Piloting a Needs Assessment to Guide Development of a Survivorship Program for a Community Cancer Center

Maura Schlairet

Mary Ann Heddon

Martha Griffis

educational needs, cancer survivorship
ONF 2010, 37(4), 501-508. DOI: 10.1188/10.ONF.501-508

Purpose/Objectives: To develop and pilot a survey to assess needs and distress of cancer survivors receiving care in a community cancer center.

Design: Descriptive, quantitative.

Setting: A community cancer center in the southeastern United States partnering with a local college of nursing faculty.

Sample: Convenience sample of 307 adult cancer survivors.

Methods: Voluntary completion of a modified survey of needs.

Main Research Variables: Cancer survivor needs and distress according to five subscales (physical effects, social issues, emotional aspects, spiritual issues, and other issues), age, and gender.

Findings: Patients on average reported experiencing more than 25 of 50 possible survivorship needs. Average distress scores associated with individual needs were low. The most frequently experienced needs were fatigue, fear of recurrence, and sleep disturbance. Middle-aged survivors experienced significantly greater need and distress across all subscales.

Conclusions: Need and distress exist among adult cancer survivors receiving treatment and follow-up in community cancer care settings, with the middle-age phase of life creating unique barriers. Survey data may provide documentation of the multidimensional impact of cancer on quality of life and can help direct survivorship program development.

Implications for Nursing: Nurses can address a barrier to survivorship care in community care settings by using the Pearlman-Mayo Survey of Needs to assess outcomes relevant to survivors. Partnership between community hospital RNs and college of nursing faculty may create local or regional solutions and serve as useful models for survivorship care.

Jump to a section


    Almquist, G., & Bookbinder, M. (1990). Developing an educational needs assessment. Journal of Nursing Staff Development, 6, 246-249.
    American College of Surgeons. (2006). Commission on cancer program standards. Chicago, IL: Author.
    American Society of Clinical Oncology. (2007). People living with cancer: Survivorship. Retrieved from
    Association of Community Cancer Centers. (2008). Comprehensive survivorship services: A practical guide for community cancer centers. Retrieved from
    Aziz, N. M., & Rowland, J. H. (2003). Trends and advances in cancer survivorship research: Challenge and opportunity. Seminars in Radiation Oncology, 13, 248-266.
    Cella, D. F. (1987). Cancer survival: Psychosocial and public issues. Cancer Investigation, 5, 59-67.
    Chouliara, Z., Kearney, N., Stott, D., Molassiotis, A., & Miller, M. (2004). Perceptions of older people with cancer of information, decision making and treatment: A systematic review of selected literature. Annals of Oncology, 15, 1596-1602. doi: 10.1093/annonc/mdh423
    Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.
    Corbin, J. M., & Strauss, A. (1988). Unending work and care: Managing chronic illness at home. San Francisco, CA: Jossey-Bass.
    Coulter, A., & Ellins, J. (2006). Patient-focused interventions: A review of the evidence. London, England: Health Foundation and Picker Institute Europe.
    Courtemanche, B. M. (1995). Determining educational needs of staff nurses: An assessment tool for nurse educators. Journal of Continuing Education in Nursing, 26, 104-108.
    Davis, C., Williams, P., Redman, S., White, K., & King, E. (2003). Assessing the practical and psychosocial needs of rural women with early breast cancer in Australia. Social Work in Health Care, 36(3), 25-36.
    Demark-Wahnefried, W., Peterson, B., McBride, C., Lipkus, I., & Clipp, E. (2000). Current health behaviors and readiness to pursue life-style changes among men and women diagnosed with early stage prostate and breast carcinomas. Cancer, 88, 674-684.
    Earle, C. C. (2006). Failing to plan is planning to fail: Improving the quality of care with survivorship care plans. Journal of Clinical Oncology, 32, 5112-5116. doi: 10.1200/JCO.2006.06.5284
    Epstein, R. M., & Street, R. L. (2007). Patient-centered communication in cancer care: Promoting healing and reducing suffering. Bethesda, MD: National Cancer Institute.
    Ferrell, B. R., Hassey-Dow, K., & Grant, M. (1995). Measurement of the quality of life in cancer survivors. Quality of Life Research, 4, 523-531.
    Finkelman, A., & Kenner, C. (2008). Educational and service partnerships: An example of global flattening. Journal of Professional Nursing, 24, 59-65. doi: 10.1016/j.profnurs.2007.02.002
    Ganz, P. A. (2002). What outcomes matter to patients: A physician-researcher point of view. Medical Care, 40(6, Suppl.), iii11-iii19.
    Gaston, C. M., & Mitchell, G. (2005). Information giving and decision-making in patients with advanced cancer: A systematic review. Social Science and Medicine, 61, 2252-2264.
    Greene, M. G., & Adelman, R. D. (2003). Physician-older patient communication about cancer. Patient Education and Counseling, 50, 55-60.
    Hack, T. F., Degner, L. F., & Parker, P. A. (2005). The communication goals and needs of cancer patients: A review. Psycho-Oncology, 14, 831-845. doi: 10.1002/pon.949
    Haynes, S. N. (2003). Clinical applications of analogue behavioral observation: Dimensions of psychometric evaluations. In A. E. Kazdin (Ed.), Methodological issues and strategies in clinical research (3rd ed.) (pp. 235-264). Washington, DC: American Psychological Association.
    Hewitt, M., Rowland, J. H., & Yancik, R. (2003). Cancer survivors in the United States: Age, health, and disability. Journal of Gerontology, 58, 82-91.
    Hodgkinson, K., Butow, P., Hunt, G. E., Pendlebury, S., Hobbs, K. M., Lo, S. K., & Wain, G. (2007). The development and evaluation of a measure to assess cancer survivors' unmet supportive care needs: The CaSUN (Cancer Survivors' Unmet Needs measure). Psycho-Oncology, 16, 796-804. doi: 10.1002/pon.1137
    Houts, P. S., Yasko, J. M., Kahn, S. B., Schelzel, G. W., & Marconi, K. M. (1986). Unmet psychological, social, and economic needs of persons with cancer in Pennsylvania. Cancer, 58, 2355-2361.
    Institutes of Medicine. (2006). From cancer patient to cancer survivor: Lost in transition. Washington, DC: National Academies Press.
    Institutes of Medicine. (2007). Implementing cancer survivorship planning: Workshop summary. Washington, DC: National Academies Press.
    Institutes of Medicine. (2008). Cancer care for the whole patient: Meeting psychosocial health needs. Washington, DC: National Academies Press.
    Jansen, J., van Weert, J., van Dulmen, S., Heeren, T., & Bensing, J. (2007). Patient education about treatment in cancer care: An overview of the literature on older patients' needs. Cancer Nursing, 30, 251-260.
    Jemal, A., Clegg, L. X., Ward, E., Ries, L. A. G., Wu, X., Jamison, P. M., … Edwards, B. K. (2004). Annual report to the nation on the status of cancer 1975-2001, with a special feature regarding survival. Cancer, 101, 3-27.
    Jemal, A., Siegel, R., Ward, E., Hao, Y., Xu, J., & Thun, M. J. (2009). Cancer statistics, 2009. CA: A Cancer Journal for Clinicians, 59, 225-249.
    Landier, W. (2009). Survivorship care: Essential components and models of delivery. Oncology (Williston Park), 23(4, Suppl.), 46-53.
    Leigh, S. (2007). Cancer survivorship: A nursing perspective. In P. A. Ganz (Ed.), Cancer survivorship: Today and tomorrow (pp. 8-13). New York, NY: Springer.
    Leigh, S. A. (1996). Defining our destiny. In B. Hoffman (Ed.), A cancer survivor's almanac: Charting the journey (pp. 261-271). Minneapolis, MN: Chronimed Publishers.
    Mandal, A., Eaden, J., Mayberry, J. K., & Mayberry, J. F. (2000). Questionnaire surveys in medical research. Journal of Evaluation in Clinical Practice, 6, 395-403.
    Martella, R. C., Nelson, R., & Marchand-Martella, N. E. (1999). Research methods: Learning to become a critical research consumer. Boston, MA: Allyn and Bacon.
    Maunsell, E., Brisson, J., & Deschěnes, L. (1992). Psychological distress after initial treatment of breast cancer. Assessment of potential risk factors. Cancer, 70, 20-25.
    Mayo Clinic Cancer Center. (2007). Survey of Needs. Unpublished instrument, Cancer Education Center of the Mayo Clinic Cancer Center, Rochester, MN.
    McBride, C. M., Clipp, E., Peterson, B. L., Lipkus, I. M., & Demark-Wahnefried, W. (2000). Psychological impact of diagnosis and risk reduction among cancer survivors. Psycho-Oncology, 9, 418-427.
    McCabe, M. S., & Jacobs, L. (2008). Survivorship care: Models and programs. Seminars in Oncology Nursing, 24, 202-207.
    McQuellon, R. P., & Danhauer, S. C. (2007). Psychosocial rehabilitation in cancer care. In P. A. Ganz (Ed.), Cancer survivorship: Today and tomorrow (pp. 238-250). New York, NY: Springer.
    Mullan, F. (1985). Seasons of survival: Reflections of a physician with cancer. New England Journal of Medicine, 313, 270-273.
    National Cancer Institute. (2007). Frequently asked questions: NCI Community Cancer Centers Program pilot: 2007-2010. Retrieved from
    National Cancer Institute. (2008). Surveillance Epidemiology and End Results (SEER): Stat fact sheets. Retrieved from
    National Cancer Institute. (2009). Cancer survivors and their doctors have different expectations about care. Retrieved from
    National Comprehensive Cancer Network. (2009). NCCN Clinical Practice Guidelines in Oncology™: Distress management [v.2.2009]. Retrieved from
    Pearlman Cancer Center. (2008). Pearlman-Mayo Survey of Needs. Retrieved from
    Price, J. H., Dake, J. A., Murnan, J., Dimmig, J., & Akpanudo, S. (2005). Power analysis in survey research: Importance and use for health educators. American Journal of Health Education, 36, 202-207.
    Queeney, D. S. (1995). An essential tool for quality improvement: Assessing needs in continuing education. San Francisco, CA: Jossey-Bass.
    Ravert, P., & Merrill, K. C. (2008). Hospital nursing research program: Partnership of service and academia. Journal of Professional Nursing, 24, 54-58.
    Rowland, J., Mariotto, A., Aziz, N., Tesauro, G., Feuer, E. J., Blackman, D., … Pollack, L. A. (2004). Cancer survivorship—United States, 1971-2001. Morbidity and Mortality Weekly Report, 53, 526-529.
    Rowland, J. H. (2007). Survivorship research: Past, present, and future. In P. A. Ganz (Ed.), Cancer survivorship: Today and tomorrow (pp. 28-42). New York, NY: Springer.
    Rutten, L. J., Arora, N. K., Bakos, A. D., Aziz, N., & Rowland, J. (2005). Information needs and sources of information among cancer patients: A systematic review of research (1980-2003). Patient Education and Counseling, 57, 250-261. doi: 10.1016/j.pec.2004.06.006
    Sanson-Fisher, R., Girgis, A., Boyes, A., Bonevski, B., Burton, L., & Cook, P. (2000). The unmet supportive care needs of patients with cancer. Cancer, 88, 226-237.
    Shaha, M., Cox, C. L., Talman, K., & Kelly, D. (2008). Uncertainty in breast, prostate, and colorectal cancer: Implications for supportive care. Journal of Nursing Scholarship, 40, 60-67.
    Siegel, K., Bradley, C. J., & Lekas, H. M. (2004). Causal attributions for fatigue among late middle-aged and older adults with HIV infections. Journal of Pain and Symptom Management, 28, 211-244.
    Simone, J. V. (2002). Understanding cancer centers. Journal of Clinical Oncology, 20, 4503-4507.
    Smyth, M. M., McCaughan, E., & Harrisson, S. (1995). Women's perceptions of their experiences with breast cancer: Are their needs being addressed? European Journal of Cancer Care, 4, 86-92.
    Soothill, K., Morris, S. M., Harman, J., Francis, B., Thomas, C., & McIllmurray, M. B. (2001). The significant unmet needs of cancer patients: Probing psychosocial concerns. Supportive Care in Cancer 9, 597-605.
    Ward, E., Halpern, M., Schrag, N., Cokkinides, V., DeSantis, C., Bandi, P., … Jemal, A. (2008). Association of insurance with cancer care utilization and outcomes. CA: A Cancer Journal for Clinicians 58, 9-31.
    Wen, K. Y., & Gustafson, D. H. (2004). Needs assessment for cancer patients and their families. Health and Quality of Life Outcomes, 2, 1-12.
    Wiener, C. L., & Dodd, M. J. (1993). Coping amid uncertainty: An illness trajectory perspective. Scholarly Inquiry for Nursing Practice, 7, 17-31.
    Witkin, B. R., & Altschuld, J. W. (1995). Planning and conducting needs assessments: A practical guide. Thousand Oaks, CA: Sage.
    Wong, F., Stewart, D. E., Dancey, J., Meana, M., McAndrews, M. P., Bunston, T., & Cheung, A. M. (2000). Men with prostate cancer: Influence of psychological factors on informational needs and decision making. Journal of Psychosomatic Research, 49, 13-19.