Abstract
BACKGROUND: Patients with cancer experience a variety of needs at every stage of their illness. Many of these needs can be addressed with palliative care. Cancer patients' palliative needs should therefore be proactively identified and managed. This study aimed to identify the needs of oncology patients receiving out-patient cancer treatment at a Portuguese cancer center. METHODS: A cross-sectional study was undertaken of consecutive patients presenting to an outpatient cancer clinic over the course of 5 days for cancer treatments. The primary outcome measure was the validated Portuguese version of the Integrated Palliative Care Outcome Scale (IPOS). "Unmet needs" were defined as symptoms/needs rated as greater than 2 out of 4. RESULTS: Of 211 patients registered for clinic visits, 167 were potentially eligible and 113 (67.7%) completed the questionnaire. Cancers of the breast (31%), colorectum (18%), and lung (14%) were the most common, and 52% were stage IV cancers. Functional levels as assessed by the Eastern Cooperative Oncology Group (ECOG) were 31.8% (ECOG 1), 54.9% (ECOG 1) and 12.4% (ECOG 2). Almost all patients (99%) reported at least one symptom or need regardless of severity; 76%, 57% and 16% reported at least one, two to four, and five or more severe symptoms/needs, respectively. The most frequently reported physical "unmet" symptoms were pain (12%), poor mobility (12%) and weakness (11%). The psychological and social needs included anxiety (18%), depression (11%), difficulty sharing feelings (25%), information needs (23%), and family concerns (47%). The prevalence of unmet needs increased notably if moderate-intensity needs (2 out of 4) were included as "unmet" needs. Female sex and higher ECOG scores were associated with higher (worse) IPOS scores. CONCLUSIONS: A high burden of unmet needs was identified among ambulatory cancer patients at this center, particularly among female patients and patients with poorer ECOG. Quality improvement initiatives are needed to improve the systematic screening of patient needs and integrate a palliative care approach earlier to help address them.