Trajectory patterns of supportive care needs among Chinese women with advanced breast cancer

Abstract

BACKGROUND: Little is known about the changes in supportive care needs among women with advanced breast cancer (ABC). Understanding how patients’ supportive care needs change during their cancer journey enable us to develop tailored interventions to meet their needs and help control health care costs. The aim of this study was to (1) examine patterns of supportive care needs over the first year following the diagnosis of advanced breast cancer and (2) identify related determinants. METHOD: 228/276 Chinese women newly diagnosed with ABC were recruited from six public oncology units and completed an interview before their first course of chemotherapy, and follow-up interviews at 6-, 12-, 18-weeks, and 12 months subsequently. At baseline, participants were assessed for supportive care needs (SCNS-34), psychological distress (HADS), symptom distress (MSAS), and optimism (C-LOT-R), and patient satisfaction (PSEQ-9). At follow-up, participants completed the measure of supportive care needs. Latent growth mixture modeling was used to identify discreet supportive care needs trajectories. Logistic regression was used to identify predictors of trajectory patterns patterns adjusted for demographic and medical characteristics. RESULTS: Two distinct trajectories were identified within Health system & information need (HSI) and Sexuality need domains and three distinct trajectories within Psychological and Physical daily living (PDL) need domains. Most women showed stable low levels of HIS (79%), Psychological (82%), PDL (84%), and Sexuality (97%) supportive care needs. One in five and one in eight women showed high initial needs in HIS, Psychological, and PDL domains, respectively. With the exception of Sexuality needs, trajectory patterns were predicted by physical symptom distress. CONCLUSIONS: Contrary to expectations, most Chinese women with advanced breast cancer showed low stable levels of supportive care needs. Physical symptom distress predicted high supportive care needs. RESEARCH IMPLICATIONS: This report is the first describing trajectories of different supportive care need domains in advanced breast cancer, thereby offering new insights into patterns of supportive care needs not previously addressed. The findings challenge assumptions that supportive care needs inevitably increase with advancing disease and raise important questions about the influences on adaptation in advanced breast cancer. CLINICAL IMPLICATIONS: Effective physical symptom management plays an important role in fulfilling women’s supportive care needs, highlighting the importance of the implementation of comprehensive symptom assessment and management in cancer care. This is particularly important as progressive disease generates more impacts. ACKNOWLEDGEMENT OF FUNDING: This work was supported by a grant from the Hong Kong Cancer Fund and a grant from the Seed Funding Programme for Basic Research by The University of Hong Kong.