Supportive care needs (SCN) of cancer patients change during their cancer trajectory. Indigenous cancer patients face unique barriers to treatment; this may be partially explained by increased levels of comorbidity.
To explore the SCN of Indigenous cancer patients undergoing treatment and examine the impact of comorbidity on need fulfilment.
Indigenous patients undergoing cancer treatment were recruited from four public hospitals. The Supportive Care Needs Assessment Tool for Indigenous People was administered to measure type and level of unmet need (26 items; 0= no need to 5 = high need) across four domains: Physical & Psychological, Hospital Care, Information & Communication, and Practical & Cultural. For each domain, summated item scores were standardised on a 0-100 scale. Standardised scores were then dichotomised (none vs. some unmet need) for logistic regression analysis. Comorbidity data was collected via medical charts. A modified Charlson Comorbidity Index (CI), based on the presence and severity of select chronic conditions, was calculated and categorised as none (CI=0), mild (CI=1), and moderate-severe (CI=2+).
Among 248 patients, 68 (27%) had mild and 43 (17%) had moderate-severe comorbidity. Median domain scores between comorbidity groups were not significant (p>0.05). Patients without comorbidity had significantly greater odds of having any unmet need in the Information & Communication (OR1.92, 95%CI 1.05-3.53, p=0.04) and Practical & Cultural (OR2.27, 95%CI 1.32-3.90, p<0.01) domains. Increased odds of having unmet need in the Physical & Psychological and Hospital Care domains was not significant (p>0.05).
Patients with better health were more likely to report unmet need in the Information & Communication and Practical & Cultural domains. Speculatively, those with better health or who are less familiar with the health system may be more vulnerable to the impacts of cancer. A better understanding of this paradox may help improve treatment outcomes among Indigenous cancer patients.