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

Abstract

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.

Risk factors of unmet needs among women with breast cancer in the post‐treatment phase

“…Based on our results, chemotherapy may especially have longer lasting direct effects on unmet need in the sexuality domain. This finding might be breast cancer‐specific . The result is consistent with the widely held belief that both physicians and patients can be reluctant to openly discuss sexuality problems due to cancer or its treatment.…”

“…Two studies with a cancer‐specific samples (ie, women with gynecologic or endometrial cancer) found a significant association between stage and unmet needs, as measured around 4 years after diagnosis, while one study did not. Comparable studies with breast cancer, other, or mixed cancer samples often lacked information on the cancer stage at diagnosis, and did not examine its influence on separate unmet need domains post‐treatment. Only 3% of our participants were diagnosed with cancer stage 3 or 4, which meant that we could not examine the influence of later cancer stages on women's levels of unmet needs.…”

“…With regard to the sociodemographic factors, there is strong evidence that younger age is associated with a higher number of unmet needs after cancer treatment. 11,33 Additionally, two studies among early cancer survivors reported associations between younger age and specific unmet need domains, namely the patient care and support, and the relationship/sexuality domain. 11 In contrast, our study showed a small but significant direct association between higher age and higher levels of unmet need in the health system-related and informational domain.…”

“…Patients' need for support may rise as they may miss regular contact with health care professionals and/or experience treatment‐induced side effects . Therefore, more prospective studies regarding risk factors of specific unmet need domains in the post‐treatment phase are required …”

“…10 Therefore, more prospective studies regarding risk factors of specific unmet need domains in the post-treatment phase are required. 11 Furthermore, health care needs, by definition, refer to problems that require an action or additional care resources to achieve optimal well-being. 8,9,12 This implies that received care resources and one's level of unmet need may be associated.…”