National Research Center for Cancer Rehabilitation, Research Unit of General Practice, University of Southern Denmark, Odense C, Denmark.
Acta Oncol. 2013 Feb;52(2):391-9. doi: 10.3109/0284186X.2012.742204. Epub 2012 Dec 17.
Two conceptually different morbidity outcomes unmet needs and health-related quality of life are used to identify cancer patients in need of clinical attention and to evaluate rehabilitation programmes. The knowledge on the interrelation between unmet needs and health-related quality of life is scarce. This paper studies the hypothesis that patient-perceived unmet needs of rehabilitation during the cancer trajectory are associated with decreased quality of life.
Based on registers, a Danish population-based cohort of adult, incident, mixed-site cancer patients diagnosed between 1 October 2007 and 30 September 2008 was established. At 14 months following diagnosis participants completed a questionnaire including health-related quality of life (EORTC QLQ C-30), psychological distress (POMS-SF), and unmet needs with regard to physical, emotional, family-oriented, sexual, work-related, and financial problems. Unmet needs were assessed through six ad hoc questions.
Questionnaires were received from 3439 of 4947 patients, resulting in a response rate of 70%. The three most frequent cancer types were breast (28.4%), prostate (14.6%) and colorectal cancer (15.2%). Overall, 60.1% expressed an unmet need of rehabilitation in at least one area, physical and emotional problems being the most frequent (40.0% and 37.5%). For all scales of the EORTC QLQ C-30 and POMS, significant adjusted mean differences were observed between patients with unmet needs in at least one area and patients with no unmet needs (p-values < 0.001). These differences were well above levels usually considered clinically relevant. Further, impairment increased with increasing number of areas in which unmet needs were reported.
We confirmed the hypothesis that patient-perceived unmet needs of rehabilitation during the cancer trajectory are associated with decreased quality of life. This study supports the use of unmet needs questions to identify patients in need of clinical attention. Interventions reducing cancer patients' perceived needs of rehabilitation may enhance quality of life.
两种概念上不同的发病率结果——未满足的需求和健康相关生活质量，被用于确定需要临床关注的癌症患者，并评估康复计划。关于未满足的需求和健康相关生活质量之间的关系的知识是有限的。本文研究了这样一个假设，即在癌症病程中，患者感知到的康复需求未得到满足与生活质量下降有关。
基于登记资料，建立了一个丹麦基于人群的成年、混合部位癌症患者队列，这些患者于 2007 年 10 月 1 日至 2008 年 9 月 30 日确诊。在诊断后 14 个月，参与者完成了一份问卷，其中包括健康相关生活质量（EORTC QLQ C-30）、心理困扰（POMS-SF）和对身体、情感、家庭导向、性、工作相关和财务问题的康复需求。通过六个特定问题评估未满足的需求。
从 4947 名患者中收到了 3439 份问卷，应答率为 70%。最常见的三种癌症类型是乳腺癌（28.4%）、前列腺癌（14.6%）和结直肠癌（15.2%）。总体而言，60.1%的患者在至少一个领域表达了康复需求，身体和情感问题最常见（40.0%和 37.5%）。对于 EORTC QLQ C-30 和 POMS 的所有量表，在至少一个领域有未满足需求的患者和没有未满足需求的患者之间，观察到了显著的调整后平均差异（p 值<0.001）。这些差异远高于通常认为有临床意义的水平。此外，随着报告未满足需求的领域数量的增加，损害程度也随之增加。
我们证实了这样一个假设，即在癌症病程中，患者感知到的康复需求未得到满足与生活质量下降有关。这项研究支持使用未满足的需求问题来识别需要临床关注的患者。减少癌症患者感知到的康复需求的干预措施可能会提高生活质量。
