Unmet Symptom Management Needs of Nursing Home Residents With Cancer

Jennifer G. Duncan, PhD, RN; Sarah Forbes-Thompson, PhD, RN; Marjorie J. Bott, PhD, RN

Disclosures

Cancer Nurs. 2008;31(4):265-273. 

In This Article

Abstract and Introduction

Abstract

Nursing home residents living with cancer have unacceptably high percentages of unrelieved pain and other symptoms. However, residents with cancer have received relatively little attention in the literature to date. This article provides an overview of previous symptom research for residents with cancer, explores clinical and organizational factors that impede effective symptom management, and proposes an agenda for future research and clinical practice. Residents with cancer have numerous symptoms that tend to be different from the symptoms of other nursing home residents. Symptom management for residents with cancer is often complicated by cognitive impairment, declining physical functioning, and comorbid illnesses. Barriers to symptom management include underuse of analgesics and hospice, nursing home staffing patterns, and lack of resources. Additional research is necessary to provide a more comprehensive understanding of residents with cancer, explore how organizational factors affect the care of residents with cancer, and evaluate interventions for effective symptom assessment and management. Collaboration of oncology nurses with clinicians and researchers in nursing home settings is needed to improve care for residents with cancer.

Introduction

Cancer is a considerable source of morbidity and mortality for older adults, with 30% of all cancer diagnoses and 43.5% of all cancer deaths occurring in adults 75 years or older.[1] Oncology services have primarily been delivered in hospital or clinic settings, yet many older adults with cancer will reside in nursing homes, either after hospitalization for cancer-related treatments or as long-term residents.[2] Approximately 9% to 11% of all nursing home residents in the United States have a cancer diagnosis.[3,4] Furthermore, between 10% and 25% of cancer deaths in older adults occur in nursing homes internationally.[5,6,7,8] Although these percentages may seem small, they represent a substantial, growing number of older adults who have received minimal attention in the healthcare literature.[2,9,10]

Nursing homes (also known as long-term care facilities or continuing care homes) are institutions that provide continuous nursing care, assistance with activities of daily living, as well as room and board for frail elders in developed countries around the world.[11] Older adults with cancer may be placed in nursing homes when continuous care is needed, but specialized hospital care is not.[10] From the limited research addressing nursing home residents who have cancer, the unmet symptom management needs of this population are unmistakable. High rates of severe and unrelieved pain have been well documented.[2,12] In addition to pain, other symptoms such as nausea or fatigue may plague residents with cancer. Recent research suggests that nursing home residents with cancer exhibit different symptom profiles compared to residents with other diagnoses.[13] In addition, residents with cancer often have complex clinical situations that may differ from younger, noninstitutionalized oncology patients. Thus, nursing home residents with cancer represent a unique population that requires further study to improve their quality of care and quality of life.

This article summarizes the current literature regarding the symptoms of residents with cancer. Specific impediments to effective symptom management in the nursing home setting are discussed. We also propose a research agenda for future work with this population, along with implications for clinical practice.

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