Breast cancer is the most common type of cancer among women worldwide, with almost 2.3 million new cases recorded in 2020.1 Similarly, female breast cancer is the most commonly diagnosed cancer in Turkey, and the incidence of breast cancer has increased significantly in recent years.2 However, early detection and advanced treatment of breast cancer have improved survival rates1 and, therefore, many survivors are requiring ongoing supportive care interventions and services.3,4

In the post-treatment period, breast cancer survivors confront many persistent physical and psychosocial problems likely to affect their well-being such as pain, fatigue, lymphedema, cognitive dysfunction, body image−related problems, fear of recurrence, social isolation, and financial distress.5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 The survivors have difficulty coping with these problems, and their supportive care needs are not often met by health professionals.16, 17, 18, 19, 20, 21, 22 However, symptom burden and unmet needs affect survivors’ well-being adversely, and they frequently experience psychological distress.7,23, 24, 25, 26, 27 Similarly, it is emphasized that one of every four breast cancer survivors experiences clinical distress due to unmet psychosocial needs.28 Distress is an unpleasant experience related to physical, psychosocial, and/or spiritual problems that affect ability to cope with cancer; it may extend along a continuum, ranging from normal feelings to psychological problems.29 Psychological distress, including anxiety and depression, are common among breast cancer survivors in the post-treatment period.15,23, 24, 25 A systematic review revealed that the prevalence of anxiety in breast cancer survivors ranged from 17.9% to 33.3% and that the prevalence of depressive symptoms ranged from 9.4% to 66.1%, which were higher than in the general female population.23 Similarly, breast cancer survivors have increased risk of anxiety, depression, and suicide compared to the general population without the history of cancer.24 In a recent study performed with Korean breast cancer survivors, 47.2%, 36.7%, and 67.8% of the survivors had anxiety, depressive symptoms, and psychological distress, respectively.7 Comorbid depressive symptoms and anxiety can increase supportive care needs after cancer treatment and have a negative effect on recovery.18,21,25 It is important to determine sources of psychological distress and related unmet needs of survivors in terms of prevention of psychological risks and improvement of the well-being of the survivors.4

During the post-treatment period, the breast cancer survivors have multitude of needs which require attention and identification.3,15 Evaluating survivors’ needs is important because unmet needs are correlated with psychological distress.20,28 Unmet needs result from discrepancies between support needs perceived by patients and the actual support provided.30 One broad framework used to examine survivors’ unmet needs is the Supportive Care Framework, which conceptualizes the care needs and services cancer patients may require. Supportive care is defined as the delivery of the necessary services for individuals diagnosed with cancer and their caregivers to meet their physical, emotional, social, psychological, informational, spiritual, and practical needs during the diagnostic, cancer therapy, and follow-up periods.31 According to the framework, if needs remain unmet, individuals experience emotional distress, which can negatively affect adaptation to cancer trajectory.19 Several studies have shown that breast cancer survivors have significant unmet needs related to information (symptom management, return to normal life), psychological support (eg, stress reduction, coping with fear of recurrence), access to health care services, and coordination of medical care at follow-up.10,13, 14,16, 17, 18, 19, 20, 21, 22

The unmet needs and psychosocial experiences of breast cancer survivors have been explored widely in the qualitative8,11-13,16 and mixed-methods studies.14,22 While these previous studies confirmed the presence of psychological distress in breast cancer survivors, they did not describe the nature of psychological distress thoroughly. Similarly, the relation between psychological distress and unmet needs was examined by using quantitative research designs.20,28 However, quantitative research does not offer an in-depth insight naturally. Besides, there is limited research about Turkish breast cancer survivors’ experiences in the post-treatment period.8,11 However, experiences of psychological distress and unmet needs can vary from culture to culture, which may play a role in understanding and prevention of distress and fulfilling needs.16 This study aimed to explore the unmet supportive care needs of breast cancer survivors who experience psychological distress. One strength of the present study is that it focused on revealing the unmet needs associated with psychological distress by breast cancer survivors. Results of the present study are expected to provide comprehensive data to guide prevention of psychological risks and improvement of well-being of breast cancer survivors.