Evaluation of Factors Associated With Unmet Needs in Adult Cancer Survivors in Canada
Evaluation of Factors Associated With Unmet Needs in Adult Cancer Survivors in Canada
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DOI：
10.1001/jamanetworkopen.2020.0506
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发表时间：
2020-03-06
影响因子：
13.8
通讯作者：
Finley, Christian
中科院分区：
文献类型：
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作者：
Shakeel, Saad;Tung, Jasmine;Finley, Christian
重要性 了解越来越多的癌症幸存者面临的挑战可以指导有效的幸存者护理模式的开发和实施。目的 确定癌症幸存者报告的身体、情感和实际问题以及相关的未满足需求。设计、背景和参与者 这项横断面调查研究从加拿大抗癌合作伙伴关系与加拿大 10 个省份的癌症机构合作进行的癌症患者转型经历研究中获得了数据，该研究于 2016 年发布。该分析仅包括 30 岁或以上接受化疗、放疗、手术治疗或这些疗法组合的乳腺癌、前列腺癌、癌症患者和癌症患者。 过去 1 至 3 年内患有结直肠癌、黑色素瘤或血液癌。数据合成和质量评估于 2017 年进行。数据分析于 2019 年 7 月完成。 主要成果和措施 结果是（1）对乳腺癌、结直肠癌、前列腺癌、黑色素瘤或血液癌成年幸存者的身体、情感和实际问题的程度和多样性进行量化； (2) 探索相关未满足需求的程度； (3) 识别与报告未满足的需求相关的患者、治疗和癌症特定因素。结果 总体而言，纳入了 10 & x202f;717 名成年受访者（5660 [53%] 女性和 6367 [60%] 年龄 >= 65 岁）。每个受访者的关注点中位数为 6（四分位距 [IQR]，3-10）。在有疑虑的受访者中，寻求帮助的疑虑中位数为 2（IQR，0-4）。据报告，未满足的需求中位数为 4 个（IQR，2-7）。 8330 名受访者 (78%) 报告了情感问题，9236 名受访者 (86%) 报告了身体问题，4668 名受访者 (44%) 报告了实际问题。 7033 名幸存者 (84%) 报告了至少 1 项未得到满足的需求，其中有情感问题、7475 名幸存者 (81%) 有身体问题、3459 名幸存者 (74%) 有实际问题。年龄、性别、年收入、婚姻状况、地理位置、语言和治疗类型是与未满足需求相关的重要因素。黑色素瘤幸存者报告情感需求未得到满足的可能性显着较高（比值比 [OR]，1.75；95% CI，1.17-2.61；P = .01），而前列腺癌幸存者（OR，0.60；95% CI，0.43-0.84；P < .001）和血液学幸存者（OR，0.70；95% CI， 0.50-0.99； P = .04) 与乳腺癌幸存者相比，癌症患者报告身体问题未得到满足的需求的可能性显着降低。全科医生与肿瘤科医生联合参与提供护理与报告未满足的情感需求（OR，0.78；95% CI，0.62-1.00；P = .05）和实际需求（OR，0.72；95% CI，0.55-0.94；P = .01）需求的可能性显着降低相关。结论和相关性 本研究中发现的癌症幸存者未满足的需求程度表明，需要加强幸存者护理，包括更好地认识幸存者的现实，对幸存者中新出现的问题进行早期干预，以及更好地整合癌症计划和初级保健以实现更无缝的过渡。问题 加拿大癌症幸存者的医疗保健需求在治疗结束后是否得到满足？结果 在这项针对参与癌症患者转变研究的 10 & x202f;717 名成年癌症幸存者的横断面调查研究中，在情感、身体和实际领域报告医疗保健问题的 10 名受访者中，近 8 名也表示支持水平不足，不同癌症类型之间的差异很小。幸存者同时面临的问题中位数为 6 个，但没有寻求帮助或无法为中位数为 4 个的问题提供帮助。意义 这项研究的结果表明，越来越多的癌症幸存者存在大量未满足的需求，这凸显了加强或实施幸存者护理模式的必要性，其中涉及综合护理和癌症治疗的平稳过渡。这项横断面调查研究分析了加拿大成年癌症幸存者的全国性调查结果，包括治疗结束后一年或更长时间的身体、情感和实际问题以及相关的未满足需求。
Importance Understanding the challenges faced by an increasing number of cancer survivors can guide the development and implementation of effective survivorship care models. Objective To identify the physical, emotional, and practical concerns and associated unmet needs reported by cancer survivors. Design, Setting, and Participants This cross-sectional survey study obtained data from the Experiences of Cancer Patients in Transitions Study of the Canadian Partnership Against Cancer, in collaboration with cancer agencies in the 10 Canadian provinces, that was disseminated in 2016. This analysis included only adult survivors aged 30 years or older who underwent chemotherapy, radiation therapy, surgical treatment, or a combination of these therapies for breast, prostate, colorectal, melanoma, or hematological cancer within the past 1 to 3 years. Data synthesis and quality assessment were conducted in 2017. Data analysis was completed in July 2019. Main Outcomes and Measures The outcomes were the (1) quantification of the magnitude and multiplicity of the physical, emotional, and practical concerns of adult survivors of breast, colorectal, prostate, melanoma, or hematological cancer; (2) exploration of the magnitude of associated unmet needs; and (3) identification of patient-, treatment-, and cancer-specific factors associated with the reporting of unmet needs. Results Overall, 10 & x202f;717 adult respondents were included (5660 [53%] female and 6367 [60%] aged >= 65 years). The median number of concerns per respondent was 6 (interquartile range [IQR], 3-10). Among respondents with concerns, help was sought for a median of 2 (IQR, 0-4) concerns. Unmet needs were reported for a median of 4 (IQR, 2-7) concerns. Emotional concerns were reported by 8330 respondents (78%), physical concerns by 9236 respondents (86%), and practical concerns by 4668 respondents (44%). At least 1 unmet need was reported by 7033 survivors (84%) with emotional concerns, 7475 (81%) with physical concerns, and 3459 (74%) with practical concerns. Age, sex, annual income, marital status, geographic location, language, and treatment type were significant factors associated with unmet needs. Survivors of melanoma cancer had a significantly higher likelihood of reporting unmet emotional needs (odds ratio [OR], 1.75; 95% CI, 1.17-2.61; P = .01), whereas survivors of prostate (OR, 0.60; 95% CI, 0.43-0.84; P < .001) and hematological (OR, 0.70; 95% CI, 0.50-0.99; P = .04) cancers were significantly less likely to report unmet needs for physical concerns when compared with breast cancer survivors. Involvement of the general practitioner combined with the oncologist in providing care was associated with a significantly lower likelihood of reporting unmet emotional (OR, 0.78; 95% CI, 0.62-1.00; P = .05) and practical (OR, 0.72; 95% CI, 0.55-0.94; P = .01) needs. Conclusions and Relevance The extent of unmet needs among cancer survivors found in this study suggests the need for enhancements in survivorship care, including better awareness of the realities of survivorship, earlier interventions for emerging concerns among survivors, and greater integration of cancer programs and primary care for more seamless transitions.Question Are the health care needs of cancer survivors in Canada being met after the end of their treatment? Findings In this cross-sectional survey study of 10 & x202f;717 adult cancer survivors who participated in the Experiences of Cancer Patients in Transitions Study, almost 8 of 10 respondents who reported health care concerns across emotional, physical, and practical domains also reported an inadequate level of support, with minimal differences across cancer types. Survivors also faced a median of 6 concerns concurrently, but help was not sought or was not available for a median of 4 concerns. Meaning Findings from this study suggest that a high level of unmet need exists among a growing number of cancer survivors, highlighting the need to enhance or implement survivorship care models that involve integrated care and a smoother transition from cancer treatment.This cross-sectional survey study analyzes findings from a nationwide survey of adult cancer survivors in Canada, including the physical, emotional, and practical concerns and associated unmet needs 1 year or more after the end of treatment.