Anne M Walling1, Nancy L Keating2, Katherine L Kahn2, Sydney Dy2, Jennifer W Mack2, Jennifer Malin2, Neeraj K Arora2, John L Adams2, Anna Liza M Antonio2, Diana Tisnado2. 1. David Geffen School of Medicine at University of California Los Angeles; Veterans Affairs Greater Los Angeles Healthcare System; UCLA Fielding School of Public Health, Los Angeles; RAND Corporation, Santa Monica; Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena; California State University, Fullerton, CA; Brigham and Women's Hospital; Harvard Medical School; Dana-Farber Cancer Institute, Boston, MA; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Patient-Centered Outcomes Research Institute, Washington, DC awalling@mednet.ucla.edu. 2. David Geffen School of Medicine at University of California Los Angeles; Veterans Affairs Greater Los Angeles Healthcare System; UCLA Fielding School of Public Health, Los Angeles; RAND Corporation, Santa Monica; Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena; California State University, Fullerton, CA; Brigham and Women's Hospital; Harvard Medical School; Dana-Farber Cancer Institute, Boston, MA; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Patient-Centered Outcomes Research Institute, Washington, DC.
Abstract
PURPOSE: Little is known about factors associated with unmet needs for symptom management in patients with cancer. METHODS: Patients with a new diagnosis of lung and colorectal cancer from the diverse nationally representative Cancer Care Outcomes Research and Surveillance cohort completed a survey approximately 5 months after diagnosis (N = 5,422). We estimated the prevalence of unmet need for symptom management, defined as patients who report that they wanted help for at least one common symptom (pain, fatigue, depression, nausea/vomiting, cough, dyspnea, diarrhea) during the 4 weeks before the survey but did not receive it. We identified patient factors associated with unmet need by using logistic regression with random effects to account for clustering within study sites. RESULTS: Overall, 15% (791 of 5,422) of patients had at least one unmet need for symptom management. Adjusting for sociodemographic and clinical factors, African American race, being uninsured or poor, having early-stage lung cancer, and the presence of moderate to severe symptoms were associated with unmet need (all P < .05). Furthermore, patients who rated their physician's communication score < 80 (on a 0 to 100 scale) had adjusted rates of an unmet need for symptom management that were more than twice as high as patients who rated their physicians with a perfect communication score (23.1% v 10.0%; P < .001). CONCLUSION: A significant minority of patients with newly diagnosed lung and colorectal cancer report unmet needs for symptom management. Interventions to improve symptom management should consider the importance of physician communication to the patient's experience of disease.
PURPOSE: Little is known about factors associated with unmet needs for symptom management in patients with cancer. METHODS:Patients with a new diagnosis of lung and colorectal cancer from the diverse nationally representative Cancer Care Outcomes Research and Surveillance cohort completed a survey approximately 5 months after diagnosis (N = 5,422). We estimated the prevalence of unmet need for symptom management, defined as patients who report that they wanted help for at least one common symptom (pain, fatigue, depression, nausea/vomiting, cough, dyspnea, diarrhea) during the 4 weeks before the survey but did not receive it. We identified patient factors associated with unmet need by using logistic regression with random effects to account for clustering within study sites. RESULTS: Overall, 15% (791 of 5,422) of patients had at least one unmet need for symptom management. Adjusting for sociodemographic and clinical factors, African American race, being uninsured or poor, having early-stage lung cancer, and the presence of moderate to severe symptoms were associated with unmet need (all P < .05). Furthermore, patients who rated their physician's communication score < 80 (on a 0 to 100 scale) had adjusted rates of an unmet need for symptom management that were more than twice as high as patients who rated their physicians with a perfect communication score (23.1% v 10.0%; P < .001). CONCLUSION: A significant minority of patients with newly diagnosed lung and colorectal cancer report unmet needs for symptom management. Interventions to improve symptom management should consider the importance of physician communication to the patient's experience of disease.
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