title: Attributing variance in supportive care needs during cancer: culture-service, and individual differences, before clinical factors.
abstract: 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.
authors.affiliation: Centre for Psycho-Oncology Research and Training, School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong, China. fielding@hku.hk
authors.forename: Richard
authors.initials: R
authors.lastname: Fielding
authors.forename: Wendy Wing Tak
authors.initials: WW
authors.lastname: Lam
authors.forename: Shiow Ching
authors.initials: SC
authors.lastname: Shun
authors.forename: Toru
authors.initials: T
authors.lastname: Okuyama
authors.forename: Yeur Hur
authors.initials: YH
authors.lastname: Lai
authors.forename: Makoto
authors.initials: M
authors.lastname: Wada
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Akechi
authors.forename: Wylie Wai Yee
authors.initials: WW
authors.lastname: Li
mesh_terms: D000368:Aged; D044466:Asian People; D003469:Culture; D005260:Female; D019538:Health Care Surveys; D006723:Hong Kong; D006801:Humans; D007206:Individuality; D007564:Japan; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D005791:Patient Care; D015995:Prevalence; D011788:Quality of Life; D012307:Risk Factors; D012944:Social Support; D013624:Taiwan