Attributing Variance in Supportive Care Needs during Cancer: Culture-Service, and Individual Differences, before Clinical Factors

Richard Fielding*, Wendy Wing Tak Lam, Shiow Ching Shun, Toru Okuyama, Yeur Hur Lai, Makoto Wada, Tatsuo Akechi, Wylie Wai Yee Li

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


Background:Studies using the Supportive Care Needs Survey (SCNS) report high levels of unmet supportive care needs (SCNs) in psychological and less-so physical & daily living domains, interpreted as reflecting disease/treatment-coping deficits. However, service and culture differences may account for unmet SCNs variability. We explored if service and culture differences better account for observed SCNs patterns.Methods:Hong Kong (n = 180), Taiwanese (n = 263) and Japanese (n = 109) CRC patients' top 10 ranked SCNS-34 items were contrasted. Mean SCNS-34 domain scores were compared by sample and treatment status, then adjusted for sample composition, disease stage and treatment status using multivariate hierarchical regression.Results:All samples were assessed at comparable time-points. SCNs were most prevalent among Japanese and least among Taiwanese patients. Japanese patients emphasized Psychological (domain mean = 40.73) and Health systems and information (HSI) (38.61) SCN domains, whereas Taiwanese and Hong Kong patients emphasized HSI (27.41; 32.92) and Patient care & support (PCS) (19.70; 18.38) SCN domains. Mean Psychological domain scores differed: Hong Kong = 9.72, Taiwan = 17.84 and Japan = 40.73 (p<0.03-0.001, Bonferroni). Other SCN domains differed only between Chinese and Japanese samples (all p<0.001). Treatment status differentiated Taiwanese more starkly than Hong Kong patients. After adjustment, sample origin accounted for most variance in SCN domain scores (p<0.001), followed by age (p = 0.01-0.001) and employment status (p = 0.01-0.001). Treatment status and Disease stage, though retained, accounted for least variance. Overall accounted variance remained low.Conclusions:Health service and/or cultural influences, age and occupation differences, and less so clinical factors, differentially account for significant variation in published studies of SCNs.

Original languageEnglish
Article numbere65099
JournalPLoS ONE
Issue number5
StatePublished - 31 May 2013


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