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      The unfulfilled promise: a systematic review of interventions to reduce the unmet supportive care needs of cancer patients

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          Abstract

          Purpose

          This review aimed to examine (a) trends in the number of publications on unmet needs over time and (b) the effectiveness of interventions designed to reduce unmet needs among cancer patients.

          Methods

          An electronic literature search of Medline to explore trends in the number of publications on patients’ unmet needs and an additional literature search of Medline, CINAHL, PsychINFO, and Web of Science databases to identify methodologically rigorous research trials that evaluated interventions to reduce unmet needs were conducted.

          Results

          Publications per year on unmet needs have increased over time, with most being on descriptive research. Nine relevant trials were identified. Six trials reported no intervention effect. Three trials reported that intervention participants had a lower number of unmet needs or lower unmet needs score, compared to control participants. Of these, one study found that the intervention group had fewer supportive care needs and lower mean depression scores; one study found that intervention participants with high problem-solving skills had fewer unmet needs at follow-up; and one study found an effect in favor of the intervention group on psychological need subscale scores.

          Conclusions

          Reasons for varying results across trials and the limited effectiveness of unmet needs interventions are more broadly discussed. These include inadequacies in psychometric rigor, problems with scoring methods, the use of ineffective interventions, and lack of adherence to intervention protocols.

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          Most cited references39

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          The prevalence of psychological distress by cancer site.

          The goal of this project was to determine the prevalence of psychological distress among a large sample of cancer patients (n=4496). In addition, variations in distress among 14 cancer diagnoses were examined. The sample was extracted from a database that consists of 9000 patients who completed the Brief Symptom Inventory as a component of comprehensive cancer care. Relevant data points for each case included age, diagnosis, gender, insurance status, marital status, race and zip code. Simple frequencies, percentages, measures of central tendency and variability were calculated. In addition, a univariate and multiple regression analysis was used to examine the relationships of these relevant variables to psychological distress. The overall prevalence rate of distress for this sample was 35.1%. The rate varied form 43.4% for lung cancer to 29.6% for gynecological cancers. While some rates were significantly different, diagnoses with a poorer prognosis and greater patient burden produced similar rates of distress. Pancreatic cancer patients produced the highest mean scores for symptoms such as anxiety and depression, while Hodgkin's patients exhibited the highest mean scores for hostility. These results offer vital support for the need to identify high-risk patients through psychosocial screening in order to provide early intervention. To simply perceive cancer patients as a homogeneous group is an erroneous assumption. Failure to detect and treat elevated levels of distress jeopardizes the outcomes of cancer therapies, decreases patients' quality of life, and increases health care costs. Copyright 2001 John Wiley & Sons, Ltd.
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            Brief assessment of adult cancer patients' perceived needs: development and validation of the 34-item Supportive Care Needs Survey (SCNS-SF34).

            This study aimed to develop and validate a short version of the Supportive Care Needs Survey (SCNS) that would reduce respondent burden and could be used in routine cancer care, without compromising the psychometric properties of the original instrument. Secondary analyses of the data from two studies (n = 888 and 250) were undertaken. All 59 items of the original SCNS were assessed using psychometric analyses and evaluated for clinical utility. The 34 items retained were examined for internal consistency, ceiling and floor effects, known groups validity, convergent validity, sensitivity and readability. The 34-item instrument has five factors (psychological, health system and information, physical and daily living, patient care and support, and sexuality needs) identical to the original instrument, explaining 73% of the variance. Internal consistency was high with Cronbach's alpha coefficients for the five factors ranging from 0.86 to 0.96. Correlations of the 34-item short-form SCNS (SCNS-SF34) with three other measures of psychosocial well-being demonstrated convergent validity (r = 0.48-0.56). Kappa coefficients of at least 0.83 for each domain indicated almost perfect agreement between the 34-item and 59-item surveys to identify patients needing help. The 34-item SCNS maintained the psychometric properties of the original instrument and could be readily comprehended by people with seventh to eighth grade education. The SCNS-SF34 is a valid instrument for measuring cancer patients' perceived needs across a range of domains, and could be utilized as part of routine cancer care.
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              The development and evaluation of a measure to assess cancer survivors' unmet supportive care needs: the CaSUN (Cancer Survivors' Unmet Needs measure).

              Many cancer survivors experience ongoing morbidity over the survivorship continuum and their supportive care needs have yet to be comprehensively assessed. This study aimed to develop and empirically evaluate a self-report measure of cancer survivors' supportive care needs. In Phase I, questionnaire items were generated based upon previous qualitative research that identified both unique and shared needs in survivors and their partners; items were constructed into the Cancer Survivors' Unmet Needs measure (CaSUN). In Phase 2, the CaSUN was completed by 353 cancer survivors who had been diagnosed with cancer between 1 and 15 years earlier and were currently disease-free. After modification, the CaSUN included 35 unmet need items, 6 positive change items and an open-ended question. Good acceptability, internal consistency and validity were demonstrated, although test-retest reliability was low. Maximum likelihood factor analysis identified five discrete factors: Existential Survivorship, Comprehensive Care, Information, Quality of Life and Relationships. Preliminary data indicates that the CaSUN meets the majority of psychometric criteria for assessment measures, although its low test-retest reliability awaits further investigation. The CaSUN will facilitate the evaluation of supportive care services and generation of service delivery recommendations for cancer survivors. Copyright 2006 John Wiley & Sons, Ltd.
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                Author and article information

                Contributors
                +61-2-49138320 , +61-2-49138779 , Mariko.Carey@newcastle.edu.au
                Journal
                Support Care Cancer
                Supportive Care in Cancer
                Springer-Verlag (Berlin/Heidelberg )
                0941-4355
                1433-7339
                17 November 2011
                17 November 2011
                February 2012
                : 20
                : 2
                : 207-219
                Affiliations
                [1 ]Priority Research Centre for Health Behavior, Faculty of Health, University of Newcastle, Room 266, Level 2, David Maddison Building, University Drive, Callaghan, NSW Australia 2308
                [2 ]Priority Research Centre for Health Behavior, Faculty of Health, University of Newcastle, Room 230A, Level 2, David Maddison Building, University Drive, Callaghan, NSW Australia 2308
                [3 ]Priority Research Centre for Health Behavior, Faculty of Health, University of Newcastle, Room 264, Level 2, David Maddison Building, University Drive, Callaghan, NSW Australia 2308
                [4 ]Priority Research Centre for Health Behavior, Faculty of Health, University of Newcastle, Room 268, Level 2, David Maddison Building, University Drive, Callaghan, NSW Australia 2308
                [5 ]Priority Research Centre for Health Behavior, Faculty of Health, University of Newcastle, Room 267, Level 2, David Maddison Building, University Drive, Callaghan, NSW Australia 2308
                [6 ]Priority Research Centre for Health Behavior, Faculty of Health, University of Newcastle, Room 260, Level 2, David Maddison Building, University Drive, Callaghan, NSW Australia 2308
                Article
                1327
                10.1007/s00520-011-1327-1
                3244607
                22089430
                5dfdd618-0479-4ee0-8df6-6fda72afa217
                © The Author(s) 2011
                History
                : 16 August 2011
                : 1 November 2011
                Categories
                Review Article
                Custom metadata
                © Springer-Verlag 2012

                Oncology & Radiotherapy
                cancer,intervention,review,oncology,needs assessment,unmet needs
                Oncology & Radiotherapy
                cancer, intervention, review, oncology, needs assessment, unmet needs

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