CANCER PATIENTS TREATMENT AND CONCRETE SERVICE NEEDS

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Evidence suggests cancer patients develop needs for concrete services when their disease recurs, advances, and/or when potentially toxic anti-tumor treatment is initiated. This process can begin either immediately or long after the time of initial diagnosis. Concrete needs can be classified into three groups: personal care; instrumental assistance; and help with administrative problems. The proposed project seeks to conduct a comprehensive needs assessment using a common instrument to be developed jointly with the National Cancer Institute of five hundred (500) patients undergoing treatment in a hospital-based medical oncology clinic or from participating community oncologists. Analyses of these survey data will be used to test the hypothesis that patients at risk of having unmet concrete service needs are those with functional deficits and with poor supports. Following the survey, we will initiate a prospective randomized clinical trial of the effects of a short-term case management and patient education program on at-risk cancer patients. A total of 250 patients drawn from clinic and private oncologists' caseloads will be randomized, and half will receive up to a three-month intervention. A pre/post-experimental design will measure the following outcomes at 3 and 6 months post-randomization; unmet needs, treatment compliance, disability days, service utilization, and service cost.