Exploratory study about needs of disease progression in cancer patients

Background: Oncological disease progression can be difficult to manage for physicians, due to therapeutic switch after a previous treatments’ failure, but also because oncologist have to be linked with information about clinical conditions for patient reassurance. Our research considers person an integrated system, looking at fundamental needs of patients, according to theoretical and empirical basis of Neo-functionalism in psychology. Several studies report more unmet needs in patients affected by cancer, despite an increased attention about bad news communication. Previous studies in the field of healthcare have shown that both communication and psychological characteristics of patients are fundamental for the therapeutic alliance and satisfaction in care. Aims: This study aims to explore emotional experience and psychological needs of cancer patients who have experienced disease progression. Specifically, the study investigates unmet needs and their associations with illness perception and quality of life. Materials and Methods: The research included 61 cancer patients who have progressed after a chemotherapy. They have been undergone to psychological questionnaires to evaluate specific needs (Needs Evaluation Questionnaire – NEQ), illness perception (Brief Illness Perception Questionnaire – Brief IPQ) and quality of life (EORT QLQ-C30). Also socio-demographic data and informations on medical therapies are considered. Results: Patients give greater importance to the empathic relationship with physician rather than accurate information about disease. Associations were found between factors observed. A patient who feels understood by the doctor has a positive illness perception and good quality of life. The need to be guided is the most reported by patients. Fragility in progression disease is accompanied by low illness control perceived, and greater delegation to the physician. The last result may be influenced by Sicilian cultural context, characterized by great caregiving and ability to be guided. Moreover, delegation to the physician is higher in patients with low levels of education. Conclusions: The results presented in this work seem to confirm that a greater knowledge about patient's specific needs of information, involvement, support, and associations with illness perception and perceived quality of life, facilitate care relationship in disease progression conditions. A good emotional contact is associated with less fear and more trust, so physician can guide patients also in difficult steps such as therapeutic switch after a previous treatments’ failure.