Race, Ethnicity Among Factors Associated With Unmet Care Needs and Greater Risk of Hospitalization in Patients With Cancer

Factors associated with unmet supportive care needs and a greater risk of hospitalization in ambulatory oncology patients include Black race, Hispanic ethnicity, more years after diagnosis, poor physical function, depression, and low health-related quality of life scores, a new study published in the Journal of the American Medical Association finds.

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“In this cohort study of ambulatory oncology patients, unmet supportive care needs were associated with worse clinical outcomes,” the researchers said.

Data were collected from patients with cancer who completed the My Wellness Check (MWC), an assessment that assesses their supportive care needs and redirects them to the necessary services upon entering an ambulatory oncology facility between October 2019 and June 2022, the study methods show.

The main outcomes of the study were time to an emergency department (ED) visit and hospitalization, which were calculated using days from the first MWC questionnaire and the first event respectively, the researchers say.

Over the study period, 5236 out of 12,563 patients completed the MWC assessment, with a mean (SD) age of 62.6 (13.1) years; a total of 3208 patients (61.3%) were undergoing an active treatment at the time of assessment, the investigators found.

A total of 940 patients (18.0%) reported 1 or more unmet supportive care needs in their MWC questionnaire, the results show. Out of these patients, 651 had 1 unmet need, 165 had 2 unmet needs, and 124 had 3 or more unmet needs.

Researchers write that among the unmet needs listed by the patients, chief among these were support for coping with a cancer diagnosis and financial concerns, followed by general information and education about cancer.

Investigators used multivariate logistic regression analysis to determine which factors were associated with unmet supportive care needs. It revealed that Black race (AOR, 1.97 [95% CI, 1.49-2.60]), Hispanic ethnicity (AOR, 1.31 [95% CI, 1.10-1.55]), 1 to 5 years after diagnosis (AOR, 0.64 [95% CI, 0.54-0.77]), more than 5 years after diagnosis (AOR, 0.60 [95% CI, 0.48-0.76)], anxiety (AOR, 2.25 [95% CI, 1.71-2.95]), depression (AOR, 2.07 [95% CI, 1.58-2.70]), poor physical function (AOR, 1.38 [95% CI, 1.07-1.79]), and low health-related quality of life (AOR, 1.89 [95% CI, 1.50-2.39]) were associated with unmet supportive care needs, according to the study results.

In conjunction with these unmet supportive care needs, the researchers observed a greater risk of emergency department visits in comparison to those without unmet needs (24.7% vs. 14.2% at 360 days; P < .001), in addition to a greater risk of hospitalization (23.3% vs. 13.9% at 360 days; P < .001). These findings were also observed when adjusting these figures for covariates.

Investigators spoke of the importance of this study in examining the true prevalence of unmet supportive care needs at the patient level, the factors associated with unmet needs, and the clinical outcomes associated with them to effectively assess the burdens of the cancer experience.

“Although previous research has identified unmet supportive care needs among patients with cancer, limited work has characterized patient-level factors that are associated with unmet needs,” they wrote. “The present study is, to our knowledge, the most comprehensive assessment of unmet supportive care needs among ambulatory oncology patients.”

Researchers discovered that the highest level of unmet needs were observed in patients who were undergoing active treatment, such as chemotherapy, radiotherapy, or immunotherapy.

One of the limitations of the study that the researchers noted was only assessing supportive care needs based on the first time completing the MWC, which researchers say could be assuaged with a longitudinal study that looks at change over time. Another limitation was the study environment, which was a large, university-based cancer center with robust resources; this could make the study findings less generalizable to a broader, under-resourced population.

“These findings suggest that addressing unmet supportive care needs is imperative for improving clinical outcomes and that efforts to address unmet needs should target specific populations,” the investigators concluded.

Reference

Penedo, J. F., et. al. (2023) Factors associated with unmet supportive care needs and emergency department visits and hospitalizations in ambulatory oncology. Journal of the American Medical Association. Available at https://jamanetwork.com/journals/jamanetworkoapen/fullarticle/2806320 . Accessed on June 23, 2023.