Analysis of the unmet needs of Palestinian advanced cancer patients and their relationship to emotional distress: results from a cross-sectional study

Abstract

Background Although several studies assessing the needs of advanced cancer patients have been conducted globally, most have focused on a specific type of cancer such as lung or breast cancer. The variation across studies has also created difficulties in generalizing the results and applying the findings in other countries. The aim of this study was to provide comprehensive information on the needs of Palestinian advanced cancer patients. The quality of life (QOL), distress levels, depression, anxiety, and spiritual well-being of the patients were also assessed. Methods A hospital-based study with a cross-sectional design was conducted on a convenience sample of patients aged 18 or above who had been diagnosed with advanced-stage cancer. The unmet needs of the patients were assessed using the Short form of the Supportive Care Needs Survey (SCNS-SF34). Four instruments were utilized to examine their distress, anxiety, depression, QOL, and spirituality. A modified Supportive Care Framework was adopted to guide the design of this study. Descriptive statistics and hierarchical linear regression were utilized to analyse the data. Results Of the 404 cancer patients invited to the study, 379 patients consented to participate and complete the questionnaire. Of them 96.8% stated that they had at least one ‘moderate to high’ level unmet need. The most frequent unmet needs were those in the physical aspects of daily living (Mean 58.94; SD ± 20.93) and psychological (Mean 58.84; SD ± 19.49) domains. Most of the patients (91%) were physically ill and reported experiencing physical symptoms. About 78.1% had a high level of distress. Almost 90% reported signs of depression and anxiety. Although they felt that their spiritual well-being was good, their QOL was poor. Hierarchical linear regression analyses confirmed that educational level, age, gender, marital status, cancer stage, cancer type, physical symptoms, depression, anxiety, distress, QOL, and spirituality were independently associated with unmet supportive care needs. Conclusion Palestinian advanced cancer patients exhibit a significantly higher prevalence of unmet needs than those in other countries, indicating a need to develop a palliative care programme within the healthcare system. They have a great need for physical, emotional/psychosocial, self-management and other services, which should be made available to them, particularly in the routine delivery of cancer care.

Mental Adjustment, Functional Status, and Depression in Advanced Cancer Patients

“…Social factors can also play an important role in patients’ emotional state [ 36 , 39 ]. In these series, females, younger individuals, unmarried or unpartnered people, and those with recurrent cancer displayed more symptoms of depression than males, older, married patients, and those suffering from cancer for the first time, which was consistent with the literature [ 5 , 12 , 13 ]. It would be necessary for healthcare professionals to develop and implement effective measures aimed at assessing and mitigating depressive symptoms in cases of advanced cancer, thereby improving their mental health, given the high rates of depression in advanced cancer patients.…”

“…As for physical factors, people with comorbidities and other chronic conditions were at a higher risk of depression; similarly, a worse cancer stage and metastases were associated with higher rates of depression [ 12 ]. In cases of advanced cancer, younger patients and women tended to exhibit more symptoms of depression than men and older individuals [ 5 , 13 ].…”

Access to advanced cancer care services in the West Bank-occupied Palestinian territory

“…Palliative care is an essential health service within Universal Health Coverage ( 29 ) and is cost effective ( 30 ). Yet, people with advanced cancer in conflict- affected areas are especially in need of palliative care as they report compounded trauma, that of living in wars and conflicts and that of enduring the symptoms and treatments of their cancers at the same time ( 29 , 31 ). Indeed, it is concerning to note the absence of palliative care and the distress due to uncontrolled pain among cancer patients in the West Bank.…”

A distress thermometer with a cutoff score of ≥ 6 is the optimal point to identify highly distressed patients with advanced cancer stages in resource-limited countries without palliative care services

“…Lung cancer is the second most commonly diagnosed cancer in Palestine, comprising 11.4% of the total cancers ( 58 ). The fragile Palestinian HCS, shortage of healthcare professionals ( 59 ), and limited resources impede achieving optimal cancer services and meeting the needs of cancer patients, including lung cancer ( 60 , 61 ). Furthermore, Palestinian patients with lung cancer are unfortunately diagnosed at a late stage, and they experience shortness of breath, coughing up blood, and severe chest pain ( 62 ).…”