Abstract
Understanding the challenges faced by an increasing number of cancer survivors can guide the development and implementation of effective survivorship care models. To identify the physical, emotional, and practical concerns and associated unmet needs reported by cancer survivors. This cross-sectional survey study obtained data from the Experiences of Cancer Patients in Transitions Study of the Canadian Partnership Against Cancer, in collaboration with cancer agencies in the 10 Canadian provinces, that was disseminated in 2016. This analysis included only adult survivors aged 30 years or older who underwent chemotherapy, radiation therapy, surgical treatment, or a combination of these therapies for breast, prostate, colorectal, melanoma, or hematological cancer within the past 1 to 3 years. Data synthesis and quality assessment were conducted in 2017. Data analysis was completed in July 2019. The outcomes were the (1) quantification of the magnitude and multiplicity of the physical, emotional, and practical concerns of adult survivors of breast, colorectal, prostate, melanoma, or hematological cancer; (2) exploration of the magnitude of associated unmet needs; and (3) identification of patient-, treatment-, and cancer-specific factors associated with the reporting of unmet needs. Overall, 10 717 adult respondents were included (5660 [53%] female and 6367 [60%] aged ≥65 years). The median number of concerns per respondent was 6 (interquartile range [IQR], 3-10). Among respondents with concerns, help was sought for a median of 2 (IQR, 0-4) concerns. Unmet needs were reported for a median of 4 (IQR, 2-7) concerns. Emotional concerns were reported by 8330 respondents (78%), physical concerns by 9236 respondents (86%), and practical concerns by 4668 respondents (44%). At least 1 unmet need was reported by 7033 survivors (84%) with emotional concerns, 7475 (81%) with physical concerns, and 3459 (74%) with practical concerns. Age, sex, annual income, marital status, geographic location, language, and treatment type were significant factors associated with unmet needs. Survivors of melanoma cancer had a significantly higher likelihood of reporting unmet emotional needs (odds ratio [OR], 1.75; 95% CI, 1.17-2.61; P = .01), whereas survivors of prostate (OR, 0.60; 95% CI, 0.43-0.84; P < .001) and hematological (OR, 0.70; 95% CI, 0.50-0.99; P = .04) cancers were significantly less likely to report unmet needs for physical concerns when compared with breast cancer survivors. Involvement of the general practitioner combined with the oncologist in providing care was associated with a significantly lower likelihood of reporting unmet emotional (OR, 0.78; 95% CI, 0.62-1.00; P = .05) and practical (OR, 0.72; 95% CI, 0.55-0.94; P = .01) needs. The extent of unmet needs among cancer survivors found in this study suggests the need for enhancements in survivorship care, including better awareness of the realities of survivorship, earlier interventions for emerging concerns among survivors, and greater integration of cancer programs and primary care for more seamless transitions.
Highlights
The Canadian health care system is facing a critical challenge: how do we provide comprehensive follow-up care that meets the individual needs of the growing number of cancer survivors in an oftensiloed system? Currently, more than 1.6 million Canadian individuals are living after cancer treatment.1 Survival is improving for most cancers, primarily owing to early diagnosis, better staging, multimodal therapies, and improved surgical techniques
Survivors of melanoma cancer had a significantly higher likelihood of reporting unmet emotional needs, whereas survivors of prostate (OR, 0.60; 95% CI, 0.43-0.84; P < .001) and hematological (OR, 0.70; 95% CI, 0.50-0.99; P = .04) cancers were significantly less likely to report unmet needs for physical concerns when compared with breast cancer survivors
The extent of unmet needs among cancer survivors found in this study suggests the need for enhancements in survivorship care, including better awareness of the
Summary
The Canadian health care system is facing a critical challenge: how do we provide comprehensive follow-up care that meets the individual needs of the growing number of cancer survivors in an oftensiloed system? Currently, more than 1.6 million Canadian individuals are living after cancer treatment. Survival is improving for most cancers, primarily owing to early diagnosis, better staging, multimodal therapies, and improved surgical techniques. The Canadian health care system is facing a critical challenge: how do we provide comprehensive follow-up care that meets the individual needs of the growing number of cancer survivors in an oftensiloed system? Existing literature is limited, preventing a comprehensive understanding of the extent of unmet physical, emotional, and practical needs of cancer survivors at a national level. Existing survey tools do not capture the full extent of unmet needs, lacking comprehensiveness, internal consistency, content and structural validity, and a conceptual framework in the development process.. Existing survey tools do not capture the full extent of unmet needs, lacking comprehensiveness, internal consistency, content and structural validity, and a conceptual framework in the development process.19 To address this gap in knowledge, the Canadian Partnership Against Cancer, in collaboration with the 10 provincial cancer agencies, developed and disseminated the national Experiences of Cancer Patients in Transitions Study. The Canadian Partnership Against Cancer is an independent organization funded by the Canadian federal government with the long-term objectives of reducing the incidence of cancer, reducing the likelihood of dying from cancer, and improving the quality of life of those affected by cancer
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