Aims: We have previously reported on the components of survivorship care ranked as most important by adult cancer survivors, and their unmet needs in each of these areas. This report describes predictors of multiple unmet needs, and levels of comfort in addressing these issues with general practitioners (GPs) and cancer specialists.
Methods: A cross-sectional survey was mailed to adult cancer survivors from 5 NSW oncology units. Self-report data were obtained regarding current care (provider and frequency of visits); ranking of physical, psychological and practical areas of importance to survivors; how well their needs were met in each of these areas; and whom among a range of care providers they would be happy to see regarding each issue. Univariate and multivariate logistic regression analyses were undertaken to assess for demographic and clinical variables associated with 4 or more unmet care needs.
Results: 228 surveys were returned (ongoing, response rate 50.5% to date). Respondents had a mean age of 59.3 years (range 32-87), 71.5% were female, with most common primary cancers being breast (71.5%), colorectal (13.9%), prostate (4.5%) and ovarian (2.2%). The most commonly reported unmet needs were information about late effects (50.3%), managing fatigue (41.7 %), genetic risk to family (34.7%), reassurance (32.0 %) and diet (31.4 %). The median number of unmet needs was 4 (range 0-23). On univariate analysis, female gender, younger age and tertiary education were associated with higher levels of unmet needs (p<0.001, p=0.11 and p=0.013). Marital status, tumour type and treatment modalities were not associated with needs, although we acknowledge limitations due to breast cancer predominance in this cohort. On multivariate analysis higher education (p=0.042) remained independently associated with higher unmet needs. Survivors were more likely to discuss the following issues with their oncologist than their GP: cancer treatment (89.9% vs 40.1%), follow-up care (80.8% vs 42.4%), frequency of check-ups (87.8% vs 28.5%) and late side-effects (77.8% vs 35.1%). They were more likely to discuss general health check-ups (94.9% vs 6.4%), lifestyle behaviours (62.5% vs 26.1%) and fatigue (61.2% vs 35%) with their GP. The majority of respondents with needs in the following areas would not discuss them with either oncologist or GP: finances (85.5%), education (84.4%), employment (68.7%), psychological support (54.8%), exercise (52.5%) and diet (51.1%)
Conclusions: Cancer survivors currently report significant unmet survivorship care needs, and their comfort levels for discussing aspects of their care varies between providers, with some key issues not entrusted to either oncologists or GPs. Models of care for cancer survivors must address these potential deficits in care.