title: Unmet care needs in people living with advanced cancer: a systematic review.
abstract: The support needs of cancer patients vary according to the phase of their cancer journey. Recent developments in healthcare are such that the advanced cancer phase is increasingly experienced as a chronic illness phase, with consequent changes in patient support needs. Understanding these needs, and identifying areas of unmet need, can enable us to develop services that are more adequate to the task of supporting this population.
  
  
  
  We conducted a systematic search of four electronic databases to identify studies examining the unmet needs of people living with advanced cancer. Relevant data were extracted and synthesised; meta-analyses were conducted to obtain pooled estimates for prevalence of needs.
  
  
  
  We identified 23 studies (4 qualitative) for inclusion. Unmet needs were identified across a broad range of domains, with greatest prevalence in informational (30-55 %), psychological (18-42 %), physical (17-48 %), and functional (17-37 %) domains. There was considerable heterogeneity amongst studies in terms of methods of assessment, coding and reporting of needs, respondent characteristics, and appraised study quality.
  
  
  
  Heterogeneity made it difficult to compare across studies and inflated confidence intervals for pooled estimates of prevalence-we need standardised and comprehensive approaches to assessment and reporting of unmet needs to further our understanding. Nonetheless, the review identified prominent needs across a range of (interacting) experiential domains. Moreover, by focussing on unmet needs for support, we were able to extrapolate potential implications for service development.
authors.affiliation: College of Social Sciences, University of Lincoln, Brayford Pool, Lincoln, UK. nmoghaddam@lincoln.ac.uk.
authors.forename: Nima
authors.initials: N
authors.lastname: Moghaddam
authors.affiliation: CityCare, Nottingham, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Coxon
authors.affiliation: CityCare, Nottingham, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Nabarro
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Beth
authors.initials: B
authors.lastname: Hardy
authors.affiliation: School of Health Sciences, University of Nottingham, Nottingham, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Cox
mesh_terms: D005260:Female; D006301:Health Services Needs and Demand / Q000592:standards*; D006801:Humans; D008297:Male; D020380:Needs Assessment / Q000592:standards*; D009369:Neoplasms / Q000523:psychology*
keywords: Advanced cancer; Supportive care; Systematic review; Unmet needs