Unmet supportive care needs linked to worse outcomes among ambulatory patients with cancer

By Jennifer Southall

On June 21, 2023

Unmet supportive care needs appeared associated with worse clinical outcomes among a cohort of ambulatory patients with cancer, according to study results published in JAMA Network Open.

In addition, patients from racial or ethnic minority groups, as well as those with more significant emotional or physical burdens, had a higher likelihood of reporting one or more unmet supportive care needs, researchers noted.

Rationale and methodology

Advances in early detection and treatment efficacy during the past several decades have led to unprecedented increases in the number of cancer survivors in the U.S. — there are more than 18 million survivors in the U.S., a number expected to exceed 26 million by 2040 and account for about 5% of the U.S. population, Frank J. Penedo, PhD, associate director of cancer survivorship and behavioral translational sciences, and director of the cancer survivorship program at Sylvester Comprehensive Cancer Center at University of Miami Miller School of Medicine, told Healio.

“Despite the survival benefit, cancer survivors may face multiple challenges, including the chronicity of treatment-related and late side effects of treatment, unmet physical, psychosocial and practical needs, and negative lifestyle behaviors,” Penedo said. “Balanced against these, there have been limited efforts in systematically assessing these challenges and triaging patients to the necessary level of care. Efforts have also been limited in assessing whether these unmet needs at least partially account for the elevated rates of ER usage and hospitalizations observed among survivors.”

Penedo and colleagues sought to characterize factors associated with unmet supportive care needs among 5,236 ambulatory patients (mean age, 62.6 years; 56.3% women; 88.2% white) with cancer and assess whether such needs had an association with ED visits and hospitalizations.

Researchers used My Wellness Check — an electronic health record-based supportive care needs and patient-reported outcomes screening and referral program — to pool data between Oct. 1, 2019, and June 30, 2022, on patient demographic characteristics, clinical characteristics and clinical outcomes.

They also collected data on patient-reported outcomes, health-related quality of life and supportive care needs and used logistic regression analyses to examine factors associated with unmet supportive care needs. They used Cox proportional hazards regression models that adjusted for covariates to assess cumulative incidence of ED visits and hospitalizations.

Findings

Results showed 18% (n = 940) of patients reported one or more unmet supportive care needs. Among them, 651 patients reported one unmet need, 165 patients reported two unmet needs, and 124 patients reported three or more unmet needs.

Researchers specifically observed an association between greater unmet supportive care needs and Black race (adjusted OR [aOR] = 1.97; 95% CI, 1.49-2.6), Hispanic ethnicity (aOR = 1.31; 95% CI, 1.1-1.55), diagnosis 1 to 5 years earlier (aOR, 0.64; 95% CI, 0.54-0.77), diagnosis more than 5 years earlier (aOR = 0.6; 95% CI, 0.48-0.76), anxiety (aOR = 2.25; 95% CI, 1.71-2.95), depression (aOR, 2.07; 95% CI, 1.58-2.7), poor physical function (aOR = 1.38; 95% CI, 1.07-1.79) and low health-related quality-of-life scores (aOR = 1.89; 95% CI, 1.5-2.39).

Moreover, compared with patients without unmet supportive care needs, those with unmet needs experienced a significantly higher risk for ED visits (adjusted HR [aHR] = 1.45; 95% CI, 1.2-1.74) and hospitalizations (aHR = 1.36; 95% CI, 1.13-1.63).

“In the past we have shown that patients who complete our systematic symptoms and unmet needs monitoring platform — My Wellness Check — report better clinical outcomes such as ER visits and hospitalizations,” Penedo said. “In this study, we extended our prior work to show that when identified physical, emotional and practical needs are met, patients with cancer and cancer survivors are less likely to visit the ER or be hospitalized. Therefore, regular assessment of these needs and getting the patient to the right level of care to address them is critical, not only to favorably impact the patient’s health, but also to reduce burden on health care systems.”

A longitudinal study is needed to examine the change in unmet needs over time, according to researchers, who also noted a lack of sensitivity analyses among the study limitations.

Implications

The findings support what researchers expected — that unmet supportive care needs predict ER visits and hospitalizations, Penedo told Healio.

“This is one of the first studies that assessed patients of diverse racial and ethnic backgrounds coming into a comprehensive cancer center for ambulatory oncology care for symptoms such as pain, fatigue, poor physical function, depression and anxiety, and unmet practical and psychosocial needs such as coping with stress, cancer education and transportation,” Penedo said. “While we still need to better understand the specific mechanisms via which such needs are related to these clinical outcomes, we believe that the presence of unmet needs exacerbate patients’ physical symptoms and negatively impact health-related quality of life, which leads to seeking urgent care.”

Penedo said next steps include further research to better understand how these unmet needs drive ER visits and hospitalizations, and whether the health care system’s triage capabilities and documented referrals effectively address these unmet needs and reduce adverse clinical outcomes.

This piece was republished from Healio.com.