Unmet needs in Head and Neck (H&N) cancer patients: unmet needs, emotional disorders and pain

Abstract

Background: few is known about head and neck (H&N) patients (pts)’ unmet needs (UNs) and about their association with debilitating symptomatologies that worse quality of life (QoL), adherence to treatments and prognosis. Caregivers (cgs)’ recognition of pts’ needs is much less assessed. The aim of the research was to investigate the main H&N pts’ UNs and their possible link with pain, anxiety, depression and distress. Besides, the study conducted an investigation on cgs’, nurses (nrs)’ and oncologist (onc)’s capacity of understanding pts’ needs, as regards five macro-areas: psychological (PsA), communicative (CmA), physical (PhA), social/health care (ShA) and sexuality (SxA). Methods: we surveyed 100 H&N pts during the active phase of chemotherapeutical treatment; 59 cgs, 6 nrs and 1 onc. The instruments used were: Hospital Anxiety and Depression Scale (HADS), Distress Thermometer (DT), a survey on somatic and emotional symptoms (sx) perceived by pts in the last 24 hours and Supportive Care Needs Survey-short Form (SCNS-SF34). Results: UNs in PsA were associated with somatic and emotional sx (c2=10.213,p<.01); UNs in CmA with pain (c2=5.260,p<.05); UNs in PhA with pain (c2=9.962,p<.01) and somatic and emotional sx (c2=6.760,p<.01); UNs in ShA with distress (c2=4.459,p<.05), anxious symptomatology (c2=4.071,p<.05) and pain (c2=14.733,p<.01); UNs in SxA with anxious symptomatology (c2=7.328,p<.01) and pain (c2=4.833,p<.05). Worry about the future was associated with distress (c2=5.929,p<.05) and anxious symptomatology (c2=17.189,p<.01); incapacity of doing usual things with distress (c2=6.540,p<.05), pain (c2=7.366,p<.01) and anxious symptomatology (c2=4.854,p<.05); concerns about the worries of people close to patient with pain (c2=12.953,p<.01) and depressive symptomatology (c2=4.529,p<.05); lack of energy with pain (c2=22.335,p<.01); fears about cancer spreading with anxious symptomatology (c2=12.815,p<.01); feelings about death and dying with anxious (c2=6.451,p<.05) and depressive symptomatology (c2=5.317,p<.05). As regards cgs, nrs and onc just cgs detected the presence of pts’ UNs in the PsA, in the PhA and in the SxA. There were many missing in the SxA regarding nrs’ and onc’s answers. Conclusions: Several UNs can negatively impact the H&N pts’ QoL. The awareness of such association between somatic, emotional and social aspects of pts’ dissatisfaction can steer health team to a more focused clinical intervention.