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      Prevalence and correlates of cancer survivors’ supportive care needs 6 months after diagnosis: a population-based cross-sectional study

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      1 , , 2 , 1 , 3 , 1
      BMC Cancer
      BioMed Central

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          Abstract

          Background

          An understanding of the nature and magnitude of the impact of cancer is critical to planning how best to deliver supportive care to the growing population of cancer survivors whose need for care may span many years. This study aimed to describe the prevalence of and factors associated with moderate to high level unmet supportive care needs among adult cancer survivors six months after diagnosis.

          Methods

          A population-based sample of adult cancer survivors diagnosed with one of the eight most incident cancers in Australia was recruited from two state-based cancer registries. Data for 1323 survivors were obtained by self-report questionnaire and linkage with cancer registry data. Unmet needs were assessed by the 34-item Supportive Care Needs Survey (SCNS-SF34). The data were examined using chi-square and multiple logistic regression analyses.

          Results

          A total of 444 (37%) survivors reported at least one ‘moderate to high’ level unmet need and 496 (42%) reported ‘no need’ for help. Moderate to high level unmet needs were most commonly reported in the psychological (25%) and physical aspects of daily living (20%) domains. The five most frequently endorsed items of moderate to high unmet need were concerns about the worries of those close to them (15%), fears about the cancer spreading (14%), not being able to do the things they used to do (13%), uncertainty about the future (13%) and lack of energy/tiredness (12%). Survivors’ psychological characteristics were the strongest indicators of unmet need, particularly caseness for anxious preoccupation coping which was associated (OR = 2.2-5.9) with unmet need for help across all domains.

          Conclusions

          Unmet supportive care needs are prevalent among a subgroup of survivors transitioning from active treatment to survivorship, although lower than previously reported. In addition to coping support, valuable insight about how to prevent or address survivors’ unmet needs could be gained by examining the substantial proportion of survivors who report no unmet needs.

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          Most cited references21

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          The MOS social support survey.

          This paper describes the development and evaluation of a brief, multidimensional, self-administered, social support survey that was developed for patients in the Medical Outcomes Study (MOS), a two-year study of patients with chronic conditions. This survey was designed to be comprehensive in terms of recent thinking about the various dimensions of social support. In addition, it was designed to be distinct from other related measures. We present a summary of the major conceptual issues considered when choosing items for the social support battery, describe the items, and present findings based on data from 2987 patients (ages 18 and older). Multitrait scaling analyses supported the dimensionality of four functional support scales (emotional/informational, tangible, affectionate, and positive social interaction) and the construction of an overall functional social support index. These support measures are distinct from structural measures of social support and from related health measures. They are reliable (all Alphas greater than 0.91), and are fairly stable over time. Selected construct validity hypotheses were supported.
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            What are the unmet supportive care needs of people with cancer? A systematic review.

            The identification and management of unmet supportive care needs is an essential component of health care for people with cancer. Information about the prevalence of unmet need can inform service planning/redesign. A systematic review of electronic databases was conducted to determine the prevalence of unmet supportive care needs at difference time points of the cancer experience. Of 94 articles or reports identified, 57 quantified the prevalence of unmet need. Prevalence of unmet need, their trends and predictors were highly variable in all domains at all time points. The most frequently reported unmet needs were those in the activities of daily living domain (1-73%), followed by psychological (12-85%), information (6-93%), psychosocial (1-89%) and physical (7-89%). Needs within the spiritual (14-51%), communication (2-57%) and sexuality (33-63%) domains were least frequently investigated. Unmet needs appear to be highest and most varied during treatment, however a greater number of individuals were likely to express unmet need post-treatment compared to any other time. Tumour-specific unmet needs were difficult to distinguish. Variations in the classification of unmet need, differences in reporting methods and the diverse samples from which patients were drawn inhibit comparisons of studies. The diversity of methods used in studies hinders analysis of patterns and predictors of unmet need among people with cancer and precludes generalisation. Well-designed, context-specific, prospective studies, using validated instruments and standard methods of analysis and reporting, are needed to benefit future interventional research to identify how best to address the unmet supportive care needs of people with cancer.
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              Brief assessment of adult cancer patients' perceived needs: development and validation of the 34-item Supportive Care Needs Survey (SCNS-SF34).

              This study aimed to develop and validate a short version of the Supportive Care Needs Survey (SCNS) that would reduce respondent burden and could be used in routine cancer care, without compromising the psychometric properties of the original instrument. Secondary analyses of the data from two studies (n = 888 and 250) were undertaken. All 59 items of the original SCNS were assessed using psychometric analyses and evaluated for clinical utility. The 34 items retained were examined for internal consistency, ceiling and floor effects, known groups validity, convergent validity, sensitivity and readability. The 34-item instrument has five factors (psychological, health system and information, physical and daily living, patient care and support, and sexuality needs) identical to the original instrument, explaining 73% of the variance. Internal consistency was high with Cronbach's alpha coefficients for the five factors ranging from 0.86 to 0.96. Correlations of the 34-item short-form SCNS (SCNS-SF34) with three other measures of psychosocial well-being demonstrated convergent validity (r = 0.48-0.56). Kappa coefficients of at least 0.83 for each domain indicated almost perfect agreement between the 34-item and 59-item surveys to identify patients needing help. The 34-item SCNS maintained the psychometric properties of the original instrument and could be readily comprehended by people with seventh to eighth grade education. The SCNS-SF34 is a valid instrument for measuring cancer patients' perceived needs across a range of domains, and could be utilized as part of routine cancer care.
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                Author and article information

                Journal
                BMC Cancer
                BMC Cancer
                BMC Cancer
                BioMed Central
                1471-2407
                2012
                18 April 2012
                : 12
                : 150
                Affiliations
                [1 ]Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, Newcastle, Australia
                [2 ]Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, Australia
                [3 ]Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, Australia
                Article
                1471-2407-12-150
                10.1186/1471-2407-12-150
                3430551
                22510387
                28591df7-3dc3-483f-9144-67f54064fa6a
                Copyright ©2012 Boyes et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 14 October 2011
                : 18 April 2012
                Categories
                Research Article

                Oncology & Radiotherapy
                Oncology & Radiotherapy

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