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A Mixed-Methods Study of Unmet Supportive Care Needs Among Head and Neck Cancer Survivors

So, Winnie K.W. PhD; Wong, Cho-Lee DN; Choi, Kai-Chow PhD; Chan, Carmen W.H. PhD; Chan, Joanne C.Y. PhD; Law, Bernard M.H. PhD; Wan, Rayman W.M. MN; Mak, Suzanne S.S. MN; Ling, Wai-Man MScN; Ng, Wai-Tong MD; Yu, Bernice W.L. MN

doi: 10.1097/NCC.0000000000000542

Background Head and neck cancer (HNC) survivors face increasing challenges to adjust to the diagnosis and late effects of treatment. Identifying unmet needs among HNC survivors is therefore important to provide a comprehensive supportive care service for them.

Objective The aim of this study was to examine the unmet supportive care needs (SCNs) of HNC survivors in the first year after treatment.

Methods An explanatory sequential mixed-method design with 2 phases was used. In the quantitative phase, standardized questionnaires were administered to 285 Chinese HNC survivors to solicit their demographic and clinical characteristics, unmet SCNs, and access to various support services. In the qualitative phase, individual semistructured interviews were conducted with 53 participants to explore their unmet needs in more detail.

Results The most prevalent unmet SCNs among the survivors were in the health system and information domain. Five categories of unmet needs emerged from the interview data: physical, psychological, health system and information, patient care and support, and sexuality. The findings reflect the inadequacy of the healthcare services for these survivors.

Conclusion Chinese HNC survivors experienced a variety of unmet SCNs, particularly in the areas of symptom management and healthcare system and information provision.

Implications for Practice The study provides insights that can (1) inform future service development, including regular symptom identification and management, improvements in communication, and counseling services and (2) identify the specific needs of these survivors as the basis for tailoring care to meet their needs.

Author Affiliations: The Nethersole School of Nursing, The Chinese University of Hong Kong (Drs So, Wong, Choi, C. Chan, J. Chan, and Law); Department of Clinical Oncology, Prince of Wales Hospital, Shatin, the New Territories (Mr Wan and Ms Mak); Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Chai Wan (Mr Ling and Dr Ng); and Department of Oncology, Princess Margaret Hospital, Lai Chi Kok, Kowloon (Ms Yu), Hong Kong.

This study was funded by the Health and Health Services Research Fund, Food and Health Bureau (grant number 09100731) and was supported by the Chinese University of Hong Kong. Its content is solely the responsibility of the authors and does not necessarily represent the official views of the institutions.

The authors have no conflicts of interest to disclose.

Correspondence: Winnie K. W. So, PhD, The Nethersole School of Nursing, The Chinese University of Hong Kong, 7/F, Esther Lee Bldg, Shatin, New Territories, Hong Kong SAR, China (

Accepted for publication July 11, 2017.

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