men.

CONCLUSIONS

A culturally tailored PN program can reduce unmet supportive care needs among H/L women cancer survivors. However, interventions specifically targeting unmet needs in H/L men and sexual health are still necessary (ClinicalTrials.gov identifier NCT02275754).

PLAIN LANGUAGE SUMMARY

Hispanic/Latino (H/L) cancer survivors often report concerns or needs that are not adequately addressed by the health care team, which could be related to psychological, health system and information, patient care and support, physical and daily living, and sexuality issues. In this randomized controlled trial of 288 H/L survivors diagnosed with breast, prostate, or colorectal cancer, women assigned to a culturally tailored patient navigation program experienced a reduction in unmet needs compared with those who received standard patient navigation. H/L men did not experience a change in unmet needs.

Risk of significant functional impairment across cancer diagnosis and care continuum

BACKGROUND

The authors examined baseline physical functional (PF) impairment among cancer outpatients in the National Cancer Institute Cancer Moonshot study Northwestern University Improving the Management of Symptoms During and Following Cancer Treatment (NU IMPACT). They hypothesized that PF impairment, measured with the Patient Reported Outcome Measurement Information System-Physical Function (PROMIS-PF) survey, would (1) be common and more prevalent for patients receiving treatment compared with no treatment and (2) differ across tumor types, independent of cancer continuum phase.

METHODS

Adults who were diagnosed with cancer in NU IMPACT (n = 2273) were sampled, and their PROMIS-PF scores were compared across tumor types and cancer continuum (curative, noncurative, or no treatment), with scores ≤40 indicating moderate-severe impairment. Multivariable logistic regression models were used to evaluate the relation among patient and cancer factors and PF scores using a 95% confidence interval.

RESULTS

Forty percent of the surveyed patients reported moderate-severe PF impairment. Patients with melanoma reported the least impairment, and those with lung cancer were 6.5 times more likely to have moderate-severe impairment (95% confidence interval, 2.393-17.769). The noncurative group was 1.5 times more likely to have moderate-severe impairment (95% confidence interval, 1.045-2.145; mean score, 43; p < .001) than the curative (mean score, 6) and no treatment (mean score, 48) groups. One-third of those who reported PF impairment also had significant pain and/or fatigue.

CONCLUSIONS

A sizeable minority experienced PF impairment across tumor types for which pain and/or fatigue co-occurred, particularly in the noncurative group. The PROMIS-PF survey effectively identified variations in physical function. Future studies will explore how screening for PF impairment can be used to refer patients for appropriate cancer rehabilitation services.

Proximity to cancer rehabilitation and exercise oncology by geography, race, and socioeconomic status

BACKGROUND

Cancer rehabilitation and exercise oncology (CR/EO) have documented benefits for people living with and beyond cancer. The authors examined proximity to CR/EO programs across the United States with respect to population density, race and ethnicity, socioeconomic status, and cancer incidence and mortality rates.

METHODS

This cross-sectional study was conducted in 2022-2023. Online searches were initiated to identify CR/EO programs. Geocoding was used to obtain latitudinal and longitudinal geospatial coordinates. Demographic data were abstracted from the 2020 5-year American Community Survey. Cancer incidence and mortality data were obtained from the Centers for Disease Control and Prevention. US 2013 Rural-Urban Continuum Code (RUCC) classification was used to define counties as either urban (RUCC 1-3) or rural (RUCC 4-9). Multivariable logistic regression was used to evaluate the association between being far from a program and census-tract level factors.

RESULTS

In total, 2133 CR/EO programs were identified nationwide. The distance from a program increased with decreasing population density: rural tracts were 17.68 ± 0.24 miles farther from a program compared with urban tracts (p < .001). Program proximity decreased as the neighborhood deprivation index increased (p < .001). Exercise oncology programs were less common than cancer rehabilitation programs in tracts with a larger proportion of minority residents (p < .001).

CONCLUSIONS

Prior research has documented that underrepresented populations have worse cancer-related symptoms and higher cancer mortality. Herein, the authors document their findings that these same populations are less likely to have proximity to CR/EO programs, which are associated with improved cancer-related symptoms and cancer mortality outcomes. To realize the positive outcomes from CR/EO programming, efforts must focus on supporting expanded programming and sustainable payment for these services.

Supportive care in transplantation: A patient-centered care model to better support kidney transplant candidates and recipients

Kidney transplantation (KT), although the best treatment option for eligible patients, entails maintaining and adhering to a life-long treatment regimen of medications, lifestyle changes, self-care, and appointments. Many patients experience uncertain outcome trajectories increasing their vulnerability and symptom burden and generating complex care needs. Even when transplants are successful, for some patients the adjustment to life post-transplant can be challenging and psychological difficulties, economic challenges and social isolation have been reported. About 50% of patients lose their transplant within 10 years and must return to dialysis or pursue another transplant or conservative care. This paper documents the complicated journey patients undertake before and after KT and outlines some initiatives aimed at improving patient-centered care in transplantation. A more cohesive approach to care that borrows its philosophical approach from the established field of supportive oncology may improve patient experiences and outcomes. We propose the "supportive care in transplantation" care model to operationalize a patient-centered approach in transplantation. This model can build on other ongoing initiatives of other scholars and researchers and can help advance patient-centered care through the entire care continuum of kidney transplant recipients and candidates. Multi-dimensionality, multi-disciplinarity and evidence-based approaches are proposed as other key tenets of this care model. We conclude by proposing the potential advantages of this approach to patients and healthcare systems.

Prevalence and Predictors of the Unmet Supportive Needs of Patients With Cancer in Oman

BACKGROUND

Unmet supportive needs are directly correlated with more frequent psychological distress, reduced quality of life, and low patient satisfaction with healthcare and indirectly connected with low compliance with treatment and increased care-related costs.

OBJECTIVE

To assess the spectrum of unmet needs among patients with cancer in Oman and identify predictors of these needs and their relationship with psychological distress and symptom burden.

METHOD

A descriptive, correlational study design was used, involving 551 patients with cancer from 2 major healthcare facilities in Muscat, Oman. Data on patients' unmet needs were collected between January and June 2023 using the Supportive Care Needs Survey Short-Form 34.

RESULTS

Participants had a mean age of 45.8 (SD, 15.6) years, with female patients comprising 65.5% of the sample. Breast cancer was the most prevalent type of cancer. The mean unmet need score was 31.0/100 (SD, 20.1). Statistical analysis revealed significant predictors of unmet needs, including marital status, treatment type, performance status, symptom interference, and psychological distress, with the regression model explaining 26% of the variance in unmet needs.

CONCLUSIONS

Healthcare providers must regularly assess supportive needs, recognizing that they may vary across populations and are influenced by cultural factors. Additionally, individuals identified as having characteristics that predict higher levels of need should receive focused and prioritized supportive care.

IMPLICATIONS FOR PRACTICE

By adopting regular tailored assessments that address the comprehensive supportive needs of patients with cancer, clinicians can significantly enhance patients' quality of life and optimize treatment outcomes.

"Oh when's your treatment ending?" "Never!" The unmet needs of cancer patients treated with immunological, biological and precision therapies: A qualitative interview study

PURPOSE

To explore the unmet supportive care needs of patients with advanced cancer receiving immuno-, biological and precision (IBP) therapies.

METHODS

We conducted semi-structured interviews with: (1) adults diagnosed with advanced cancer (lung, colorectal, ovary, breast, renal, melanoma) treated with an IBP therapy (e.g. tyrosine kinase inhibitors, monoclonal antibodies, immunotherapy), for at least one month; (2) healthcare professionals involved in providing hospital care for patients receiving IBP therapies. Interviews were audio-recorded, transcribed and analysed using the Framework Analysis approach; the framework comprised of 11 domains of unmet need: activities of daily living, autonomy, economic, healthcare, information, physical, psychological, role, sexual, social; and an "other" category (to capture data relating to unmet needs that did not fit within pre the-defined domains).

RESULTS

Thirty-one patients and 22 healthcare professionals were interviewed. Ten domains of unmet needs (exceptions: spiritual, other) were evident in the data. Identified unmet needs related to: (1) utilising the IBP therapies (e.g. specific treatment side effects [physical domain], living long-term with uncertainty [psychological], others not understanding why they were not cured [social]; and (2) living with (advanced) cancer (e.g. retiring from work [role], loss of independence [autonomy]).

CONCLUSIONS

Patients with advanced cancer being treated with IBP therapies have a diverse range of often inter-related unmet needs. It is vital that healthcare professionals involved in the care of cancer patients using IBP therapies are alert to the unmet needs among this patient group. Interventions and services should be developed to address these needs.

Global unmet psychosocial needs in cancer care: health policy

Preventable psychosocial suffering is an unmet need in patients with cancer around the world, significantly compromising quality of life and impairing cancer health outcomes. This narrative review overviews the global prevalence of emotional distress and cancer-related needs and the access barriers to psychosocial care. The COVID-19 pandemic has served only to amplify the need for psychosocial care, exacerbating the inadequacy of available psychosocial resources, particularly in low- and middle-income countries. Proposed solutions include implementing routine screening for emotional distress, addressing stigma related to mental health needs, and increased attention to the psychosocial dimensions of cancer care in oncology training and interprofessional models of care. There is an urgent need to address health policy issues such as resource allocation in cancer control plans and to embrace technological innovation in order to fill the universal gaps to providing more equitable psychosocial cancer care.

Funding

None.

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.

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.

Enhancing Cancer Supportive Care: Integrating Psychosocial Support, Nutrition, and Physical Activity Using Telehealth Solutions

This review explores current guidelines for integrating psychosocial support, nutrition, and physical activity into cancer care and examines the resources available to deliver comprehensive care effectively and equitably, with a focus on telehealth solutions. A review of current guidelines related to psychosocial support, nutrition, and exercise in oncology published between the years 2020 and 2024 was conducted. Additionally, relevant articles from the authors' personal archives were included. Current guidelines emphasize routine psychosocial distress screening, nutritional assessment, and tailored physical activity interventions for patients with cancer. The National Comprehensive Cancer Network and ASCO highlight the need for regular psychosocial evaluations and the management of common psychiatric disorders. The American Cancer Society and the Academy of Nutrition and Dietetics recommend nutritional screening, personalized counseling, and exercise to improve treatment tolerance and overall quality of life. Despite these recommendations, challenges such as resource limitations, time constraints, and financial barriers hinder their implementation. Integrating psychosocial support, medical nutrition therapy, and physical activity into cancer care is essential to enhancing patients' quality of life. Telehealth offers a viable solution to overcome barriers by providing remote access to supportive services, facilitating comprehensive care, and promoting patient engagement. The effectiveness of telehealth in delivering psychosocial, nutritional, and physical activity support highlights its potential to improve patient outcomes and overcome barriers to care. Telehealth technologies hold high potential to optimize cancer care delivery, ensuring personalized support for patients throughout their cancer journey.

Global disparities in cancer supportive care: An international survey

BACKGROUND

The global cancer burden is rising, particularly in low- and middle-income countries (LMIC), highlighting a critical research gap in understanding disparities in supportive care access. To address this, the Multinational Association of Supportive Care in Cancer (MASCC) Health Disparities Committee initiated a global survey to investigate and delineate these disparities. This study aims to explore and compare supportive care access disparities between LMIC and High-Income Countries (HIC).

METHODS

An online cross-sectional survey was conducted among active members of MASCC. Members, representing diverse healthcare professions received email invitations. The survey, available for 3 weeks, comprised sections covering (1) sociodemographic information; (2) clinical service/practice-related disparities in their region/nation; (3) population groups facing disparities within their region or country. Chi-squared or Fisher's exact test for cross-sectional analyses, and a multivariable logistic regression model was employed for statistical analysis.

RESULTS

A total of 218 active members participated, with one-quarter (26.6%) from LMIC and 18.4% ethnic minorities, timely cancer care (43.7%) and timely supportive care (45.0%) emerged as the most pressing disparities globally. Notably, participants from LMIC underscored cancer drug affordability (56.4%) and supportive care guideline implementation (56.4%) as critical issues. Economically disadvantaged populations were noted as more likely to face disparities by both LMIC and HIC (non-US-based) respondents, while US-based respondents identified racial/ethnic minorities as facing more disparities.

CONCLUSION

This global survey reveals significant disparities in cancer supportive care between LMIC and HIC, with a particular emphasis on medication affordability and guideline implementation in LMIC. Addressing these disparities requires targeted intervention, considering specific regional priorities.

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.

Evaluating the Implementation of Integrated Proactive Supportive Care Pathways in Oncology: Master Protocol for a Cohort Study

BACKGROUND

Supportive care (SC) refers to the prevention and management of complications of cancer and its treatment. While it has long been recognized as an important cancer care delivery component, a high proportion of patients face unaddressed SC needs, calling for innovative approaches to deliver SC.

OBJECTIVE

The objective of this master protocol is to evaluate the implementation of different integrated proactive SC pathways across the cancer care continuum in our institution (Gustave Roussy, Villejuif, France). Pathways studied in this master protocol may occur shortly after diagnosis to prevent treatment-related burden; during treatment to monitor the onset of toxicities and provide timely symptom management; and after treatment to improve rehabilitation, self-management skills, and social reintegration.

METHODS

This study is guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. The primary objective is to evaluate the impact of SC pathways on patients' distress and unmet needs after 12 weeks, measured by the National Comprehensive Cancer Network's Distress Thermometer and Problem List. Secondary objectives will focus on the pathways (macrolevel) and each SC intervention (microlevel), evaluating their reach (administrative data review of the absolute number and proportion of clinical and sociodemographic characteristics of patients included in the pathways); short-term and long-term efficacy through their impact on quality of life (EQ-5D-5L and the 30-item European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire) and symptom burden (MD Anderson Symptom Inventory, Hospital Anxiety and Depression Scale, Insomnia Severity Index, and 22-item European Organization for Research and Treatment of Cancer Sexual Health Questionnaire); adoption by patients and providers (administrative data review of SC referrals and attendance or use of SC strategies); barriers to and leverage for implementation (surveys and focus groups with patients, providers, and the hospital organization); and maintenance (cost-consequence analysis). Pilot evaluations with a minimum of 70 patients per pathway will be performed to generate mean Distress Thermometer scores and SDs informing the calculation of formal sample size needed for efficacy evaluation (cohorts will be enriched accordingly).

RESULTS

The study was approved by the ethics committee, and as of February 2024, a total of 12 patients were enrolled.

CONCLUSIONS

This study will contribute toward innovative models of SC delivery and will inform the implementation of integrated SC pathways of care.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06479057; https://clinicaltrials.gov/study/NCT06479057.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/52841.

Supportive care needs after surgery in patients with breast cancer

PURPOSE

This study aimed to determine supportive care needs and related factors after surgery in patients with breast cancer.

METHODS

This cross-sectional study was conducted with 98 breast cancer patients in a Training and Research Hospital in Istanbul between September 2022 and November 2023. The Personal Information Form and the Supportive Care Needs Survey Short Form Turkish version were used to collect data. One-way variance analysis, post hoc (Tukey, LSD), and t-test were used to analyze the data.

RESULTS

The total scale mean score for women who underwent surgery for breast cancer in the study was 83.95 22.97. Statistically significantly higher total scale scores were observed in younger women and those who received chemotherapy and radiotherapy than in others. The mean physical and daily living subscale scores of those who received chemotherapy and radiotherapy were higher than those who did not (p < .05). The psychology subscale mean scores of those who were young and unemployed were higher than the others (p < .05). The mean sexuality scores of those who were young, those with high education levels, and those who received chemotherapy were higher than the other groups (p < .05). Age factor affects SCN scores in women with breast cancer.

CONCLUSION

Supportive care needs are higher among women with breast cancer who are younger and receive chemotherapy and radiotherapy. The physical needs of those who receive chemotherapy and radiotherapy, the psychological needs of those who are younger and unemployed, and the need for support regarding sexuality were greater among those who are younger and with higher education. Nurses should be aware of the specific needs of these disadvantaged groups and provide individualized holistic care.

Cancer Survivors' and Care Partners' Audio Diaries on Stress and Social Support Resources During the COVID-19 Pandemic

OBJECTIVES

To describe cancer survivors' and care partners' perceived stress and social support during the COVID-19 pandemic and assess the feasibility of audio diaries for assessing role-related needs and resources.

METHODS

Participants (N = 51; n = 28 survivors, n = 23 care partners) recorded three monthly audio diaries reporting stress and support experiences. Diaries were transcribed and content-analyzed using a hybrid approach. Stress-related content was inductively coded, and social support content was deductively coded by type (instrumental, information, emotional, companionship, appraisal; κ = 0.75) then inductively coded. Descriptive statistics summarized sociodemographic data and compared coding frequencies by role. We developed narrative summaries of stress and support categories and selected quotes for contextual detail.

RESULTS

Cancer-related stressors were most prevalent (28.8%), followed by work (26.8%), family (23.1%), social isolation (13.4%), and finances (8.0%). While no significant difference in reporting frequency was observed between roles, cancer-related stress was more prevalent for survivors while work-related stress was mentioned more by care partners. Emotional support was the most prevalent support type (32.1%), followed by companionship (25.3%), appraisal (17.9%), instrumental (16.67%), and informational support (8%). Survivors reported more appraisal support than care partners (χ2 = 6.48, df = 1, P = .011) and more support for self-care, while care partners expressed more other-oriented concerns and focused more on managing responsibilities and interactions outside the household.

CONCLUSIONS

The pandemic complicated and intensified role-based stressors already present in the survivorship context. Our findings highlight the importance of informal social support networks, particularly when access to formal services is limited, and suggest that audio diaries can be an effective tool for assessing support needs and resources.

IMPLICATIONS FOR NURSING PRACTICE

Nurses and healthcare providers should tailor social support assessments to address the distinct support needs and individual resources of cancer survivors and their care partners. This is especially critical in contexts that limit access to care and formal services.

Immunotherapy-associated symptoms, distress, financial toxicity and unmet supportive care needs of patients with cancer

PURPOSE

To examine the unmet care needs (i.e., overall needs and need subdomains [physical and daily living needs, psychological and emotional needs, care and support needs, and health-system and informational needs]) of patients with cancer undergoing immunotherapy alone or in combination with other anticancer therapies, as well as related influencing factors.

METHODS

A cross-sectional design was adopted. Cancer patients who received immunotherapy completed consent and questionnaires. Unmet care needs were evaluated with the Chinese version of the Supportive Care Needs Survey Screening Tool, symptom severity with the Symptom Severity Scale, distress severity with the Distress Thermometer Scale, and financial toxicity using the Financial Toxicity - Functional Assessment of Chronic Illness Therapy Questionnaire.

RESULTS

In total, 105 patients were surveyed. The most frequently reported unmet needs were psychological and emotional needs (56.2%) followed by health-system and informational needs (36.2%). The major factors associated with unmet care needs and their subdomains were years of education, symptoms, distress, and financial toxicity. Years of education predicted overall unmet care needs, psychological and emotional needs, and care and support needs; symptoms predicted overall unmet care needs and all four subdomains; distress predicted psychological and emotional needs and health-system and informational needs; and financial toxicity predicted overall needs and psychological and emotional needs.

CONCLUSIONS

Patients with higher education, severe symptoms, distress, and financial toxicity reported more unmet care needs. The findings of this study could be incorporated into immunotherapy-related clinical practice guidelines and future interventions to improve the quality of cancer care.