INTRODUCTION

Cancer is a non-communicable disease that ranks as the second leading cause of death in women (14%) ¹. Especially in developing countries, the highest cancer cases in women are breast and gynecological ^1,2. Breast cancer cases even reached 1.7 million and deaths in 500 thousand cases, while gynecological cancer reached more than 500 thousand cases and caused death in 265,000 survivors. Furthermore, another astonishing fact is that 90% of deaths in gynecological cancer patients occur in developing countries ^1,3. The number of cases is in line with the amount of attention needed by survivors of gynecological cancer and breast cancer, especially related to improving survivors' quality of life ⁴.

Quality of life is one of the goals of cancer survivor care ^5,6. Quality of life in survivors is certainly related to the course of the disease and the effects of primary therapy undertaken by survivors, such as side effects of chemotherapy, radiotherapy, and surgery/operative ⁷. Survivors of gynecological and breast cancer experience physical and psychological effects and other multidimensional aspects ^8,9. Psychological effects experienced by survivors, such as anxiety, depression, and fear of relapse, also decrease the quality of life of survivors of gynecological cancer or breast cancer ^10,11.

The complexity of the disease and cancer treatment forms a variety of needs for survivors of gynecological cancer and breast cancer, including biological (physical), psychological, social, cultural, and spiritual needs during and after treatment ^12,13. If these needs are not met, it is known as "unmet needs," which will impact the survivor's quality of life ^14,15. The more unmet needs, the worse the quality of life for gynecological cancer survivors ^{6)(16)(17)(18}. Therefore, to improve survivors' quality of life, one way to be pursued is to minimize unmet needs ^{9)(13)(16)(17}.

Various studies state that the unmet needs of gynecological cancer survivors and breast cancer consist of six types: existential survivorship, comprehensive cancer care, information, relationships, and others ^17,19. Furthermore, the factors influencing unmet needs include age, educational status, income, cancer location, treatment options, cancer stage, recurrence, and sources of information ^20,21. This systematic review aims to determine the unmet needs most often experienced by survivors of gynecological cancer and breast cancer based on the results of previous studies.

METHODS

This study is a study with a systematic review design. Researchers used several electronic databases as data sources: Science Direct, Cochrane Library, Ebsco, Pubmed, ProQuest, and CINAHL. Researchers searched articles based on keywords, namely unmet needs, gynecological cancer, breast cancer, and survivors. The selection of articles in this systematic review uses the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) procedure ²². Researchers set several inclusion criteria in the selection of research articles, namely as follows:

The exclusion criteria in this study were research articles with gynecologic cancer survivors and breast cancer survivors with mental disorders.

RESULTS

Results of searching the literature

Researchers conducted an article search on an electronic database repuTable to predefined criteria and obtained 838 articles. Furthermore, after deleting the article that is still duplicated, 255 reports were received. The screening was conducted on these articles and investigated 243 words that did not meet the criteria for article selection. A total of 16 full-text articles were further reviewed, but four were excluded because they did not meet most critical appraisal items with JBI instruments. The total number of articles included in this systematic review study is 12 (Figure 1).

Figure 1: PRISMA Flow Diagram. 

Characteristics of research

Table 1 contains the characteristics of the studies included in this study.

Table 1: Description of studies included in the systematic review. 

Risk of bias

Researchers tested the risk of research bias on selected articles using the Robvis tools. Most low-risk article essays bias well across the parameters of Robvis software. Figures 2 and 3 show the risk bias summary of the selected article (Figure 2) (Figure 3).

Figure 2: Risk of bias. 

Figure 3: Summary plot. 

DISCUSSION

Gynecological and breast cancer survivors have long-term and complex treatment ^29,30. The disease's complexity and treatment effects result in the emergence of various multidimensional needs in survivors of gynecological cancer or breast cancer ¹¹. These needs must be met to improve survivors' quality of life ²⁵. The condition of not optimal comprehensive care has caused various unmet needs for gynecological and breast cancer survivors ¹¹. Selected articles in this systematic review of unmet needs have been criticized using analysis with the Joanna Briggs Institute (JBI) instrument with good results and a low risk of bias in the RobVis instrument.

Most of the selected articles in this systematic review study state that the highest unmet need in gynecological and breast cancer survivors is the need for information ^{12)(13)(17)(21)(23)(24)(26)(27)(28}. Survivors whose information needs are met will be able to utilize self-management strategies and support other survivors to improve their well-being. This explains that this fulfilled information need is related to survivors' quality of life ^4,23. Information needed by gynecological and breast cancer survivors includes diagnosis/cancer, the possibility of recovery/recovery, course of disease/prognosis, medical therapy options, and risk of treatment side effects ^12)(13)(26. Other information includes an explanation of laboratory examination results and additional support, counseling with professionals, information on efforts to prevent recurrence and complications, and the benefits and disadvantages of each therapy undertaken ^23,24.

Survivors with unmet information needs are associated with increased depression and anxiety ^17,23. Other research shows that unmet needs related to this information become the most common / the most ranked. This indicates that there is dissatisfaction experienced by survivors, obstacles in delivering information, and a lack of communication between health teams and survivors ^12,17. Survivors who are dissatisfied or feel unmet information need to express a desire for more comprehensive information, second opinion, and other specific information ^12)(13)(23.

Unmet needs related to this information not only occur in survivors of gynecological and breast cancer in the early stages but also occur in survivors of the end stage, it implies a high need for this information about the condition of survivors based on the course of the disease (stage of cancer experienced) ^17,24. The longer a survivor has cancer / the higher the scene is not directly proportional to the knowledge/information that the survivor has longer has cancer / the more increased the location is not directly proportional to the knowledge/information that the survivor has ¹⁷. Most survivors claim to seek their lead over the internet, not even getting an explanation related to treatment, especially a second opinion ¹³. Unmet needs associated with this information occur in survivors of gynecological and breast cancer in various parts of the world, such as most regions of Asia, Mexican, and Latin America ^12,28. The information needs meeting for survivors to increase their involvement in care, risk assessment, understanding of screening and care, and even improving the quality of care outcomes ²⁷.

The highest unmet needs are the psychologic and psychosocial domains associated with fears of recurrence, worsening of symptoms, or side effects of treatment ^{9)(12)(17)(21)(25)(26}. In one of the studies, researchers stated that unmet needs related to this psychological domain are higher in survivors who experience recurrence and survivors who are already in a terminal condition ²⁵. Concerns facing death, the future, depression, and fear of leaving family and others lead to emotional and mood instability and worsening quality of life. One of the efforts to reduce this unmet psychosocial need is to provide adequate information about what survivors want and need to know in counseling and assessment related to this domain so that this need is no longer neglected ^12)(25)(26. Of course, you can also use support groups of fellow survivors to get information based on the experiences of other survivors ^13)(17)(21. Findings from this systematic review indicate that the two highest unmet needs domains in survivors of gynecological and cervical cancer are related to health care information and psychological/psychosocial domains, where one of the efforts to prevent and or overcome it is by providing adequate information.

Information on survivors includes clear explanations of disease diagnosis, treatment, and treatment, nutrition, psychological, and sources of financial assistance that survivors can access ²⁶. Some alternative solutions that can be considered and further researched effectiveness include interdisciplinary training of therapeutic communication skills, operational standards of procedures regarding providing information, assessment of the information needed to package information related to the survivorship care plan, quality supervision or quality of nursing care services and health care teams in general. In addition, the use of technology is also needed in efforts to improve care services. The limitations of this systematic review study are that the selected articles are still heterogeneous from the number of respondents, and the cancer stage is not included in the inclusion criteria.

CONCLUSIONS

The highest unmet needs for gynecological and breast cancer survivors are informational and psychological needs. Informational needs related to disease prognosis, treatment, nutrition, side effects, and potential recurrence. Furthermore, survivors also need psychological support. This finding implies the need for further research on effective techniques of survivor care, especially in terms of providing adequate information and psychological support to improve the quality of holistic nursing care for gynecological and breast cancer survivors.