Originally published as JCO Early Release 10.1200/JCO.2009.22.5151 on November 2 2009

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Patients' Supportive Care Needs Beyond the End of Cancer Treatment: A Prospective, Longitudinal Survey

From the Florence Nightingale School of Nursing and Midwifery, King's College London; Cancer Services, Guy's and St Thomas' NHS Foundation Trust; National Cancer Research Institute, Psycho-Social Oncology Clinical Studies Group, London; Cancer Services, Royal United Hospital Bath National Health Service (NHS) Trust, Bath; Oncology Centre, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire; Division of Specialised Services, University Hospitals Bristol NHS Foundation Trust, Bristol; and the 3 Counties Cancer Network, Cheltenham, United Kingdom.

Corresponding author: Jo Armes, PhD, MSc, RN, Florence Nightingale School of Nursing and Midwifery, Division of Health and Social Care Research, King's College London, Rm 3.21, James Clerk Maxwell Bldg, 57 Waterloo Rd, London SE1 8WA; e-mail: jo.armes{at}kcl.ac.uk.

Purpose To estimate prevalence and severity of patients' self-perceived supportive care needs in the immediate post-treatment phase and identify predictors of unmet need.

Patients and Methods A multicenter, prospective, longitudinal survey was conducted. Sixty-six centers recruited patients for 12 weeks. Patients receiving treatment for the following cancers were recruited: breast, prostate, colorectal, and gynecologic cancer and non-Hodgkin's lymphoma. Measures of supportive care needs, anxiety and depression, fear of recurrence, and positive and negative affect were completed at the end of treatment (T0) and 6 months later (T1).

Results Of 1,850 patients given questionnaire packs, 1,425 (79%) returned questionnaires at T0, and 1,152 (62%) returned questionnaires at T1. Mean age was 61 years; and most respondents were female (69%) and had breast cancer (57%). Most patients had no or few moderate or severe unmet supportive care needs. However, 30% reported more than five unmet needs at baseline, and for 60% of these patients, the situation did not improve. At both assessments, the most frequently endorsed unmet needs were psychological needs and fear of recurrence. Logistic regression revealed several statistically significant predictors of unmet need, including receipt of hormone treatment, negative affect, and experiencing an unrelated significant event between assessments.

Conclusion Most patients do not express unmet needs for supportive care after treatment. Thirty percent reported more than five moderate or severe unmet needs at both assessments. Unmet needs were predicted by hormone treatment, negative mood, and experiencing a significant event. Our results suggest that there is a proportion of survivors with unmet needs who might benefit from the targeted application of psychosocial resources.

Supported by Macmillan Cancer Support and King's College London.

Presented in part at the 2nd COMPASS Annual Scientific Meeting, June 17, 2008, Edinburgh, United Kingdom; United Kingdom Oncology Nursing Society Conference, July 13, 2007, London, United Kingdom; National Cancer Research Institute Conference, September 30-October 3, 2007, Birmingham, United Kingdom; and 14th European Cancer Conference of the European Cancer Organization, September 23-27, 2007, Barcelona, Spain.

The analysis, opinions, and assertions contained herein are those of the authors and are not to be construed as reflecting the views or position of Macmillan Cancer Support or King's College London.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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