What are the needs of patients with newly diagnosed uveal melanoma, and what sociodemographic, medical, and psychosocial factors assessed prior to cancer diagnosis are associated with unmet need severity after diagnosis among this patient group?
This survey study demonstrated that nearly all patients endorsed at least 1 unmet need at 1 week after diagnosis, and while need severity decreased within 3 months, most patients continued to report important unmet needs. Neuroticism, instrumental social support, and social network size as assessed before diagnosis were associated with unmet need severity more than sociodemographic and medical characteristics.
Social support and neuroticism prior to diagnosis could be assessed to identify patients for proactive supportive intervention.
Understanding supportive care needs in patients with cancer is important for developing approaches that enhance quality of life and promote satisfaction with care.
To characterize the nature and frequency of sociodemographic, medical, and psychosocial factors associated with unmet needs in patients with uveal melanoma 1 week and 3 months after diagnosis.
Design, Setting, and Participants
This 3-month, prospective, longitudinal survey study was conducted at a university-based ophthalmology practice from June 1, 2007, to July 1, 2011. Data were analyzed in April 2017. Consecutive patients (n = 429) scheduled for diagnostic evaluation for an intraocular abnormality were assessed for eligibility. Participants were ineligible (n = 25) if they were younger than 18 years, had previous advanced cancer, or evidenced cognitive impairment. Of the patients who provided informed consent (n = 306), those subsequently diagnosed with uveal melanoma by an ophthalmologist (n = 107) were included in the analysis.
Main Outcomes and Measures
Unmet needs (ie, desire for help in psychological, physical, health information, communication, or social domains) were assessed using the Cancer Needs Questionnaire. Multivariable regression analyses determined factors associated with unmet need severity across 3 months.
One hundred seven patients (58 [54%] men; mean [SD] age, 59.0 [12.8] years) completed the baseline assessment. At 1 week after diagnosis, nearly all patients (85 of 86 [99%]) expressed at least 1 unmet need, as did 68 of 79 (86%) 3 months later. The most frequently endorsed needs were in the health information and psychological domains. Patients’ unmet needs declined significantly over 3 months (mean [SD] change, −10.0 [14.4]; 95% CI, −6.4 to −13.6; t = −5.6). Sociodemographic and medical characteristics were unrelated to unmet need severity. However, higher prediagnosis instrumental social support (b = −0.2; 95% CI, −0.3 to −0.1; z = −2.8) and lower neuroticism (b = 0.3; 95% CI, 0.1-0.5; z = 2.9) predicted lower unmet need severity 1 week after diagnosis. Having a smaller social network predicted lower unmet need severity 3 months after diagnosis (b < 0.1; 95% CI, <0.1 to <0.1; z = 2.4) as well as a decline in needs from diagnosis to 3 months later (b < 0.1; 95% CI, <0.1 to <0.1; z = 2.3).
Conclusions and Relevance
Within 1 week after diagnosis and 3 months later, most patients with uveal melanoma cited important health information and psychological needs. These findings suggest that prior to or at diagnosis, the severity of such needs and psychosocial factors that may be associated can be identified for proactive supportive intervention.
Williamson TJ, Jorge-Miller A, McCannel TA, Beran TM, Stanton AL. Sociodemographic, Medical, and Psychosocial Factors Associated With Supportive Care Needs in Adults Diagnosed With Uveal Melanoma. JAMA Ophthalmol. Published online February 22, 2018. doi:10.1001/jamaophthalmol.2018.0019
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