title: Unmet needs mediate the relationship between symptoms and quality of life in breast cancer survivors.
abstract: OBJECTIVE
  This study aimed to compare the symptoms, unmet needs, and QoL reported by women at 6 months to <2 years and 2 to 5 years following surgery and adjuvant treatment for breast cancer. It also evaluated the relationships among symptoms, unmet needs, and QoL using structural equation modeling.
  
  
  METHODS
  In this study, 113 and 137 survivors following breast cancer treatment 6 months to <2 years and 2 to 5 years, respectively, completed the Memorial Symptom Assessment Scale, the Supportive Care Needs Survey-34, and the Medical Outcomes Study 12-item Short Form Health Survey version 2.0 during their medical follow-up.
  
  
  RESULTS
  The mean numbers of symptoms and unmet needs were 5.43 and 3.0, respectively, for survivors at <2 years, and 5.24 and 2.42, respectively, for survivors at 2 to 5 years following treatment. The most common reported symptoms were related primarily to physical domains. No significant differences were found between the two survivor groups on the MSAS scores. Survivors at <2 years reported significantly higher scores in Psychological and Health Care System/Information needs (p < 0.01), and lower composite scores in physical and mental QoL (p < 0.05) than those at 2 to 5 years post-treatment. Significant direct and indirect effects were found of symptom burden through unmet needs on survivors' physical and mental QoL after adjustment for survival time, and the models showed a good fit.
  
  
  CONCLUSIONS
  Results suggest that breast cancer survivors continue to endure many symptoms independent of the survivorship period. The unmet needs mediate the relationship between symptom burden and survivors' QoL.
authors.affiliation: Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Level 2, Clinical Research Centre, MD11, 10 Medical Drive, Singapore, 117597, Singapore. nurckfk@nus.edu.sg.
authors.forename: K K F
authors.initials: KKF
authors.lastname: Cheng
authors.affiliation: National University Hospital, National University Health System, Singapore, 119074, Singapore.
authors.forename: W H
authors.initials: WH
authors.lastname: Wong
authors.affiliation: National University Hospital, National University Health System, Singapore, 119074, Singapore.
authors.forename: C
authors.initials: C
authors.lastname: Koh
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D020380:Needs Assessment; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D012846:Singapore / Q000453:epidemiology; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data; D063189:Symptom Assessment; D013995:Time
keywords: Breast cancer; Cancer survivorship; Quality of life; Symptoms; Unmet needs