Cluster Analysis Demonstrates the Need to Individualize Care for Cancer Survivors

• Published in: The oncologist (Dayton, Ohio) Vol. 23; no. 12; pp. 1474 - 1481
• Main Authors: de Rooij, Belle H., Park, Elyse R., Perez, Giselle K., Rabin, Julia, Quain, Katharine M., Dizon, Don S., Post, Kathryn E., Chinn, Garrett M., McDonough, Allison L., Jimenez, Rachel B., van de Poll‐Franse, Lonneke V., Peppercorn, Jeffrey
• Format: Journal Article
• Language: English
• Published: United States AlphaMed Press 01.12.2018
• Subjects: Aftercare; Cancer Survivors; Cluster Analysis; Cross-Sectional Studies; Female; Health Outcomes and Economics of Cancer Care; Health services needs and demand; Health services research; Humans; Male; Middle Aged; Needs assessment; Patient care planning; Precision Medicine - methods; Quality of Life - psychology; Surveys and Questionnaires; Survivors; Health services needs and demand; Needs assessment; Patient care planning; Survivors; Health services research
• ISSN: 1083-7159; 1549-490X
• DOI: 10.1634/theoncologist.2017-0558

Background In efforts to inform clinical screening and development of survivorship care services, we sought to characterize patterns of health care needs among cancer survivors by (a) identifying and characterizing subgroups based on self‐reported health care needs and (b) assessing sociodemographic, clinical, and psychosocial factors associated with these subgroups. Methods We conducted a cross‐sectional self‐administered survey among patients presenting for routine follow‐up care for early‐stage cancer at our academic medical center. Latent class cluster analysis was used to identify clusters of survivors based on survivorship care needs within seven domains. Multiple logistic regression analyses were used to assess factors associated with these clusters. Results Among 292 respondents, the highest unmet needs were related to the domains of side effects (53%), self‐care (51%), and emotional coping (43%). Our analysis identified four clusters of survivors: (a) low needs (n = 123, 42%), (b) mainly physical needs (n = 46, 16%), (c) mainly psychological needs (n = 57, 20%), and (d) both physical and psychological needs (n = 66, 23%). Compared with cluster 1, those in clusters 2, 3, and 4 were younger (p < .03), those in clusters 3 and 4 had higher levels of psychological distress (p < .05), and those in clusters 2 and 4 reported higher levels of fatigue (p < .05). Conclusion Unmet needs among cancer survivors are prevalent; however, a substantial group of survivors report low or no health care needs. The wide variation in health care needs among cancer survivors suggests a need to screen all patients, followed by tailored interventions in clinical care delivery and research. Implications for Practice The characterization of patients as having few needs, predominantly physical needs, predominantly psychological needs, or substantial needs that are both physical and psychological provides a productive framework for clinical care of cancer survivors and to guide further research in this field. Further research is needed to define the tailored information and services appropriate for each group of patients and to define optimal screening tools to efficiently identify the needs of individuals in oncology practice. Because of advances in health care and an aging population, the number of cancer survivors is increasing. How to best identify and address the needs of cancer survivors remains undefined. This article explores distinct subgroups of patients with similar needs and presents a cluster analysis based on self‐reported care needs among cancer survivors.