Attributing Variance in Supportive Care Needs during Cancer: Culture-Service, and Individual Differences, before Clinical Factors

Abstract

BackgroundStudies using the Supportive Care Needs Survey (SCNS) report high levels of unmet supportive care needs (SCNs) in psychological and less-so physical & daily living domains, interpreted as reflecting disease/treatment-coping deficits. However, service and culture differences may account for unmet SCNs variability. We explored if service and culture differences better account for observed SCNs patterns.MethodsHong Kong (n = 180), Taiwanese (n = 263) and Japanese (n = 109) CRC patients’ top 10 ranked SCNS-34 items were contrasted. Mean SCNS-34 domain scores were compared by sample and treatment status, then adjusted for sample composition, disease stage and treatment status using multivariate hierarchical regression.ResultsAll samples were assessed at comparable time-points. SCNs were most prevalent among Japanese and least among Taiwanese patients. Japanese patients emphasized Psychological (domain mean = 40.73) and Health systems and information (HSI) (38.61) SCN domains, whereas Taiwanese and Hong Kong patients emphasized HSI (27.41; 32.92) and Patient care & support (PCS) (19.70; 18.38) SCN domains. Mean Psychological domain scores differed: Hong Kong = 9.72, Taiwan = 17.84 and Japan = 40.73 (p<0.03–0.001, Bonferroni). Other SCN domains differed only between Chinese and Japanese samples (all p<0.001). Treatment status differentiated Taiwanese more starkly than Hong Kong patients. After adjustment, sample origin accounted for most variance in SCN domain scores (p<0.001), followed by age (p = 0.01–0.001) and employment status (p = 0.01–0.001). Treatment status and Disease stage, though retained, accounted for least variance. Overall accounted variance remained low.ConclusionsHealth service and/or cultural influences, age and occupation differences, and less so clinical factors, differentially account for significant variation in published studies of SCNs.

Perioperative Comprehensive Supportive Care Interventions for Chinese Patients with Esophageal Carcinoma: a Prospective Study

“…Chinese patients prioritized or emphasized needs for information about their disease, treatment and care, whereas German and Japanese patients preferred psychological support more often (Lam et al, 2011;Fielding, 2013). These evidences match with our clinical experiences and this is why we emphasized the part of health information and education in our study.…”

Unmet care needs in people living with advanced cancer: a systematic review

“…In particular, heterogeneity in time and place complicates comparison across studies: culture and service differences may account for a large proportion of variance in reporting of unmet care needs (in terms of both the needs that are prioritised and the likelihood that needs are being addressed; [43]). The comparability of needs in the earlier versus later studies reviewed is questionable given that, in the context of recent treatment advances, the trajectory of advanced cancer is changing.…”

Psychometric Assessment of the Chinese Version of the Supportive Care Needs Survey Short-Form (SCNS-SF34-C) among Hong Kong and Taiwanese Chinese Colorectal Cancer Patients

“…Taiwan uses a national health insurance approach while Hong Kong uses a mixture of public and private health services. There is evidence that Hong Kong and Taiwan CRC patients report different health system and information related needs and psychological needs, with Hong Kong patients reporting greater unmet health system and information related needs and Taiwanese patients greater psychological unmet needs [8]. Third, we also tested the convergent validity, discriminant validity, and internal reliability of the SCNS-SF using both Hong Kong and Taiwan samples.…”

“…Multiple studies have investigated the supportive care needs of different cancer groups at different time points throughout the cancer journey across different cultures [1]–[8].…”

“…Diagnosis and treatment of CRC not only affects patients physically but also substantially impacts their quality of life [10], [11], psychological wellbeing [12] and body image [13] at considerable financial cost. Because significant individual and cultural differences exist in these impacts [8] then reliably assessing unmet supportive care needs becomes crucial to cost-effective care provision.…”