Healthcare needs of patients with metastatic cancer and impacts of social vulnerability: a multicentric cross-sectional study in France

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CONTEXT: Understanding the healthcare needs of patients with metastatic cancer is necessary for reducing symptom burden and optimizing supportive care interventions. Little is known about the impact of social vulnerability on unmet patient needs and healthcare resources utilization in a healthcare system with universal health coverage. OBJECTIVES: This study aimed to describe the healthcare needs and resource utilization of patients with metastatic cancer in France, while also examining how social vulnerability influences these factors. METHODS: We conducted an observational, multicentric, cross sectional study concerning inpatients and outpatients with incurable metastatic cancer. We assessed quality of life (EORTC-QLQC30), supportive care needs (SCNS-SF34), social vulnerability (EPICES score), and healthcare utilization. RESULTS: 361 patients were included; 67.9% had a good performance status (0 or 1), and 59.4% were undergoing their 1st or 2nd line of systemic treatment. They had numerous moderate to severe symptoms including fatigue (75.9%), sleep disorders (61.2%), dyspnea (56.4%), and pain (54.4%). The most important unmet needs were psychological needs (51.4% of moderate/severe needs). 26.8% of patients had visited the emergency room and 38.5% had been admitted to the hospital in the past three months for a cancer complication. 40.3% of patients were socially vulnerable. In multivariate analysis, patients with high social vulnerability had significantly higher cachexia, less surgical treatment in the past and less recent systemic treatment, and more frequent hospitalization at home. CONCLUSION: Even when fit, patients with metastatic cancer had numerous health issues and unmet needs. Despite universal healthcare coverage, socially precarious patients seem to have a later diagnosis and less systemic treatment. Nevertheless they have the same unmet needs and strenghted medical and social care at home. A systematic monitoring of healthcare needs could help to trigger supportive care interventions. TRIAL REGISTRATION: This trial was registered in ClinicalTrial.gov PRS with the ID NCT05339945 on April 21, 2022.

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