Symptom Distress in Older Adults Following Cancer Surgery

Janet H. Van Cleave, PhD, RN; Brian L. Egleston, PhD; Elizabeth Ercolano, DNSc, RN; Ruth McCorkle, PhD, RN

Disclosures

Cancer Nurs. 2013;36(4):292-300. 

In This Article

Results

Patient Characteristics

The mean age of study participants was 71.8 (SD, 5.4) years, and study participants' ages ranged from 65 to 69 years (n = 147, 45.1%). Patients were balanced across digestive (n = 73, 22.4%), thoracic (n = 90, 27.6%), gynecologic (n = 75, 23.0%), and genitourinary cancer sites (n = 88, 27.0%). At baseline, the majority of patients had 3 or more numbers of symptoms (n = 206, 63.8%), and the mean mental health score was 3.9 (SD, 1.1; range of 1–5, with 5 representing better health) (Table 1).

Mean Symptom Distress Scores by Age Category and Cancer Site

Mean symptom distress scores at each data collection time were calculated by age category and cancer site (Table 2; Figures 1 and 2). Patients with the highest symptom distress at baseline were thoracic cancer patients 65 to 69 years old (mean, 29.9; n = 45), whereas patients with genitourinary cancer 70 to 74 years old had the lowest symptom distress (mean, 24.8; n = 30). At 3 months, patients 75 years or older with digestive cancer reported the highest symptom distress (mean, 26.0; n = 24) compared with patients 65 to 69 years old with genitourinary cancer (mean, 17.6; n = 48). Patients 75 years or older with thoracic cancer reported the highest symptom distress (mean, 26.7; n = 15) compared with patients 70 to 74 years old with genitourinary cancer (mean, 17.0; n = 24).

Figure 1.

Mean symptom distress over time by type of cancer. Higher number represents greater symptom distress.

Figure 2.

Mean symptom distress over time by age. Higher number represents greater symptom distress.

Association of Age Categories With Symptom Distress

We explored the association of age categories with symptom distress while controlling for demographic, biologic, psychological, treatment, and function covariates at the postoperative period (baseline), then at 3 and 6 months (Table 3). The findings showed that symptom distress decreased significantly over time, reflecting a typical postoperative course (3 months: β = −2.636 [95% confidence interval [CI], −4.142 to −1.130; P < .001]; 6 months: β = -2.566 [95% CI, −4.181 to −0.951; P = .002]).

Our analysis showed significant relationships among cancer site, mental health, and function. Compared with those with a diagnosis of genitourinary cancers, patients with digestive, thoracic, and gynecologic cancers had significantly increased symptom distress (digestive: β = 2.827 [95% CI, 1.297–4.357; P < .001]; thoracic: β = 4.453 [95% CI, 2.602–6.303; P < .001]; gynecologic: β = 2.221 [95% CI, 0.312–4.131; P = .023]; genitourinary: reference) (Figure 1). In addition, those with better mental health reported less symptom distress (β = −1.337 [95% CI, −1.772 to −0.902; P < .001]).Worse function was also associated with increased symptom distress (β = −0.329 [95% CI, −0.393 to −0.265; P < .001]).

Our analysis demonstrated other statistically significant relationships. Patients with 3 or more comorbidities reported increased symptom distress (β = 1.766 [95% CI, 0.051–3.481; P = .044]). The interaction term of age and time was also significantly associated with symptom distress; participants 75 years or older reported greater symptom distress over the 6-month period than patients 65 to 69 years old (β = 2.491 [95% CI, 0.012–4.969; P = .049]). This was also reflected in a graph of the mean number of symptoms over time (Figure 2).

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