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. 2020 Oct 15;8(1):5–17. doi: 10.4103/apjon.apjon_41_20

Table 1.

Reviewed studies in chronological order

Author (year) Country Research Question Methods Questionnaires-Assessments Results Limitations
Konstantinidis et al (2019) Greece[16] What are the unmet needs of hematological cancer patients? Sample size: 102 patients with leukemia, HL, NHL, and MM
Sampling: Convenience
Design: Cross-sectional
Setting: General Hospital
NEQ Informational/educational: 47% in total, “more information about my future condition” (44.1%).
Social: “support” needs (66.7%).
Daily living/practical: “financial” (total: 61.8%), “assistance and treatment needs” (50%) “to have more help with eating, dressing and going to the bathroom” (13.7%).
Family-related/relational: 55.9% in total, “to receive less commiseration from other people” (48%), and “to feel more useful within my family” (42.2%).
Health system related needs:” communication needs” (46%),” structure related needs” (41%) “better attention from nurses” (18.6%).
Spirituality: “to speak with a spiritual advisor” (11.8%), Patients with acute and chronic leukemia expressed more needs than those with other diseases (P=0.037).
The less satisfied patients (<8/10) reported more informational needs about their diagnosis and their future condition (P=0.002), about their exams and treatments (P=0.001), communicative (P<0.001), assistance and treatment (P<0.001) and hospital infrastructure (P<0.001).
Comparisons between the prevalence of needs among patients with different hematological malignancies could not be made in detail because of the small sample size of those subgroups.
Generalization should be made by caution since all patients came from the one region of Greece.
First use of NEQ in Greek hematological cancer patients
Troy et al (2018) USA[17] What is the patient-reported sources of distress, and its associations with clinical outcomes? Sample size: 124 MDS patients who contributed a PL only (n=14), or both DT and PL (n=110)
Sampling: Convenience
Design: Retrospective cohort study
Setting: Tertiary care medical left
NCCN Distress Thermometer (DT) DT ≥4 should be evaluated for referral to specialty services to address unmet needs Problem List (PL) Most frequently reported categories of problems were:
Physical (233 reports), emotional (104 reports), practical (49 reports), and family related (41 reports). Spirituality needs were reported only once during the study. Within each of these categories, the number of problems reported per patient was not strongly associated with DT scores. 89% reported 1,379 problems during 23,613 person-days of follow-up (median=4 problems/patient/visit, range=1-23). The 5 most frequent were fatigue (n=78), pain (n=46), worry (n=45), sleep (n=41), and tingling hands/feet (n=33). The total number of problems reported per patient was significantly correlated with the maximum distress level reported by each patient (P<0.0001). 49% had at least 1 DT ≥4 and 18% had 2 or more DT ≥4. The therapy itself was associated with greater maximum distress (n=75) compared with no therapy (n=35). Treatment with hypomethylating agents (P=0.75) or lenalidomide (P=0.09) was not associated with distress. The use of growth factors was associated with higher distress (n=32) compared with non-use of growth factors (n=78) (P=0.02). Receipt of red blood cells was associated with higher maximum distress (n=54) compared with never receiving packed red cells (n=56) (P=0.03). Patients who received platelets reported higher distress (n=22) compared with patients who did not receive platelets (n=88); this difference approached statistical significance (P=0.06).
Study design
The cohort was not measured from a common baseline
DT findings was not validated against other measures
Tzelepis et al (2017) Australia[18] Which are the differences between the unmet needs of rural and urban hematological cancer survivors? Sample size: 1417 patients (1145 urban, 272 rural) with leukemia, lymphoma, and myeloma
Sampling: Recruitment from five Australian state cancer registries
Design: Cross-sectional
Setting: Outpatient
SUNS Physical: Dealing with feeling tired was the most common “high/very high” unmet need for rural (15.2%) and urban (15.5%) survivors. “Coping with having a bad memory or lack of focus” was the second highest “high/very high” unmet need for urban survivors (13.1%) and the third highest for rural survivors (11.8%).
Psychological/emotional: Emotional health domain had the highest mean unmet need score for rural and urban survivors (P=0.01).
Daily living/practical: “Finding car parking that I can afford at the hospital or clinic” (11.0%) for rural survivors, “Having access to cancer services close to my home” were the second highest high/very high unmet need for rural survivors (14.3%).
Family-related/relational: “Dealing with feeling guilty about what I have put others through” (11.1%) for rural survivors.
Rurality was associated with a decreased unmet emotional health domain score (P=0.01) whereas travelling for more than 1h to place of treatment was associated with increased unmet financial concerns and unmet access and continuity of care (P<0.0001). Depression, anxiety, and stress were associated with increased unmet need scores for all five domains (P<0.0001).
Heterogeneous sample of hematological cancer survivors
Boucher et al (2018) USA[19] Which are the changes in the experience of illness (symptoms, needs) in the AML population changes over time? Sample size: 22 patients with high-risk AML
Sampling: Convenience
Design: Qualitative, semi-structured interviews, content analysis
Setting: Inpatient, University Hospital in New York
T1-T2: baseline (initiation of treatment)- 3 months after initiation Four themes were analyzed: physical symptoms, psychological issues, uncertainty regarding prognosis, and patients’ sources of support. Patients reported pain and/or fatigue, most often describing low energy levels, or feeling “weak” or “tired.” Patients reported restrictions in activities as a result of feeling weak or tired. Specific challenges noted by patients included feelings of helplessness/hopelessness, activity restriction, fatigue, fevers, caregiver stress, and lack of clarity regarding treatment decision making. Small, single-site study,
The study also focuses on high-risk patients with aggressive treatment
Swash et al (2018) United Kingdom[20] What are the types of needs that patients had throughout their experiences of diagnosis, treatment and survivorship and how these needs shaped the patients’ experience? Sample size: 6 NHL patients
Sampling: Convenience
Design: Qualitative, in-depth interpretative phenomenological approach, 3 small focus groups
Setting: Hospital in the North West of England
The themes that emerged were concerns for family, information needs and the need for psychological support.
Other more specific areas of psychological needs were fear of recurrence, maintaining hope, coping, and struggling with emotions (guilt and anger). Participants reported feeling different to other cancer patients. Lack of understanding of their diagnosis by friends and family and lack of access to relevant support services are notable unmet needs that differ from previous findings. Feeling supported was important to all, and where there was no support the consequent unmet need was felt strongly
Small sample
Single left
Monterosso et al (2018) Australia[21] What are the unmet informational, psychological, emotional, social, practical, and physical needs and preferences for posttreatment survivorship care of individuals living with MM? Sample size: 14 patients (6 to 49 months postdiagnosis)
Sampling: Participants were identified through the hospital cancer registry patient records
Design: Qualitative and descriptive design with 2 focus groups and thematic analysis
Setting: Tertiary hospital in Western Australia
Seven categories of needs were revealed : informational, health-system related (experience with health-care professionals), physical (coping with side effects: hair loss, fatigue, peripheral neuropathy) , psychological ( dealing with emotions , hope and positivity, living with the chronicity of myeloma) , support needs (peer support, need for a link person), relational (communicating with family and friends, relationship with children). Treatment side effects were described as one of the worst aspects of the experience, with many people reporting feeling unprepared to recognize or cope with them. Participants in this study described unmet needs across a breadth of domains that varied over time. Small sample size Single site recruitment Self-selection of participants
Oberoi et al (2017) Australia[22] Which is the course of anxiety, depression and unmet needs in DLBCL and MM survivors in the first 2 years post diagnosis? Sample size: 236 DLBCL and 178 MM survivors
Sampling: Recruitment from the population-based Victorian Cancer Registry.
Design: Longitudinal study
Setting: Outpatient
HADS SCNS-SF34 T1-T2: Approximately 7- and 15-months post diagnosis Changes in unmet needs was generally similar for the two groups, except for moderate to high psychological needs (P<0.05). For both groups, unmet needs in the psychological, physical and daily living domains were most common at T1. Analyses for each need’s domain showed an effect of time for psychological needs (P=0.02) and information needs (P=0.03), but not for sexuality, physical and daily living and patient care needs. There was no significant effect of cancer type on any need’s domains. At T1 and T2, psychological, physical and daily living domains were still the main areas of need. Time affected the psychological (P=0.00), physical, daily living (P=0.02) and information needs (P=0.03). Cancer type affected psychological needs (P=0.02) and information needs survivors reporting “moderate to high” needs. A significant interaction between time and cancer type was found only for psychological needs domain (P=0.03). In the MM group, receiving chemotherapy before T1 was associated with higher moderate to high psychological needs at T1. A relatively low response rate at T1.
Low representation of patients in the 65 to 85-year age groups in the DLBCL group and in the 75 to 85-year age group in MM patients may affect the generalizability of the findings to the larger population of MM and DLBCL survivors.
Oberoi et al (2017) Australia[23] What is the influence of anxiety, depression and unmet supportive care needs on QoL in MM and DLBCL patients? Sample size: 414 patients with MM and DLBCL
Sampling: Recruitment from the population-based Victorian Cancer Registry.
Design: Longitudinal study
Setting: Outpatient
FACT-G
HADS
SCNS-SF34
T1-T2: 8 months apart
Informational/educational: 24% of respondents reported at least one “moderate-to-high” informational need.
Physical: 30% of respondents reported at least one “moderate-to-high” unmet need at the physical and daily living needs domain.
Psychological/emotional: 30% of respondents reported at least one “moderate-to-high” unmet need in the psychological and emotional needs domain.
Daily living/practical: 30% of respondents reported at least one “moderate-to-high” unmet need in the daily living needs domain. 11% reporting a patient care need.
Sexuality: 8.5% reporting at least one sexuality need.
At T1, 15% of participants had elevated anxiety and 18% had elevated depression scores. While most unmet needs domains had “weak-to-moderate” correlations with anxiety and depression, T1 physical needs were strongly correlated with T1 depression (r=0.51). Except physical well- being, all other QoL subscales and overall QoL were significantly associated with T1 anxiety (P=0.000, P=0.001). All QoL subscales and overall QoL were significantly associated with T1 depression (P=0.000, P=0.001. Only patient care needs were associated with physical (P=0.040) and social well-being (P=0.003) and overall QoL (P=0.020).
Use of a general measure for QoL rather than a measure specific to hematological patients
Low response rate
Oberoi et al (2017) Australia[24] Which are the patient-reported unmet needs and anxiety and depression for survivors of DLBCL and MM? Sample size: 414 patients with MM and DLBCL
Sampling: Recruitment from the population-based Victorian Cancer Registry
Design: Longitudinal study
Setting: Outpatient
HADS
SCNS-SF34
T1-T2: 8 months apart
Informational/educational: 24% of participants reported at least one “moderate to high unmet need” (T1) and 14% information needs at T2.
Physical: 30% of participants reported at least one “moderate to high unmet need” (T1) and 23% at T2.
Psychological/emotional: 30% of participants reported at least one “moderate to high unmet need” (T1)) and 23% at T2.
Daily living/practical: 30% of participants reported at least one “moderate to high unmet need” (T1) and 23% at T2, 11% “patient care needs” (T1) and 8% at T2.
Sexuality: 9% of participants reported at least one “moderate to high unmet need” (T1) and 8% at T2. The most common “moderate to high” unmet supportive care needs at T1 “Not being able to do the things you used to do “(21.8%) (physical domain) and at T2 “ Concerns about the worries of those close to you” (13.5%) (psychological domain).T1 psychological needs were associated with T1 information needs (r=0.54) and physical and daily living needs (r=0.56). T2 anxiety was associated with T1 anxiety (OR 4.75, 95% CI 1.86-11.09), T2 psychological needs (OR 1.68, 95% CI1.34-2.11) and with T1 social problems (OR2.33,95% CI 1.03-5.05) in multivariate analysis. T2 depression was associated with both T1 (OR 1.28, 95% CI 1.06-1.57) and T2 psychological needs (OR 1.35, 95% CI 1.06-1.70), T2 physical needs (OR 1.89, 95% CI 1.27-2.81) and T1 depression (OR 4.52, 95% CI 1.88-10.86).
Not able to adjust for the impact of response to treatment on outcomes The interval between the two assessments was long Low response rate
Monterosso et al (2017) Australia[25] What are the post-treatment experiences and preferences for follow-up support of lymphoma survivors? Sample size: 17 patients (NHL: 16, HL: 1)
Sampling: Participants were identified through the hospital cancer registry patient records\
Design: Qualitative and descriptive design with 2 focus groups and thematic analysis
Setting: Tertiary hospital with a comprehensive cancer left in Western Australia
Five key themes were revealed: information; loss and uncertainty; family, support, and post-treatment experience; transition, connectivity and normalcy, and person-centered post treatment care. Survivors described a sense of loss as they transitioned away from regular interaction with the hospital at the end of treatment, but also talked about the need to find a “new normal”. Establishing post-treatment support structures that can provide individualized information, support, reassurance and referrals to community and peer support were identified as a helpful way to navigate the transition from patient to post-treatment survivor. Small sample size Single site recruitment
Self-selection of participants
The use of a clinical psychologist as the facilitator for the focus groups
Yu et al (2017) China[26] Which are the unmet supportive care needs, with concomitant influencing factors, in adult acute leukemia patients in China? Sample size: 311 patients with acute leukemia
Sampling: Convenience
Design: Cross-sectional
Setting: 5 medical centers in Xian, China
SCNS-SF34 Informational: Health information dimension scored the highest rate of 55%. “Being informed about your test results as soon as possible”, “Being informed about things you can do to help yourself to get well” and “Being informed about cancer which is under control or in remission” were the three highest scoring entries.
Psychological: The psychological needs dimension scored the second highest unmet needs, scoring 35 (IQR: 32.50).
Physical and daily living needs scored 25 (IQR: 35.00) and 25 (IQR: 40.00), respectively.
Sexuality: Sexual need scored the lowest rate of 0.00 (IQR: 24.99).
Age (P<0.005) and “whether the treatment was the initial one or not” (P<0.005) influenced sexual need dimension. KPS score (P<0.001) and income (P<0.05) were the common factors influencing the rest of the three dimensions with treatment stage adding to two of them except “physiological and daily living needs” dimension. The dimensions of “psychological needs” and “care and support needs” were associated with “monthly average income” (P<0.001) KPS score”(P<0.01) and “treatment stage” (P<0.01) factors, whereas the “marital status” (P<0.01), “KPS score” (P<0.05) and “treatment stage” (P<0.001) were the significant variables for the dimension of “health information need”.
Kim et al (2016) South Korea[27] Which are the unmet needs of NHL survivors in Korea and their associations with HRQoL? Sample size: 826 NHL survivors
Sampling: Survivors identified from electronic medical records of the hospitals
Design: Cross-sectional
Setting: 3 university hospitals in South Korea
Need Scale for Cancer Patients Undergoing Follow-up Care (NS-C) developed in Korea EORTC QLQ-C30 Informational/educational: Most frequently reported unmet needs were “being informed about prevention of recurrence” (50.7%), “being informed about prevention of metastasis” (49.7%).
Psychological/emotional: The third most frequently reported need was “having self-confidence of overcoming cancer” (42.7%).
Among six domains, unmet need prevalence ranged from 1.7% to 38.3%. Most commonly reported domains with unmet needs were “treatment and prognosis” (38.3%) and “keeping mind under control” (30.5%). Multivariate logistic analyses revealed that younger age (domain: Diet and exercise P=0.002), being unmarried (domain: Relationship with health professionals P=0.013, Keeping mind under control P=0.025), and low monthly income (domain: Diet and exercise P=0.003, Support P=0.008) were associated with unmet needs of multiple domains. Participants with unmet needs demonstrated significantly poorer HRQOL, and the most clinically meaningful differences were found in social function (P<0.001) and emotional function (P<0.001).
Study design Low response rate
Selection bias
Not consider potential psychosocial predictors
Boyes et al (2015) Australia[28] Which is the prevalence and which are the correlates of the unmet supportive care needs of patients with hematological malignancy? Sample size: 311 patients
Sampling: Convenience
Design: Cross-sectional
Setting: Outpatient hematology clinics at three comprehensive cancer treatment centers in Australia
SCNS-SF34 Psychological/emotional: Most commonly reported (35%; 95% CI 30-41%). The third most common “moderate to high “unmet need was “uncertainty about the future” (21%; 95% CI 16-25%).
Daily living/practical: Most commonly reported in physical aspects of daily living (35%; 95% CI 30-41%) domains. The second “moderate to high “unmet need was “not being able to do the things you used to do” (21%; 95% CI 17-26%).
Physical: Highest “moderate to high “unmet need for lack of energy/tiredness (24%; 95% CI 20-30%).
51% of participants reported having at least one “moderate to high” level unmet need, while 25% reported “no need” for help with any items. Females, aged <55 years, not in the labour force, had higher odds of reporting “moderate to high” level unmet supportive care needs.
Sample characteristics SCNS-SF34 is not a specific tool for hematological cancer patients
Hall et al (2015) Australia[29] Which are the most prevalent unmet needs of hematological cancer survivors? Sample size: 715 survivors
Sampling: Australian state-based cancer registries
Design: Cross-sectional
Setting: Outpatient
SUNS Psychological/emotional: “Dealing with feeling tired” (17%), was the most frequently endorsed “high/very high” unmet need. “Coping with having a bad memory or lack of focus” was the second (14%) and “Dealing with feeling worried (anxious)” was the third. Following were: “Dealing with feeling stressed “(12%),” Dealing with not feeling able to set future goals or make long-term plans “(12%) and “Dealing with being told I had cancer” (12%).
Daily living/practical (financial problems): “Finding car parking that I can afford at the hospital or clinic “(12%).
Family-related/relational: “Finding someone to talk to who understands and has been through a similar experience” (13%) and “Dealing with people who expect me to be “back to normal” (12%).
Higher levels of psychological distress (e.g., anxiety, depression and stress) and indicators of financial burden as a result of cancer (e.g., having used up savings and trouble meeting day-to-day expenses due to cancer) were consistently identified as characteristics associated with the three most prevalent “high/very high” unmet needs.
Sample was not representative of the entire population of hematological cancer survivors, with non-participants and participants differing with regard to age at diagnosis and cancer type Low response rate
Hall et al (2014) Australia[30] Which are the subgroups of hematological cancer survivors who report “high/very high” level of unmet need on multiple (≥7) items of supportive care? Sample size: 696 survivors Sampling: Australian state-based cancer registries Design: Cross-sectional Setting: Outpatient SUNS DASS-21 25% reported a “high/very high” level of unmet need on seven or more items of the SUNS. Survivors who: had relocated due to their cancer (OR: 2.04; 95% CI: 1.18, 3.52), had difficulty paying bills (OR: 2.42; 95% CI: 1.34, 4.38), had used up their savings as a result of cancer (OR: 1.90;95% CI: 1.06, 3.40), and were classified as having above normal symptoms of depression (OR: 3.65; 95% CI: 2.17, 6.15) and stress (OR: 5.94; 95% CI: 3.22, 10.95) on DASS-21 had statistically significantly higher odds of reporting seven or more “high/very high” unmet needs. Low response rate No clinically standardized cut-off point for use with the SUNS to help determine which cancer survivors would benefit most from additional intervention
Hall et al (2013) Australia[31] What are the differences between the unmet needs of Australian and Canadian hematological cancer survivors? Sample size: 207 Australian & 127 Canadian survivors
Sampling: Australian sample: data from a sub-sample of respondents participating in a larger, national study
Canadian sample: all hematological cancer survivors who participated in the Canadian Survivors Unmet Needs study
Design: Cross-sectional
Setting: Outpatient
SUNS Psychological/emotional: “Dealing with feeling tired” was identified as the highest concern by survivors.
Country (P=0.045) was associated with survivors reporting a “high/very high” unmet need with “worry about earning money” with Australians reporting marginally non significantly higher odds than Canadians (OR 2.1; 95% CI; 0.99, 4.3). Country was not significantly associated with any other outcome. Australians reported a higher level of “financial concerns” (P<0.049) and “relationships” (P<0.024) unmet needs compared with Canadians. Having additional financial burden in the previous month due to cancer treatment, younger age at diagnosis, female sex, vocational or other level of education, and consulting a health care professional for cancer treatment or concerns about cancer in the last month were factors associated with multiple areas of unmet needs. Australian and Canadian hematological cancer survivors were found to experience similar levels of unmet needs.
Low response rate
Low consent rate
Distribution of the residuals from the final linear regression models was slightly to moderately skewed, with some heteroscedasticity
Eligibility criteria for the countries’ participants
Zimmerman et al (2013) Canada[32] What are the symptoms and referral rates to specialized palliative care and psychosocial oncology services of patients with acute leukemia? Sample size: 249 patients with acute leukemia
Sampling: Convenience
Design: Cross-sectional
Setting: University Cancer Centre
MSAS Physical: Patients reported a median of 9 physical symptoms. The most common were lack of energy (79%), drowsiness (56%), dry mouth (54%), weight loss (54%) and pain (49%). Physical symptoms were associated with poorer functional status (P<0.0001).
Psychological/emotional: Patients reported a median of 2 psychological symptoms. The most prevalent psychological symptoms were difficulty sleeping (55%), worrying (43%), difficulty concentrating (39%), and feeling sad (36%). Psychological symptoms were associated with past psychiatric history (P=0.007) and acute lymphocytic leukemia (ALL) (P=0.013).
Patients with intense lack of energy, difficulty sleeping, and pain were more likely to report intense worrying/sadness (P<0.001). No patients with moderate-severe pain were referred for specialized symptom control and only 13% of those with severe worrying/sadness were referred to psychiatry/psychology within one month of the assessment.
Study design Eligibility criteria of the participants
Parry et al (2012) USA[33] Which are the Unmet Service Needs in Adult Leukemia and Lymphoma Survivors After Treatment? Sample size: 477 leukemia and lymphoma survivors
Sampling: Recruitment from Colorado Central Cancer Registry
Design: Cross-sectional
Setting: Outpatient
The Houts et al. service need inventory Sexuality: Sexual Issues (41%) were the highest unmet needs.
Daily living/practical: The second most prevalent unmet need was “handling medical and living expenses” (38%), employment (32%), and health insurance (30%).
Psychological/emotional: Emotional difficulties (37%) were the third most prevalent unmet needs. Women were more likely to report unmet childcare needs than men (P=0.004); younger individuals were more likely to report needing help with emotional difficulties and family problems (P=0.000).
Family-related/relational: Individuals who had experienced a recurrence reported more unmet needs on family problems (P=0.027) than patients who had not experienced recurrence.
Lower income was related to greater unmet need regarding medical and living expenses (P=0.000). Relationships were also observed among the service needs, suggesting overlapping areas of unmet need.
Study design
Under-representation in the sample of individuals experiencing socioeconomic disadvantage and multiple comorbidities
Molassiotis et al (2011) United Kingdom[34] Which are the unmet needs and QOL of patients with MM and their partners? Sample size: 132 patients with MM
Sampling: Convenience
Design: Cross-sectional
Setting: Specialist referral left in the United Kingdom and three district general hospitals
CaSUN
HADS
EORTC QLQ-C30
EORTC QLQ-MY20
Psychological/emotional: About 27.4% of patients reported signs of anxiety and 25.2% reported signs of depression. Anxious/depressed patients had more than double unmet needs than non-anxious/depressed patients (P<0.05). About 40.8% were worried about their health in the future.
Physical: QOL was moderate, with key areas of impairment being physical, emotional, social and cognitive functioning, and patients complained of several symptoms, including tiredness (40.7%), pain (35.9%), insomnia (32.3%), peripheral neuropathies (28.3%) and memory problems (22.3%). The presence of “side effects of treatment” (EORTC MY20 module subscale) was the single most important variable in predicting unmet supportive care patients’ needs, explaining 25% of the total variance in the “unmet patient needs” item (P<0.001).
Daily living/practical: 1/4 of the patients reported unmet supportive care needs. The most common needs were related to accessibility of hospital car parking, obtaining life and/or travel insurance, and managing their concerns about myeloma coming back.
Low response rate
The CaSUN is tested in patients free of disease
Sample characteristics
Lobb et al (2009) Australia[35] Which are the informational, emotional and support needs of patients with hematological malignancy at the completion of? treatment? Sample size: 66 survivors
Sampling: Convenience
Design: Cross-sectional
Setting: Hematological departments from two hospitals
CaSUN The most frequently endorsed unmet needs included managing the fear of recurrence (73%) and health system related (33% the need for a case-manager, 31% the need for communication between doctors) especially the first year after treatment. Predictors of unmet needs included younger patients (P=0.01), marital status (P=0.03) and employment (P=0.03). 59% reported they would have found it helpful to talk with a health-care professional about their experience of diagnosis and treatment at the completion of treatment and endorsed significantly more need in the areas of quality of life (P=0.03), psychological/emotional and relational (P=0.04) needs. Younger patients reported significantly more emotional and relationship needs (P=0.007). Small sample Study design

*IQR: interquartile range, HL: Hodgkin's lymphoma, NHL: Non-Hodgkin's lymphoma, MM: Multiple myeloma, MDS: Myelodysplastic syndromes , DLBCL: Diffuse large B- cell lymphoma patients, AML: Acute myeloid leukemia , NCCN: National Comprehensive Cancer Center, QOL: Quality of life, HRQOL: Health related quality of life, NEQ: Needs Evaluation Questionnaire, SUNS: Survivor Unmet Needs Survey, SCNS-SF34: Supportive care needs survey-short form, CaSUN: Cancer Survivors Unmet Needs measure, MSAS: Memorial Symptom Assessment Scale , KPS : Karnofsky performance status, FACT-G: Functional Assessment of Cancer Therapy-General, EORTC QLQ-C30: European organization for research and treatment of cancer-Quality of life, EORTC-QLQ-MY20: European organization for research and treatment of cancer-Quality of life for Multiple Myeloma, HADS: Hospital Anxiety and Depression Scale, DASS-21: Depression Anxiety Stress Scale