Impact of unmet needs on health-related quality of life among cancer survivors in Ulsan, Korea

BACKGROUND: Cancer survivorship care emphasizes biomedical interventions, but psychological and social difficulties remain underaddressed. This study aimed to (i) quantify the association between unmet needs and quality of life (QOL), and (ii) evaluate whether these associations are consistent across two health-related QOL (HRQoL) instruments among cancer survivors. METHODS: Cross-sectional survey of adults (≥ 19) in Ulsan, Korea (2021, 2022). HRQoL (EQ-5D-5 L; EORTC QLQ-C30) was related to unmet-need domains using multivariable linear regression adjusted for prespecified sociodemographic and clinical covariates (gender, age, cancer type/stage, education level, household size, household monthly income, smoking status, alcohol consumption). Statistical analyses included Student's t-tests, one-way ANOVA, and multivariable linear regression. RESULTS: After excluding cases with insufficient information, 372 survivors were analyzed. EQ-5D-5 L utility was negatively associated with age ≥ 60 years (B=-0.04, 95%CI[-0.07, -0.01]), advanced cancer stage (Stage IV: B=-0.11, 95%CI[-0.14, -0.07]), unmet psychological needs (B=-0.09, 95%CI[-0.13, -0.06]), and unmet financial needs (B=-0.04, 95%CI[-0.09, -0.001]). On the EORTC QLQ-C30, advanced cancer stage showed negative associations with the functional scale (Stage IV: B=-14.87, 95%CI[-18.65, -11.10]) and positive associations with the symptom scale (Stage IV: B = 9.01, 95%CI[6.44, 11.57]). Higher household income (B = 4.99, 95%CI[1.71, 8.26]) was positively associated with the functional scale, while unmet psychological needs were negatively associated with the functional scale (B=-5.96, 95%CI[-10.04, -1.89]) and positively associated with the symptom scale (B = 8.80, 95%CI[6.04, 11.57]). CONCLUSIONS: Unmet psychological needs showed the most consistent associations with poorer HRQoL across both generic and cancer-specific instruments. Unmet financial needs showed weaker but directionally consistent associations, and the concurrent use of both instruments provided complementary perspectives on survivorship-related quality of life.