There is a need to identify TC survivors at risk of poorer outcomes and for interventions to target the areas of greatest impairment (i.e., psychological distress and mental HRQOL).

Objective: This cross-sectional study aimed to identify the prevalence and correlates of supportive care needs in testicular cancer (TC) survivors. Methods:Men who had completed active anti-cancer treatment for TC between 6 months and 5 years previously showing no evidence of recurrence were recruited from 14 Australian cancer centres (September 2009 -February 2011. Participants completed a self-report questionnaire measuring sociodemographics, disease and treatment information, supportive care needs (CaSUN), psychological distress (DASS21) and health-related quality of life (HRQOL; SF36v2).Results: Of the 486 eligible TC survivors invited to participate, 244 completed the questionnaire. Sixty-six percent reported one or more unmet supportive care needs. The mean number of unmet needs was 4.73 (SD=7.0, Range=0-34). The most common unmet needs related primarily to existential survivorship issues (e.g. life stress) and relationships (e.g. sex life). Younger age and presence of chronic illness other than TC were significantly associated with higher number of unmet needs. Number of unmet needs was more highly correlated with psychological distress and HRQOL than unmet need strength. Conclusions:The majority of TC survivors reported one or more unmet needs. Unmet needs regarding existential survivorship issues were frequently reported by TC survivors despite their favorable prognosis. Relationships unmet needs were less prevalent, but still more common than in breast and gynecological cancer survivors. These findings appear to be related to the young age of TC survivors. As higher number of unmet needs is significantly associated with psychological morbidity and impaired HRQOL, interventions addressing this constellation of issues are needed. KeywordsTesticular cancer, Survivor, Supportive care needs, Psychological distress, Health-related quality of life, Oncology 3 Introduction Testicular cancer (TC) is the most prevalent cancer (excluding skin) in men aged 15-35 years [1] and its incidence is rising, particularly among Caucasians [2]. Advances in diagnosis and treatment, particularly cisplatin-based chemotherapy, have achieved cure rates exceeding 95% [3], resulting in increasing numbers of TC survivors. There is a growing awareness of cancer survivors' supportive care needs [4], commonly defined as "the requirement of some action or resource that is necessary, desirable, or useful to attain optimal well-being" [5; p227]. Needs are considered met if the required action/resource has been provided, or unmet if not. Identification of unmet needs can guide assessment, planning and delivery of services to improve TC survivors' psychological wellbeing and health-related quality of life (HRQOL) [6].

Findings highlight the need to integrate patient/family education within improved communication, individualize care, use more nonpharmacological strategies, empower patients/families to self-manage pain, and reorganize multidisciplinary roles around patient-centered care and outcomes. These conclusions require validation via consensus and intervention trials.

Background Improved survival means that cancer is increasingly becoming a chronic disease. Understanding and improving functional outcomes are critical to optimising survivorship. We quantified physical and mental health-related outcomes in people with versus without cancer, according to cancer type. Methods Questionnaire data from an Australian population-based cohort study (45 and Up Study (n = 267,153)) were linked to cancer registration data to ascertain cancer diagnoses up to enrolment. Modified Poisson regression estimated age- and sex-adjusted prevalence ratios (PRs) for adverse person-centred outcomes—severe physical functional limitations (disability), moderate/high psychological distress and fair/poor quality of life (QoL)—in participants with versus without cancer, for 13 cancer types. Results Compared to participants without cancer (n = 244,000), cancer survivors (n = 22,505) had greater disability (20.6% versus 12.6%, respectively, PR = 1.28, 95%CI = (1.25–1.32)), psychological (22.2% versus 23.5%, 1.05 (1.02–1.08)) and poor/fair QoL (15.2% versus 10.2%; 1.28 (1.24–1.32)). The outcomes varied by cancer type, being worse for multiple myeloma (PRs versus participants without cancer for disability 3.10, 2.56–3.77; distress 1.53, 1.20–1.96; poor/fair QoL 2.40, 1.87–3.07), lung cancer (disability 2.81, 2.50–3.15; distress 1.67, 1.46–1.92; poor/fair QoL 2.53, 2.21–2.91) and non-Hodgkin’s lymphoma (disability 1.56, 1.37–1.78; distress 1.20, 1.05–1.36; poor/fair QoL 1.66, 1.44–1.92) and closer to those in people without cancer for breast cancer (disability 1.23, 1.16–1.32; distress 0.95, 0.90–1.01; poor/fair QoL 1.15, 1.05–1.25), prostate cancer (disability 1.11, 1.04–1.19; distress 1.09, 1.02–1.15; poor/fair QoL 1.15, 1.08–1.23) and melanoma (disability 1.02, 0.94–1.10; distress 0.96, 0.89–1.03; poor/fair QoL 0.92, 0.83–1.01). Outcomes were worse with recent diagnosis and treatment and advanced stage. Physical disability in cancer survivors was greater in all population subgroups examined and was a major contributor to adverse distress and QoL outcomes. Conclusions Physical disability, distress and reduced QoL are common after cancer and vary according to cancer type suggesting priority areas for research, and care and support.