Risk factors for current and future unmet supportive care needs of people with pancreatic cancer. A longitudinal study

Abstract

Purpose: This study aims to determine if the supportive care needs of people with pancreatic cancer change over time and identify the factors associated with current and future unmet needs. Methods: Australian pancreatic cancer patients completed a self-administered survey at 0–6 months post-diagnosis (n = 116) then follow-up surveys 2 (n = 82) and 4 months (n = 50) later. The validated survey measured 34 needs across five domains. Weighted generalised estimating equations were used to identify factors associated with having ≥1 current or future moderate-to-high unmet need. Results: The overall proportion of patients reporting ≥1 moderate-or-high-level need did not significantly change over time (baseline = 70 % to 4 months = 75 %), although there was a non-significant reduction in needs for patients who had a complete resection (71 to 63 %) and an increase in patients with locally advanced (73 to 85 %) or metastatic (66 to 88 %) disease. Higher levels of pain (OR 6.1, CI 2.4–15.3), anxiety (OR 3.3, CI 1.5–7.3) and depression (OR 3.2, CI 1.7–6.0) were significantly associated with current needs. People with pain (OR 4.9, CI 1.5–15.4), metastatic disease (OR 2.7, CI 0.7–10.0) or anxiety (OR 2.5, CI 0.7–8.6) had substantially higher odds of reporting needs at their next survey. The prevalence of needs was highest in the physical/daily living and psychological domains (both 53 % at baseline). Pain and anxiety had respectively the strongest associations with these domains. Conclusions: Careful and continued attention to pain control and psychological morbidity is paramount in addressing significant unmet needs, particularly for people with metastatic disease. Research on how best to coordinate this is crucial.