Changes in supportive care needs after first-line treatment for ovarian cancer: identifying care priorities and risk factors for future unmet needs Vanessa L. Beesley 1 *, Melanie A. Price 2 , Penelope M. Webb 1 , Peter O’Rourke 3 , Louise Marquart 3 , Australian Ovarian Cancer Study Group 1 , Australian Ovarian Cancer Study–Quality of Life Study Investigators 2 and Phyllis N Butow 2 1 Gynaecological Cancers Group, Queensland Institute of Medical Research, Herston, QLD, Australia 2 Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, The University of Sydney, Sydney, NSW, Australia 3 Statistics Unit, Queensland Institute of Medical Research, Herston, QLD, Australia *Correspondence to: Queensland Institute of Medical Research, Gynaecological Cancers Group, Locked Bag 2000, Royal Brisbane Hospital, Herston, QLD 4029, Australia. E-mail: Vanessa.Beesley@qimr. edu.au Received: 24 November 2011 Revised: 26 July 2012 Accepted: 8 August 2012 Abstract Objective: The objective of this paper is to determine changes in supportive care needs after first-line treatment for ovarian cancer and identify risk factors for future unmet needs. Methods: Two hundred and nineteen women with ovarian cancer were asked to complete a baseline survey 6–12 months after diagnosis then follow-up surveys every 6 months for up to 2 years. The validated Supportive Care Needs Survey-Short Form measured 34 needs across five domains. Logistic regression identified baseline variables associated with future needs. Results: At baseline, standardized median scores (possible range 0–100, least-to-greatest need) within the psychological, system/information, physical, patient care and sexuality need domains were 25, 20, 15, 15 and 8, respectively. The most frequently reported moderate-to-high unmet needs at baseline were needing help with fear about cancer spreading (25%), concerns about worries of those close (20%), being informed about things to help get well (20%), uncertainty about future (19%) and lack of energy (18%). All except the item about being informed were still reported as unmet needs by ≥15% of women 2 years later. Median health system/information, patient care and sexuality need scores decreased over 2 years (p < 0.05), whereas psychological and physical scores remained constant. Risk factors for having ≥1 moderate-to-high unmet overall, psychological or physical need 1–2 years after baseline included older age, advanced disease, unmet need, anxiety, depression, insomnia and less social support at baseline. Conclusion: Women with ovarian cancer report needing ongoing assistance to deal with psycholog- ical and physical needs over the first 2 years after first-line treatment. Targeting individuals at risk of future unmet needs should be prioritized. Copyright © 2012 John Wiley & Sons, Ltd. Introduction Most women with ovarian cancer have advanced disease at diagnosis [1]. They are typically treated with surgery and six 3-weekly cycles of adjuvant chemotherapy. Although most women initially respond to treatment, 80% experi- ence disease recurrence and go on to have multiple courses of chemotherapy over several years, before succumbing to their disease [1]. Survival is an important objective of treatment but, in the context of advanced disease and the debilitating side effects of ongoing treatment, maximizing quality of life is also a priority issue. Comprehensive care involves not only curative efforts but also attention to a whole range of patient needs [2]. It is through meeting these needs that we can improve overall quality of life [3]. Needs assessment tools explicitly assess the stated desire for some action or resource that will help the patient attain optimal well-being [4]. Such tools directly measure the gap between a person’s experience of a service and the actual service required [5], highlighting deficiencies in service delivery. Little information is available about the specific needs of women with ovarian cancer. The only published study to date, a cross-sectional single clinic sample of 50 women, reported that the most frequently reported needs were psychosocial, such as fear about the cancer returning or spreading [6]. While other studies include women with ovarian cancer among heterogeneous gynecological samples, these have been cross-sectional, mainly longer-term survivors [7–9] and/or convenience samples [9,10] and do not separately report on women with ovarian cancer. The needs of women with ovarian cancer are likely to differ from those of other gynecolog- ical cancer subgroups, due to their predominantly late stage diagnosis and ongoing courses of chemotherapy. Some support needs are also likely to change over time. Studies of women with ovarian cancer have shown that compared with women undergoing first-line chemotherapy, those on post- treatment have significantly higher physical and functional well-being [11], lower depression and bet- ter quality of life [12]. After initial treatment-associated clinical care, some needs may be resolved, or addressed by family, friends or community organizations, although others may remain unmet [13]. Only one longitudinal study has been published that assessed unmet needs of cancer patients beyond the end of primary treatment. In this study, 30% of a mixed cancer group (including breast, prostate, colorectal, and gynecological cancer and non- Hodgkin’s lymphoma survivors) who were treated with Copyright © 2012 John Wiley & Sons, Ltd. Psycho-Oncology Psycho-Oncology (2012) Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/pon.3169