A diagnosis of cancer can affect a person’s physical, psychological, spiritual, and social well-being. Some of these effects will resolve over time due to individual personal coping resources, social and professional support and some needs emerge later or increase over time.
Supportive care is defined as “the provision of the necessary services for those living with or affected by cancer to meet their physical, emotional, social, psychological, informational, spiritual and practical needs during the diagnostic, treatment, and follow-up phases, encompassing issues of survivorship, palliative care and bereavement”.1
- Physical – “Needs related to physical comfort and freedom from pain, optimum nutrition, ability to carry out one’s usual day-to-day functions”2
- Emotional – “Needs related to a sense of comfort, belonging, understanding and reassurance in times of stress and upset” 2
- Social – “Needs related to family relationships, community acceptance and involvement in relationships”2
- Psychological – “Needs related to the ability to cope with the illness experience and its consequences, including the need for optimal personal control and the need to experience positive self-esteem” 2
- Informational – “Needs requiring information to reduce confusion, anxiety and fear; to inform the person’s or family’s decision-making; and to assist in skill acquisition”2
- Spiritual – “Needs related to the meaning and purpose in life to practice religious beliefs”2
- Practical – “Needs requiring direct assistance in order to accomplish a task or activity and thereby reduce the demands on the person”2
Supportive care interventions can prevent or minimise the adverse effects of cancer and its treatment, across all phases of a person’s cancer experience. Nurses contribute to effective supportive care by:2, 3
- reducing the risk of developing unmet supportive care needs
- detecting unmet supportive care needs early
- implementing interventions to address supportive care needs, during and following treatment, and at end of life
- timely referral to other professionals, individuals and services if required.
Interventions may include self-management support, information, psychological support, symptom control, social support, rehabilitation, spiritual support, palliative care and bereavement care.3
Why is this important?
Early identification and referral of individuals with unmet supportive care needs can result in improved outcomes, such as:4, 5
- decreased levels of patient distress
- a decrease in the likelihood of the development of clinical anxiety and depression
- enhanced quality of care and patient satisfaction
- improved communication with the health care team
- increased adherence to cancer treatments
- decreased longer term costs and usage of the health care system.
Unmet supportive care needs can be associated with significant morbidity and distress. Distress has been defined as an unpleasant emotional experience of a psychological (cognitive, behavioural, emotional), social and/or spiritual nature that may interfere with the ability to cope effectively with cancer, its symptoms, and its treatment. Distress extends along a continuum, ranging from common feelings of vulnerability, sadness and fears to problems that can become disabling, such as depression, anxiety, panic, social isolation, and existential and spiritual crisis.6 Rates of clinically significant distress have been reported to be between 25% and 45% among people with cancer.7, 8
A high proportion of unmet supportive care needs are psychological. Individuals need assistance in managing fears about the future and the cancer spreading; lack of control; and feeling sad, depressed or anxious.9 Fewer than 10% of people are referred for psychosocial help despite having needs identified.8 Reasons for the lack of follow-up include:10, 11
- inappropriate timing of referrals
- health professionals not knowing about available supportive care resources
- health professionals not asking about supportive care needs
- health professionals not able to skillfully introduce the supportive care service.
The most common unmet needs experienced throughout the cancer journey are summarised in Table 1.
Table 1: Common unmet supportive care needs4, 12, 13
|Phase of cancer journey||Common unmet supportive care needs|
|Post treatment, follow-up and survivorship phase:||
|Advanced and end of life phase:||