Supportive Care in Cancer

, Volume 20, Issue 7, pp 1377–1394 | Cite as

A systematic review of unmet needs of newly diagnosed older cancer patients undergoing active cancer treatment

  • M. T. E. Puts
  • A. Papoutsis
  • E. Springall
  • A. E. Tourangeau
Review Article



The aim of this study is to systematically review evidence with regard to answering the following questions: (1) What are the unmet care needs of older persons diagnosed with cancer who are undergoing active cancer treatment? (2) What are the predictors of unmet needs of older persons while undergoing active cancer treatment?


A systematic review of the literature published between January 1996 and December 2010 was completed. Manuscripts could be published in English, French, Dutch, or German searching the Medline, Embase, Psychinfo, Cinahl, and the Cochrane Library databases. The literature search was performed by two researchers with the assistance of a university librarian. Abstracts were reviewed by two reviewers for inclusion.


Thirty studies were included. A significant proportion of newly-diagnosed patients undergoing cancer treatment had unmet needs, ranging from 15 to 93 %. The most common needs varied by study but included psychological needs, information needs, and needs in the physical domain. Most studies showed that the level of unmet needs was highest after diagnosis and start of treatment and decreased over time. Predictors of unmet needs included: younger age, female gender, depression, physical symptoms, marital status, treatment type, income, and education.


The level of unmet needs in newly diagnosed older cancer patients after the start of treatment is high, and the most common needs are psychological and information needs. More research is needed which would focus on the needs of older adults with comorbid conditions, and how these comorbid conditions influence the level of unmet needs.


Systematic review Geriatric oncology Supportive care needs Frail elderly Newly diagnosed cancer Unmet needs 

Supplementary material

520_2012_1450_MOESM1_ESM.pdf (175 kb)
ESM 1PDF 175 kb


  1. 1.
    Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA (2009) Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol 27(17):2758–2765PubMedCrossRefGoogle Scholar
  2. 2.
    Canadian Cancer Society’s Steering committee (2010) Canadian Cancer Statistics 2011. Canadian Cancer Society, TorontoGoogle Scholar
  3. 3.
    Given B, Given CW (2008) Older adults and cancer treatment. Cancer 113(12 Suppl):3505–3511PubMedCrossRefGoogle Scholar
  4. 4.
    The Chief Public Health Officer (2010) The chief public health officer’s annual report on the state of public health in Canada 2010. Growing older-adding life to years. Public Health CanadaGoogle Scholar
  5. 5.
    Gysels M, Higginson IJ, Rajasekaran M, Davis E, Harding R (2004) Improving supportive and palliative care for older adults with cancer: research evidence. National Institutes of Clinical Excellence & Kings College London, LondonGoogle Scholar
  6. 6.
    Harrison JD, Young JM, Price MA, Butow PN, Solomon MJ (2009) What are the unmet supportive care needs of people with cancer? A systematic review. Support Care Cancer.Google Scholar
  7. 7.
    Given B, Given CW (2009) Cancer treatment in older adults: implications for psychosocial research. J Am Geriatr Soc 57(Suppl 2):S283–S285PubMedCrossRefGoogle Scholar
  8. 8.
    Balducci L (2009) Supportive care in elderly cancer patients. Curr Opin Oncol 21(4):310–317PubMedCrossRefGoogle Scholar
  9. 9.
    Balducci L (2005) Supportive care of elderly patients with cancer. Support Cancer Ther 2(4):225–228PubMedCrossRefGoogle Scholar
  10. 10.
    Balducci L (2003) New paradigms for treating elderly patients with cancer: the comprehensive geriatric assessment and guidelines for supportive care. J Support Oncol 1(4 Suppl 2):30–37PubMedGoogle Scholar
  11. 11.
    Houldin AD, Wasserbauer N (1996) Psychosocial needs of older cancer patients: a pilot study abstract. Medsurg Nurs 5(4):253–256PubMedGoogle Scholar
  12. 12.
    Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62(10):1006–1012PubMedCrossRefGoogle Scholar
  13. 13.
    Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting Meta-Analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA 283(15):2008–2012PubMedCrossRefGoogle Scholar
  14. 14.
    von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, STROBE Initiative (2008) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. J Clin Epidemiol 61(4):344–349CrossRefGoogle Scholar
  15. 15.
    Spencer L, Ritchie J, Lewis J, Dillon L, National Centre for Social Research (2003) Quality in qualitative evaluation: a framework for assessing research evidence. Government Chief Social Researcher’s OfficeGoogle Scholar
  16. 16.
    Beatty L, Oxlad M, Koczwara B, Wade TD (2008) The psychosocial concerns and needs of women recently diagnosed with breast cancer: a qualitative study of patient, nurse and volunteer perspectives. Health Expect 11(4):331–342PubMedCrossRefGoogle Scholar
  17. 17.
    Halkett GK, Lobb EA, Oldham L, Nowak AK (2010) The information and support needs of patients diagnosed with high grade glioma. Patient Educ Couns 79(1):112–119PubMedCrossRefGoogle Scholar
  18. 18.
    Macvean ML, White VM, Pratt S, Grogan S, Sanson-Fisher R (2007) Reducing the unmet needs of patients with colorectal cancer: a feasibility study of the pathfinder volunteer program. Support Care Cancer 15(3):293–299PubMedCrossRefGoogle Scholar
  19. 19.
    Newell S, Sanson-Fisher RW, Girgis A, Ackland S (1999) The physical and psycho-social experiences of patients attending an outpatient medical oncology department: a cross-sectional study. Eur J Cancer Care (Engl) 8(2):73–82CrossRefGoogle Scholar
  20. 20.
    Minstrell M, Winzenberg T, Rankin N, Hughes C, Walker J (2008) Supportive care of rural women with breast cancer in Tasmania, Australia: changing needs over time. Psychooncology 17(1):58–65PubMedCrossRefGoogle Scholar
  21. 21.
    Sanson-Fisher R, Girgis A, Boyes A, Bonevski B, Burton L, Cook P (2000) The unmet supportive care needs of patients with cancer. Supportive Care Review group. Cancer 88(1):226–237PubMedCrossRefGoogle Scholar
  22. 22.
    Sharpe L, Butow P, Smith C, McConnell D, Clarke S (2005) The relationship between available support, unmet needs and caregiver burden in patients with advanced cancer and their carers. Psychooncology 14(2):102–114PubMedCrossRefGoogle Scholar
  23. 23.
    Smith DP, Supramaniam R, King MT, Ward J, Berry M, Armstrong BK (2007) Age, health, and education determine supportive care needs of men younger than 70 years with prostate cancer. J Clin Oncol 25(18):2560–2566PubMedCrossRefGoogle Scholar
  24. 24.
    Thewes B, Butow P, Stuart-Harris R, Greater Southern Area Health Service Screening Collaborative Group (2009) Does routine psychological screening of newly diagnosed rural cancer patients lead to better patient outcomes? Results of a pilot study. Aust J Rural Health 17(6):298–304PubMedCrossRefGoogle Scholar
  25. 25.
    Yoon J, Malin JL, Tisnado DM, Tao ML, Adams JL, Timmer MJ, Ganz PA, Kahn KL (2008) Symptom management after breast cancer treatment: Is it influenced by patient characteristics? Breast Cancer Res Treat 108(1):69–77PubMedCrossRefGoogle Scholar
  26. 26.
    Taylor EJ (2006) Prevalence and associated factors of spiritual needs among patients with cancer and family caregivers. Oncol Nurs Forum 33(4):729–735PubMedCrossRefGoogle Scholar
  27. 27.
    Stephens PA, Osowski M, Fidale MS, Spagnoli C (2008) Identifying the educational needs and concerns of newly diagnosed patients with breast cancer after surgery. Clin J Oncol Nurs 12(2):253–258PubMedCrossRefGoogle Scholar
  28. 28.
    Hawkins NA, Pollack LA, Leadbetter S, Steele WR, Carroll J, Dolan JG, Ryan EP, Ryan JL, Morrow GR (2008) Informational needs of patients and perceived adequacy of information available before and after treatment of cancer. J Psychosoc Oncol 26(2):1–16PubMedCrossRefGoogle Scholar
  29. 29.
    Chen SC, Yu WP, Chu TL, Hung HC, Tsai MC, Liao CT (2010) Prevalence and correlates of supportive care needs in oral cancer patients with and without anxiety during the diagnostic period. Cancer Nurs 33(4):280–289PubMedCrossRefGoogle Scholar
  30. 30.
    Chen SC, Lai YH, Liao CT, Chang JT, Lin CC (2009) Unmet information needs and preferences in newly diagnosed and surgically treated oral cavity cancer patients. Oral Oncol 45(11):946–952PubMedCrossRefGoogle Scholar
  31. 31.
    Chen SC, Liao CT, Lin CC, Chang JT, Lai YH (2009) Distress and care needs in newly diagnosed oral cavity cancer patients receiving surgery. Oral Oncol 45(9):815–820PubMedCrossRefGoogle Scholar
  32. 32.
    Chen SC, Tsai MC, Liu CL, Yu WP, Liao CT, Chang JT (2009) Support needs of patients with oral cancer and burden to their family caregivers. Cancer Nurs 32(6):473–481PubMedCrossRefGoogle Scholar
  33. 33.
    McIllmurray MB, Thomas C, Francis B, Morris S, Soothill K, Al-Hamad A (2001) The psychosocial needs of cancer patients: findings from an observational study. Eur J Cancer Care (Engl) 10(4):261–269CrossRefGoogle Scholar
  34. 34.
    McNamara S (1999) Information and support: a descriptive study of the needs of patients with cancer before their first experience of radiotherapy. Eur J Oncol Nurs 3(1):31–37CrossRefGoogle Scholar
  35. 35.
    Ream E, Quennell A, Fincham L, Faithfull S, Khoo V, Wilson-Barnett J, Richardson A (2008) Supportive care needs of men living with prostate cancer in England: a survey. Br J Cancer 98(12):1903–1909PubMedCrossRefGoogle Scholar
  36. 36.
    Bryant-Lukosius D, Browne G, DiCenso A, Whelan T, Gafni A, Neville A, Sathya J (2010) Evaluating health-related quality of life and priority health problems in patients with prostate cancer: a strategy for defining the role of the advanced practice nurse. Can Oncol Nurs J 20(1):5–14PubMedGoogle Scholar
  37. 37.
    Fitch MI, Steele R (2010) Identifying supportive care needs of women with ovarian cancer. Can Oncol Nurs J 20(2):66–74PubMedGoogle Scholar
  38. 38.
    Hohenadel J, Kaegi E, Laidlaw J, Kovacik G, Cortinois A, Kang R, Jadad AR (2007) Leveling the playing field: the personal coach program as an innovative approach to assess and address the supportive care needs of underserved cancer patients. J Support Oncol 5(4):185–193PubMedGoogle Scholar
  39. 39.
    van Harteveld JT, Mistiaen PJ, Dukkers van Emden DM (1997) Home visits by community nurses for cancer patients after discharge from hospital: an evaluation study of the continuity visit. Cancer Nurs 20(2):105–114PubMedCrossRefGoogle Scholar
  40. 40.
    Verdonck-de Leeuw IM, de Bree R, Keizer AL, Houffelaar T, Cuijpers P, van der Linden MH, Leemans CR (2009) Computerized prospective screening for high levels of emotional distress in head and neck cancer patients and referral rate to psychosocial care. Oral Oncol 45(10):e129–e133PubMedCrossRefGoogle Scholar
  41. 41.
    Browall M, Carlsson M, Horvath GG (2004) Information needs of women with recently diagnosed ovarian cancer—a longitudinal study. Eur J Oncol Nurs 8(3):200–207, discussion 208–10PubMedCrossRefGoogle Scholar
  42. 42.
    Siedentopf F, Marten-Mittag B, Utz-Billing I, Schoenegg W, Kentenich H, Dinkel A (2010) Experiences with a specific screening instrument to identify psychosocial support needs in breast cancer patients. Eur J Obstet Gynecol Reprod Biol 148(2):166–171PubMedCrossRefGoogle Scholar
  43. 43.
    Salminen E, Vire J, Poussa T, Knifsund S (2004) Unmet needs in information flow between breast cancer patients, their spouses, and physicians. Support Care Cancer 12(9):663–668PubMedGoogle Scholar
  44. 44.
    Saraswathi N (2005) Needs and concerns of breast cancer patients-SGH experience. Singap Nurs J 35(4):34–41Google Scholar
  45. 45.
    (1999) Health literacy: report of the council on scientific affairs. ad hoc committee on health literacy for the council on scientific affairs. JAMA 281(6):552–557Google Scholar
  46. 46.
    Amalraj S, Starkweather C, Nguyen C, Naeim A (2009) Health literacy, communication, and treatment decision-making in older cancer patients. Oncology (Williston Park) 23(4):369–375Google Scholar
  47. 47.
    Sparks L, Nussbaum JF (2008) Health literacy and cancer communication with older adults. Patient Educ Couns 71(3):345–350PubMedCrossRefGoogle Scholar
  48. 48.
    Jennens RR, Giles GG, Fox RM (2006) Increasing under representation of elderly patients with advanced colorectal or non-small-cell lung cancer in chemotherapy trials. Intern Med J 36(1445–5994; 4):216–220PubMedCrossRefGoogle Scholar
  49. 49.
    Owusu C, Lash TL, Silliman RA (2007) Effect of undertreatment on the disparity in age-related breast cancer-specific survival among older women. Breast Cancer Res Treat 102(2):227–236PubMedCrossRefGoogle Scholar
  50. 50.
    Yood MU, Owusu C, Buist DS, Geiger AM, Field TS, Thwin SS, Lash TL, Prout MN, Wei F, Quinn VP, Frost FJ, Silliman RA (2008) Mortality impact of less-than-standard therapy in older breast cancer patients. J Am Coll Surg 206(1):66–75PubMedCrossRefGoogle Scholar
  51. 51.
    Bouchardy C, Rapiti E, Blagojevic S, Vlastos AT, Vlastos G (2007) Older female cancer patients: importance, causes, and consequences of undertreatment. J Clin Oncol 25(14):1858–1869PubMedCrossRefGoogle Scholar
  52. 52.
    Velanovich V, Gabel M, Walker EM, Doyle TJ, O’Bryan RM, Szymanski W, Ferrara JJ, Lewis FR Jr (2002) Causes for the undertreatment of elderly breast cancer patients: tailoring treatments to individual patients. J Am Coll Surg 194(1):8–13PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • M. T. E. Puts
    • 1
  • A. Papoutsis
    • 1
  • E. Springall
    • 2
  • A. E. Tourangeau
    • 1
    • 3
  1. 1.Lawrence S. Bloomberg Faculty of NursingUniversity of TorontoTorontoCanada
  2. 2.Gerstein Science Information CentreUniversity of Toronto LibrariesTorontoCanada
  3. 3.Institute for Clinical Evaluative SciencesTorontoCanada

Personalised recommendations