Abstract
Purpose
The support needs of cancer patients vary according to the phase of their cancer journey. Recent developments in healthcare are such that the advanced cancer phase is increasingly experienced as a chronic illness phase, with consequent changes in patient support needs. Understanding these needs, and identifying areas of unmet need, can enable us to develop services that are more adequate to the task of supporting this population.
Methods
We conducted a systematic search of four electronic databases to identify studies examining the unmet needs of people living with advanced cancer. Relevant data were extracted and synthesised; meta-analyses were conducted to obtain pooled estimates for prevalence of needs.
Results
We identified 23 studies (4 qualitative) for inclusion. Unmet needs were identified across a broad range of domains, with greatest prevalence in informational (30–55 %), psychological (18–42 %), physical (17–48 %), and functional (17–37 %) domains. There was considerable heterogeneity amongst studies in terms of methods of assessment, coding and reporting of needs, respondent characteristics, and appraised study quality.
Conclusions
Heterogeneity made it difficult to compare across studies and inflated confidence intervals for pooled estimates of prevalence—we need standardised and comprehensive approaches to assessment and reporting of unmet needs to further our understanding. Nonetheless, the review identified prominent needs across a range of (interacting) experiential domains. Moreover, by focussing on unmet needs for support, we were able to extrapolate potential implications for service development.
Notes
In order to capture everyday needs of people living with advanced disease, we focussed on the chronic phase: i.e. we excluded patients considered to be at the end-stage of cancer (following the definition of chronic advanced cancer by Harley et al. [11]) or reporting acute needs at points of inpatient admission. Although increasingly experienced and recognised [11] we found (in initial scoping searches) that few studies used consistent terms or definitions to describe the pre-end-stage phase of advanced cancer; consequently, we used a broadly sensitive search but then applied exclusion criteria to enable sufficient specificity.
Eight of the quantitative studies primarily assessed needs in a single domain and were not included in the meta-analysis (which was restricted to studies applying multidimensional needs assessments).
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This work was supported by Research Capability Funding from the National Institute of Health Research, awarded via CityCare.
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The authors declare that they have no competing interests. None of the authors has a financial relationship with any organisation for which this research would present a conflict of interest. The data were in the hands of the authors at all times and are available to the journal upon request.
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Moghaddam, N., Coxon, H., Nabarro, S. et al. Unmet care needs in people living with advanced cancer: a systematic review. Support Care Cancer 24, 3609–3622 (2016). https://doi.org/10.1007/s00520-016-3221-3
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DOI: https://doi.org/10.1007/s00520-016-3221-3