Study of unmet needs in symptomatic veterans with advanced cancer: incidence, independent predictors and unmet needs outcome model

Abstract

Veteran patients possess distinctive characteristics such as a higher mortality rate, lower socioeconomic status and poorer health status. We report the prevalence and predictors of unmet needs and examine the association between unmet needs and quality of life (QOL). Two hundred ninety-six male cancer patients who presented with distressing symptom(s) completed the following instruments: a 14-item multidimensional unmet needs questionnaire, Functional Assessment of Cancer Therapy (FACT-G), Memorial Symptom Assessment Scale-Short Form (MSAS-SF) and other validated measurements of function, depression, health and social support. Multiple linear regression models were used to identify independent predictors of each unmet needs domain and of total unmet needs. The relationships between total unmet needs, QOL and multidimensional variables were also explored. The median number of total unmet needs was three, and the most frequently reported unmet needs areas were physical (80.0%), activities of daily living (53.3%), nutrition (46.1%) and emotional (32.5%). Different predictors of each unmet needs domain were identified. Younger age was associated with a higher risk of unmet needs in physical, economic and medical domains. Higher psychological symptom distress was associated with more unmet needs in the emotional/social, economic and medical domains. Physical symptom distress, extent of disease and health measure were only significant in the physical unmet needs domain. The depression, psychological and physical symptom distress scores, confident and affective social support scores, total unmet needs and age independently predicted FACT-G total QOL score (R(2)=63%, P < 0.00001). Patients with higher psychological, physical symptom distress and depression scores, younger age, lower functional status and metastatic disease were more likely to report more unmet needs. The total number of unmet needs was predictive of QOL. The unmet needs and QOL outcomes model was developed but needs further validation.

Prevalence of pain in patients with cancer: a systematic review of the past 40 years

“…In 46 studies, (part of) the aim of the study had been to determine the prevalence of pain in cancer patients. This had not been a primary goal in the other eight studies [11,13,49,65,71,73,75,82,84]. One study looked at unmet needs, one described the experiences of a palliative care programme, two compared usual care with intensive care, one was on the influence of demographic and disease specific variables on pain and one compared differences in symptoms between cancer and noncancer patients.…”

The Effect of Stress and Depression on Unmet Medical Needs

“…[34][35][36] For instance, a study about the survivors of World Trade Center terrorist attacks reported that one-third of people who had posttraumatic stress disorder or depression experienced UMN.…”

A comparison of the FACT-G and the Supportive Care Needs Survey (SCNS) in women with ovarian cancer: unidimensionality of constructs

“…While oncological studies increasingly include both HRQoL and needs questionnaires [4][5][6][7][8][9][10][11][12][13], few studies have compared the two approaches and these comparisons have primarily involved correlational analysis alone [4; 7; 8; 11; 12].…”