Unmet needs, quality of life, and lived experiences of patients with metastatic breast cancer in central Viet Nam: A convergent mixed-methods study.

Abstract

56 Background: Metastatic breast cancer (mBC) imposes a significant burden in lower-middle-income countries, yet data on the specific needs of these patients remain scarce. This study aimed to analyze the unmet needs, quality of life (QoL), and lived experiences of patients with mBC in Central Vietnam. Methods: We conducted a convergent mixed-methods study across eight medical centers in Central Vietnam (Jan-May 2025). The quantitative component involved a cross-sectional survey of 283 mBC patients using the EORTC QLQ-C30, DASS-21, and the adapted Cancer Survivors' Unmet Needs scale (CaSUNE-VN). Concurrent in-depth interviews with a subsample (n=38) were analyzed using thematic analysis. Results: The cohort had a mean age of 56.0 ± 11.0 years, with a high proportion (36.7%) diagnosed with de novo mBC. Quantitative analysis revealed substantial unmet needs, with financial support being the most prevalent (65.4%), followed by sleep improvement (49.8%) and managing fear of recurrence (45.2%). Global QoL was moderately impaired (mean 59.4 ± 19.1). Notably, financial difficulties represented the highest symptom burden (60.4 ± 37.0), surpassing physical symptoms like fatigue and pain. The prevalence of anxiety and depression was 66.1% and 51.6%, respectively. Qualitative analysis identified five core themes: (1) the overwhelming burden of financial toxicity; (2) a duality of positive clinical relationships and negative systemic barriers; (3) the indispensable role of family as a lifeline; (4) a profound psychosocial toll managed by resilience; and (5) a fundamental shift in life perspectives. Conclusions: Patients with mBC in Central Vietnam face a multifaceted burden dominated by severe financial toxicity and psychological distress. While family support serves as a critical buffer, there are urgent unmet needs regarding financial protection, psychological support, and palliative care education. System-level interventions are required to address these gaps. Top 5 most frequently reported unmet needs and mental health prevalence (N=283). Item / Domain Category n (%) / Mean (SD) Top Unmet Needs Help finding financial support Quality of Life 185 (65.4%) Info to improve sleep quality Nutrition & Lifestyle 141 (49.8%) Manage fear of recurrence Emotional 128 (45.2%) Info on balanced diet Nutrition & Lifestyle 124 (43.8%) Advice on supplements Nutrition & Lifestyle 121 (42.8%) Mental Health (DASS-21) Anxiety (Mild to Severe) Clinical Status 187 (66.1%) Depression (Mild to Severe) Clinical Status 146 (51.6%) Quality of Life (QLQ-C30) Financial Difficulties Score Symptom Scale 60.4 (37.0) Data derived from the CaSUNE-VN, DASS-21, and EORTC QLQ-C30 instruments. For QLQ-C30 symptom scales, higher scores indicate greater symptom burden.