Psychosocial impact of cancer and its treatment
Unmet supportive care needs are prevalent among cancer patients
Potential to reduce unmet needs through timely identification and tailored intervention
Methods
Definition of unmet needs
Aim 1: examining trends in the number of unmet needs publications over time
Literature search
Inclusion criteria for examination of trends in the number of publications on unmet needs
Aim 2: systematic review of intervention studies
Literature search
Inclusion and exclusion criteria
Results
Aim 1
Aim 2
Reference | Aim and study design | Setting and sample | Description of intervention | Needs measure | Results |
---|---|---|---|---|---|
McLachlan et al. 2001 [35] | To determine whether providing the health care team with a report on patients’ perceived cancer needs (primary outcome), QoL, and psychosocial information would reduce cancer needs | 450 cancer patients (mixed cancer types) recruited from an outpatient clinic | For intervention participants, a computer-generated, one-page summary of their baseline survey results was generated immediately for discussion with their doctor. The intervention nurse was present at the consultation and, following the consultation, developed an individualized management plan based on the needs identified in the summary | CNQ short form | Of the 14 comparisons on the needs measure, the only difference found was on the spiritual need item at 6 months. This difference was in favor of the control group—mean improvement in spiritual needs was 6.6 lower in the intervention group compared to the control group |
RCT | Country: Australia | The management plan followed prespecified referral pathways developed by a multidisciplinary team. The nurse implemented the management plan and initiated referrals as appropriate | Compared changes in domain scores at 2 and 6 months post-randomization | ||
Control group participants received usual care, hence their health care team was not provided with a summary of their baseline results | |||||
Allen et al. 2002 [37] | To examine whether a problem-solving intervention for younger women with breast cancer was effective in reducing unmet needs and emotional distress | 164 breast cancer patients aged 50 or younger identified from clinic records and recruited by telephone. Patients were also asked to nominate a primary support person who was also invited to participate | Intervention participants and their primary support person (if nominated), received a problem-solving intervention delivered over six sessions by an oncology nurse. The first and last sessions took place in the patient’s home or convenient location (2 h each). Four telephone sessions 2 weeks apart were scheduled in the intervening period | CARES | No statistically significant difference between the groups on the CARES global and subscale scores were observed at either follow-up assessment |
RCT | Country: USA | The content of the intervention covered skills in defining and analyzing problems, generating alternative strategies to address the problem, deciding on a strategy, implementation of a strategy, and evaluation of its success | Compared changes in CARES scores at 4 and 8 months’ post-randomization | Post hoc subgroup analyses indicated that, compared to control group women with high problem-solving skills, experimental group women with high problem-solving skills had better scores on one subscale at 4-month follow-up and better scores on the global CARES scores on four out of the five subscales at 8-month follow-up. Conversely, control group participants who had poorer coping skills at baseline performed better than intervention group participants with poor coping skills at 8-month follow-up on three out of five subscales | |
Control group participants received unspecified usual care | |||||
Boyes et al. 2005 [36] | To examine the effect of providing medical oncologists immediate feedback about cancer patient’s self-reported psychosocial well-being on patients’ anxiety, depression, perceived needs, and physical symptoms | 80 cancer patients (mixed cancer types) recruited from a medical oncology clinic | Both intervention and control participants completed the SCNS-34 via touch screen computer at four consecutive consultations (first, baseline visit and three follow-up visits or until the end of the chemotherapy course, depending on which occurred first) | SCNS-34 (short form) | No significant difference on any of the need domains between the arms at follow-up visits |
Quasi-RCT | Country: Australia | For the intervention participants only, the computer-generated feedback report of their results was placed in the patient’s file and available for the doctor to discuss with the patient during the consultation | Compared average number of moderate or high needs per domain, across the visits | ||
Aranda et al. 2006 [30] | To examine the effectiveness of a brief, nurse-delivered intervention designed to address the needs of women with advanced breast cancer | 105 women with advanced breast cancer recruited from one of four participating outpatient clinics | Intervention participants received | Supportive Care Needs Survey (SCNS) | No significant differences between groups were found on any of the SCNS domain scores at 1 or 3 month follow-up |
RCT | Country: Australia | 1. An hour face-to-face session with a breast care nurse. Needs identified by the SCNS were prioritized and tailored responses were provided, including coaching and practicing self-care strategies for identified issues. A self-care plan was provided, along with written information and a relaxation CD. A written summary of the session was provided to the treating doctor and placed in the medical record | Compared changes in domain scores at 1 and 3 months post-baseline | Post hoc analyses showed a greater decrease from baseline to follow-up in psychological needs for intervention participants with baseline psychological needs scores over 50 than for control participants with scores over 50 at baseline | |
2. A follow-up, telephone session a week later with the nurse to check whether the strategies had been effective in addressing concerns, discuss lingering or new concerns, modify and reinforce self-care strategies or address new concerns as needed | |||||
Control group participants were also referred to a breast care nurse; however, he/she was not trained in the intervention procedures | |||||
McVean et al. 2007 [34] | To examine the acceptability and potential effectiveness of the Pathfinder Program, a telephone-based, volunteer-delivered support intervention | 52 colorectal cancer patients recruited via a state-based cancer registry | Intervention participants were contacted by telephone at least twice by a trained volunteer, called a “Pathfinder”, once after completion of the initial survey at baseline and 3 months thereafter. Prior to the initial call, participants received a tailored summary of their baseline survey results. Pathfinders were also sent a letter summarizing participants’ survey results and, during the phone call, worked with participants to clarify their needs and identify strategies to address these. A copy of the summary was sent to the participant’s doctor with his/her permission. At the follow-up call, after the second survey, pathfinders reviewed the success of each strategy with participants | SCNS | The decrease in average number of needs from baseline to 3-month follow-up was greater for intervention than for control participants |
Quasi-RCT (pilot) | Country: Australia | Control group participants received a letter informing them of their allocation to this group and received usual care | Nine-item colorectal cancer symptom checklist developed for the purpose of this study | ||
Compared the decrease in mean SCNS needs from baseline to 3-month follow-up | |||||
Girgis et al. 2009a [31] | To examine the efficacy of two supportive care intervention models, telephone caseworker, and oncologists/GP, in decreasing anxiety, depression, and unmet needs and improving QoL | 356 patients with nonlocalized breast or colorectal cancer were recruited from the NSW Central Cancer Registry | A baseline computer-assisted telephone interview (CATI) was used to generate a feedback sheet, which include a summary page of concerns and issues and suggestions for management strategies. This summary page was then forwarded to either a caseworker or oncologist/GP (according to group allocation). Participants did not receive copies of their own feedback sheets | SCNS-34 (short form) | Although a trend toward decreased needs in the telephone caseworker group was evident at 6 months, there were no significant differences in the percentage of participants experiencing at least one unmet need between the groups, across time |
RCT | Country: Australia | Telephone caseworker—oncology nurses with telephone counseling training, based at the Cancer Council NSW helpline service telephoned participants to discuss reported issues identified on the feedback sheet and used the modified helpline database to refer them to appropriate resources/services. Caseworkers followed up at 6-week intervals to assess coping | 10 items from the NA-ACP | ||
Oncologist/GP—two hard copies of the feedback sheet generated from the CATIs were mailed to the participant’s nominated oncologist and GP for discussion at their next appointment. Clinicians were asked to keep one feedback sheet for their records and to return the second one to track which concerns were discussed and if any actions were taken | Compared percentage of participants experiencing at least one unmet supportive care need at 3 and 6 months post-baseline | ||||
Control group participants received standard care | |||||
King et al. 2009 [32] | To examine the effectiveness of an intervention designed to improve patient continuity of care | 93 cancer patients (mixed cancer types) recruited from an outpatient clinic | Those allocated to receive the full intervention (arm 1) completed a 17-item continuity assessment. Patients were asked to tick a box indicating which items/issues they wished to discuss with the clinical team. Participants could list up to four additional issues. Feedback on the patient’s assessment was then provided to the clinical nurse specialist, and any resulting actions were documented | SCNS | A trend toward a greater reduction in unmet needs from the control group (highest) to the full intervention group (lowest) was observed at 6-week follow-up across the SCNS need domains; however, these differences were not statistically significant |
Three-arm pilot RCT | Country: England | Those allocated to the partial intervention (arm 2) completed the 17-item checklist; however, no feedback was given to the clinical team | Compared unmet needs at baseline and 6 weeks post-intervention | ||
Participants in the control arm (arm 3) received standard care | |||||
Scandrett et al. 2010 [33] | To examine whether feedback on a needs assessment to the clinical team improves documentation of needs, reported needs, and processes of care related to needs | 451 cancer inpatients (mixed cancer types) were recruited from oncology service of an urban, academic tertiary care hospital | Intervention participants: (1) completed the NEST13+ by face-to-face interview on admission to the hospital and (2) NEST13+ responses were used to derive recommended clinical responses, which were communicated to their medical team the next day | NEST13+ | No significant differences were found between groups in any dimension of the NEST13+ at discharge |
Quasi-RCT | Country: USA | Usual-care participants completed a “sham” interview comprising of 12 questions about satisfaction with the admission process and facilities | Compared NEST13+ admission and discharge interviews | ||
White et al. 2011 [29] | To examine the effectiveness of the Pathfinder Program, a telephone-based, volunteer-delivered support intervention, in reducing the prevalence of unmet supportive care needs and elevated levels of anxiety and depression among people with colorectal cancer over a 9-month period | 653 colorectal cancer patients recruited via a state-based cancer registry | Participants completed surveys at baseline and at 3- and 6-month follow-up. After each of these surveys, intervention participants were contacted by a Pathfinder. The content of the intervention at each contact is described in McVean’s pilot study above | SCNS | No differences were found between the intervention and control groups for the proportion of moderate or high unmet needs at any follow-up |
RCT | Country: Australia | Control group participants received a letter informing them of their allocation to this group and received usual care | Nine-item colorectal cancer symptom checklist developed for the purpose of this study | ||
Compared percent of participants in the intervention and usual-care group with any priority unmet needs. Follow-up assessments were at 3, 6, and 9 months post-baseline |