Identifying unmet cancer survivor needs in a background of comprehensive and free health care: A cross-sectional study from India.

Abstract

e24064 Background: Very limited data exists on identifying the unmet needs of cancer survivors in the Indian subcontinent, with no studies in the background of free health care. We tried to estimate the unmet needs of cancer survivors with access to government-sponsored free healthcare at our institute in India. Methods: The survey included 189 serving government employees and their dependents aged > 18 years. All employees can access free cancer care, including supportive care (dieticians and psychological counsellors included). All patients had completed their treatment and were on follow-up. The survey recorded demographics, cancer therapy details, and the CASUN questionnaire. Results: 67.4% of the respondents were male. Breast cancer (18.5%) and head and neck cancers (15.8) were the most common malignancies treated.43.3% of patients were treated with more than two modalities of treatment. The average time post-treatment was 32.6 months (45.18) .62.9 % of participants had at least one unmet need of moderate to severe strength. The most common of these needs were related to quality-of-life issues (Q12(28.8%)) and therapy-related effects management (Q 11(27.7%)), closely followed by concerns about cancer recurrence (Q19(26.9%)). The least common need was legal service access (Q 17 (1.63%)). The mean score of total unmet needs was 19.44(17.91), with the score in different domains as follows: Existential survivorship -10.14(10.27), Comprehensive cancer care - 2.80(3.62), Information - 1.34(2.12), Quality of life 1.96(1.94), Relationships -1.58 (2.05). Positive changes were analysed qualitatively, and interactions with other cancer survivors and making positive life changes, like seeking help from mental health professionals, were found to have the greatest positive impact. Our study found that these scores were lower than most studies in the Indian Subcontinent and reflected the average scores of high-income countries. The findings highlight the importance of comprehensive cancer care, with due importance being given to the psychosocial needs of cancer survivors. Our scores can be attributed to access to free healthcare services, the early integration of supportive care and a focus on rehabilitation and psychological care during and after treatment in our setup. However, despite all of the above, there was still an unmet need regarding the quality of life and fear of recurrence, which requires further analysis and attention. Conclusions: A large proportion of cancer survivors suffer from moderate-to-severe unmet needs, even with access to completely free healthcare. However, free healthcare with a focus on physical and psychological rehabilitation can reduce the strength and incidence of these unmet needs, even in low-to middle-income countries. This study can be a basis for building further research on this topic and scrutinising more survivorship issues in detail.