Association between unmet needs and quality of life of cancer patients: A population-based study

Figures & data

Table I. Characteristics of participants in a Danish cohort study of cancer rehabilitation, 14 months following the diagnosis of cancer. The frequencies of the different unmet needs include distribution by sex, age and cancer diagnosis.

	All n (%)	Unmet needs in at least one area n (%)	Unmet physical needs n (%)	Unmet emotional needs n (%)	Unmet family-oriented needs n (%)	Unmet sexual needs n (%)	Unmet work-related needs n (%)	Unmet financial needs n (%)
All	3439	2066 (60.1)	1275 (40.0)	1205 (37.5)	1013 (31.6)	1058 (33.4)	808 (25.3)	849 (26.7)
Sex
Female	1973 (57.4)	1196 (60.6)	768 (42.1)	736 (40.1)	596 (32.5)	524 (28.9)	472 (26.0)	468 (25.8)
Male	1466 (42.6)	870 (59.4)	507 (37.1)	469 (34.0)	417 (30.3)	534 (39.3)	336 (24.4)	381 (27.8)
Age (years)
18–44	270 (7.9)	196 (72.6)	81 (31.0)	120 (45.6)	110 (42.2)	77 (29.0)	95 (35.7)	85 (32.0)
45–64	1543 (44.9)	992 (64.3)	610 (41.4)	600 (40.2)	488 (32.8)	532 (36.0)	437 (29.5)	436 (29.6)
65+	1626 (47.3)	878 (54.0)	584 (40.1)	485 (33.2)	415 (28.4)	449 (31.4)	276 (19.1)	328 (22.8)
Cancer diagnosis
Breast	976 (28.4)	609 (62.4)	391 (43.0)	371 (40.1)	301 (32.8)	275 (30.2)	236 (26.1)	222 (24.5)
Colorectal	522 (15.2)	307 (58.8)	200 (41.2)	161 (33.3)	146 (30.2)	166 (35.0)	120 (25.2)	128 (26.9)
Prostate	501 (14.6)	300 (59.9)	165 (36.2)	152 (32.4)	124 (26.8)	215 (46.4)	96 (20.6)	112 (24.1)
Malignant melanoma	233 (6.8)	114 (48.9)	65 (29.6)	67 (30.7)	50 (22.7)	40 (18.4)	45 (20.7)	46 (21.3)
Gynaecological	230 (6.7)	134 (58.3)	81 (38.2)	83 (38.3)	65 (30.0)	65 (30.2)	60 (27.8)	63 (29.4)
Lung	188 (5.5)	128 (68.1)	82 (47.1)	79 (45.9)	68 (39.9)	60 (36.6)	45 (25.3)	54 (30.9)
Head and neck	125 (3.6)	77 (61.6)	44 (37.6)	54 (46.6)	37 (31.9)	44 (37.9)	33 (28.2)	37 (31.2)
Lymphoma	104 (3.0)	72 (69.2)	39 (38.2)	49 (48.0)	48 (47.1)	35 (34.7)	34 (34.0)	37 (37.0)
Other	560 (16.3)	325 (58.0)	208 (40.4)	189 (36.8)	174 (33.7)	158 (31.0)	139 (26.9)	151 (29.3)

Table II. Associations between health-related quality of life (EORTC QLQ C-30¹) and perceived unmet needs in at least one area, 14 months following a diagnosis of cancer.

	N	Mean (95% CI)	Adjusted mean difference^2 (95% CI)	p-value
Global health status/quality of life
Unmet needs	1997	67.1 (66.2, 68.0)	−12.2 (−13.7, −10.8)	< 0.001
No unmet needs	1229	79.5 (78.5, 80.6)
Functional subscales
Physical functioning
Unmet needs	1989	77.9 (76.9, 78.8)	−10.0 (−11.4, −8.6)	< 0.001
No unmet needs	1218	87.2 (86.2, 88.3)
Role functioning
Unmet needs	1977	71.7 (70.3, 73.1)	−15.0 (−17.0, −12.9)	< 0.001
No unmet needs	1210	86.3 (84.9, 87.7)
Emotional functioning
Unmet needs	1983	76.4 (75.3, 77.4)	−14.0 (−15.5, −12.6)	< 0.001
No unmet needs	1204	90.9 (90.1, 91.7)
Cognitive functioning
Unmet needs	2004	78.7 (77.6, 79.7)	−11.5 (−13.0, −10.0)	< 0.001
No unmet needs	1229	90.4 (89.5, 91.3)
Social functioning
Unmet needs	1983	84.4 (83.4, 85.4)	−10.1 (−11.5, −8.7)	< 0.001
No unmet needs	1218	94.9 (94.1, 95.7)
Symptom subscales
Fatigue
Unmet needs	1994	36.8 (35.6, 38.0)	15.3 (13.5, 17.1)	< 0.001
No unmet needs	1218	21.5 (20.3, 22.8)
Nausea and vomiting
Unmet needs	2007	7.5 (6.7, 8.3)	3.8 (2.7, 4.9)	< 0.001
No unmet needs	1232	3.6 (3.0 4.3)
Pain
Unmet needs	1989	23.2 (22.0, 24.4)	12.4 (10.7, 14.2)	< 0.001
No unmet needs	1213	10.7 (9.6, 11.9)
Single symptom items
Dyspnoea
Unmet needs	2007	18.3 (17.1, 19.5)	6.8 (5.0, 8.6)	< 0.001
No unmet needs	1229	11.6 (10.3, 12.8)
Insomnia
Unmet needs	2022	30.4 (29.0, 31.8)	12.1 (9.9, 14.2)	< 0.001
No unmet needs	1236	18.0 (16.6, 19.4)
Appetite loss
Unmet needs	2019	13.2 (12.0, 14.3)	7.0 (5.4, 8.7)	< 0.001
No unmet needs	1235	6.3 (5.3, 7.3)
Constipation
Unmet needs	2016	12.9 (11.8 14.0)	6.3 (4.8, 7.9)	< 0.001
No unmet needs	1233	7.0 (5.9, 8.0)
Diarrhoea
Unmet needs	2016	13.6 (12.5, 14.7)	5.0 (3.3, 6.6)	< 0.001
No unmet needs	1240	8.7 (7.6, 9.8)
Financial difficulties
Unmet needs	2000	9.6 (8.6, 10.6)	7.4 (6.1, 8.7)	< 0.001
No unmet needs	1228	1.6 (1.1, 2.0)

¹EORTC QLQ C-30, European Organization for the Research and Treatment of Cancer quality of Life Questionnaire Core 30. High scores represent healthy functioning in the functioning scales and global health status, but a high level of problems for symptom scales and single symptom items.

²Adjusted for sex, age (three age groups), and cancer diagnosis.

Table III. Associations between psychological distress (POMS-SF¹) and perceived unmet needs in at least one area, 14 months following a diagnosis of cancer.

	N	Mean range	Mean (95% CI)	Adjusted difference^2 (95% CI)	p-value
Total mood disturbance		−24–124
Unmet needs	1689		10.6 (9.6, 11.7)	12.6 (11.2, 14.1)	< 0.001
No unmet needs	1061		−2.3 (−3.1, −1.4)
Anger/hostility		0–28
Unmet needs	1911		2.6 (2.4, 2.8)	1.4 (1.2, 1.7)	< 0.001
No unmet needs	1181		1.1 (1.0, 1.3)
Confusion/bewilderment		0–20
Unmet needs	1920		3.1 (3.0, 3.3)	1.6 (1.4, 1.8)	< 0.001
No unmet needs	1186		1.5 (1.3, 1.6)
Depression/dejection		0–32
Unmet needs	1856		4.7 (4.4, 4.9)	2.9 (2.5, 3.2)	< 0.001
No unmet needs	1165		1.7 (1.5, 1.9)
Fatigue/inertia		0–20
Unmet needs	1932		5.5 (5.3, 5.7)	2.5 (2.2, 2.9)	< 0.001
No unmet needs	1194		2.9 (2.7, 3.1)
Tension/anxiety		0–24
Unmet needs	1945		4.4 (4.2, 4.6)	2.4 (2.1, 2.7)	< 0.001
No unmet needs	1184		1.9 (1.8, 2.1)
Vigour/activity		0–24
Unmet needs	1867		9.4 (9.2, 9.6)	−2.0 (−2.4, -1.6)	< 0.001
No unmet needs	1143		11.1 (10.8, 11.5)

¹POMS-SF, Profile of Mood States-Short Form. A high score of the total mood disturbance score and five of the six subscales indicates a high degree of distress. A high score of the vigour/activity subscale indicates a low degree of distress.

²Adjusted for sex, age (three age groups), and cancer diagnosis.

Table IV. Associations between health-related quality of life and psychological distress and number of areas with unmet needs among cancer patients, 14 months following diagnosis.

		Global Health Status^1		Total mood disturbance^2
	n(%)	Mean (95% CI)	Adjusted difference^3 (95% CI)	Mean (95% CI)	Adjusted difference^3 (95% CI)
No unmet needs	1373 (39.0)	79.5 (78.5, 80.6)	–	–2.3 (–3.1, –1.4)	–
Unmet needs in 1 area	618 (18.0)	72.6 (71.0, 74.1)	–7.0 (–8.9, –5.1)	3.8 (2.3, 5.3)	6.0 (4.1, 8.0)
Unmet needs in 2 areas	356 (10.4)	67.7 (65.5, 69.9)	–11.6 (–13.9, –9.2)	10.9 (8.4, 13.4)	12.8 (10.4, 15.2)
Unmet needs in 3 areas	284 (8.3)	66.9 (64.5, 69.2)	–12.5 (–15.1, –10.0)	11.8 (8.9, 14.6)	13.6 (11.0, 16.2)
Unmet needs in 4 areas	307 (8.9)	62.7 (60.5, 64.9)	–16.8 (–19.3, –14.4)	15.4 (12.7, 18.0)	17.3 (14.7, 19.9)
Unmet needs in 5 areas	208 (6.1)	60.4 (57.5, 63.3)	–18.7 (–21.6, –15.8)	17.5 (14.1, 20.9)	19.2 (16.2, 22.1)
Unmet needs in 6 areas	293 (8.5)	64.5 (61.9, 67.1)	–14.9 (–17.4, –12.3)	13.8 (10.8, 16.8)	16.1 (13.5, 18.7)

¹EORTC QLQ C-30: European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30. High scores represent healthy functioning in the functioning scales and global health status, but a high level of problems for symptom scales and single symptom items.

²POMS-SF: Profile of Mood States-Short Form. A high score of the total mood disturbance score and five of the six subscales indicates a high degree of distress. A high score of the vigour/activity subscale indicates a low degree of distress.

³Adjusted for sex, age (three age groups), and cancer diagnosis.