According to the present findings regarding the patients’ supportive needs, the duration of cancer and care time or hours had the highest relationship with the total score of supportive needs in both the direct and indirect paths. Also, the caregivers’ quality of life had a negative and direct relationship with the patient’s duration of cancer, and a positive and direct relationship with the care time.
Meeting the physical needs of patients is of particular importance [29-31]. The positive correlation observed in the present study between physical needs and the other dimensions of supportive care needs indicates the reduction in the patients' physical needs over time. In other words, the shorter was the duration of illness, the more did the patients need psychological, sexual, and supportive care. In a study by Mohammadzadeh Nimekari (2019), physical needs and sexual needs had the highest and lowest mean scores among the patients’ supportive care needs, in respective order. The psychological dimension, system & information, and supportive dimensions had a moderate mean score. Higher scores indicated the patients’ greater supportive care needs .
Similar to the present findings, Wang et al.  also found that the length of time from the diagnosis was negatively correlated with supportive care needs. A higher score of supportive care needs was observed among the women who had a shorter duration of cancer or were in the higher stages of cancer. In a study by Shahsavari et al., the most dire need of the participants in the chemotherapy stage was related to the physical dimension and the lowest to the supportive dimension.
Unmet needs can vary even in patients with the same conditions . In the present study, the most common unmet needs of the patients in all the groups were related to the physical dimension. In the follow-up period, women with breast cancer had more unmet needs in the supportive dimension followed by the physical dimension, and their lowest level of supportive care needs pertained to the sexual dimension. In contrast to the present findings, some studies [12, 15, 33, 35] have reported the need for system & information to be the most prevalent unmet need. In the present study, the decreased physical needs of the patients in the follow-up period compared to the chemotherapy period may have been because the patients had passed the active phase of treatment and its side-effects and had somewhat regained their physical strength. Abdollahzadeh examined patients four to six months after their initial treatment; also, half of the participants were recruited from patients visiting a non-governmental breast cancer support center that provided training as well .
In the present study, sexuality needs decreased with age. Also, a significant direct relationship was reported between the patients’ age and the duration of cancer and care time. The mean duration of cancer was two years. It could be the case that the lack of a support association or institution in Bandar Abbas has made the need for support one of the greatest unmet needs in this group of patients. The reason for the difference in the results of these studies with the present study may be that, in the above studies, patients had completed the initial courses of treatment. Chemotherapy is associated with serious and non-serious drug side-effects [36, 37]. The side-effects of treatment can affect the needs of patients in the physical dimension.
The elapse of one year from the major breast cancer treatments received is associated with a gradual increase in sexual activity in these women . In the present study, the duration of cancer correlated directly with the highest score of care needs; in other words, as the duration of cancer increased, the total score of the patient's supportive needs also increased. Moreover, an increased duration of cancer was directly associated with less fulfillment of sexual needs and indirectly with less fulfillment of psychological needs. The differences in the duration of cancer in the chemotherapy, hormone therapy, and follow-up groups could be the reason for the difference in the unmet sexual needs of the patients between the three groups. The duration of cancer was 8.06±6 months in the chemotherapy group and 24.02±6.37 months in the follow-up group.
Socio-demographic characteristics play a clear role in predicting care needs. According to previous studies on the care needs of breast cancer patients, younger patients and patients with a sexual partner had more sexual needs [16, 39] and unmet physical and daily living needs  than the older patients. Similarly, a study by Shahsavari et al.  showed that the need for care decreases with age and increases with disease stage.
Asian women are generally reluctant to talk about their sexual issues and consider talking about such matters embarrassing and unreasonable . It appears that the taboos about sexual issues in the Iranian society can justify the subtle role of sexual needs among patients with breast cancer. In addition, the social culture may influence the answers to the question of sexual needs.
In the efforts to cope with their caregiving burden, the caregivers of cancer patients have reported unmet needs of their own during their patient’s active treatment or completion of treatment [11, 42].
In the present study, the mean total quality of life scores of the family caregivers of breast cancer patients in the three groups, i.e. the chemotherapy, hormone therapy, and follow-up groups, was 55.26±15.6, 54.12±13.4, and 48.10±7.9, respectively. Meanwhile, in some studies [43, 44], the total quality of life score of caregivers has been reported as above 80%. In the present study, the highest and lowest mean scores of the caregivers in the domains of quality of life pertained to psychological stress and financial concerns, respectively. The caregivers of cancer patients had a poor quality of life due to fatigue, anxiety, and care pressures. A study in China found that the burden of care in caregivers has an adverse effect on their quality of life, especially their mental health .
In contrast to the findings of some studies, the present study observed a negative and direct relationship between the caregivers’ quality of life and the patients’ duration of cancer (especially in patients in the follow-up period). As the hours of caring for the cancer patient increased, the score of the mental and psychological burden of caring decreased in her caregiver. Khanjari et al. investigated the caregivers of recently-diagnosed cancer patients (two to three weeks after diagnosis and six months later) , while in the present study, the mean care time was eight months at the very least (in the chemotherapy group). The quality of life of caregivers as a result of the care given varies from the time of diagnosis until one to two years later, and during this time, they experience greater psychological burden; meanwhile, for the care given to patients with more than two years since their diagnosis, both the patient and her caregiver tend to have gotten more adapted to the disease by this time .
Demographic characteristics such as age and gender are the most important predictors of quality of life in patients’ caregivers . In the study by Hashemian et al., the mean quality of life scores of caregivers were similar to the scores in the present study. In the present study, the mean age of the caregivers was 43.46±9.5 years and most caregivers were the patients' husbands, which justifies the disparity between the present study and some other studies [43, 47, 48]. Turkoglu et al. studied the family caregivers of patients with different types of cancer . In these three studies, most caregivers (60-80%) were female, while in the present study, most caregivers were the husbands of the patients and were male.
Strengths In the present study, the supportive care needs of patients with breast cancer and the quality of life of their family caregivers were assessed simultaneously in different courses of treatment (chemotherapy and hormone therapy) and the post-treatment follow-up.
Limitations Since this research was carried out in Bandar Abbas, its results should be generalized to other parts of Iran only with caution. Also, due to the high impact of disease periods (chemotherapy, radiotherapy, and follow-up) on the supportive needs of patients, further studies with larger sample sizes are required on patients in different stages of the disease and especially in the follow-up period.