Differences in the symptom experience of older versus younger oncology outpatients: a cross-sectional study.

Janine K Cataldo,Laura Dunn,Bruce Cooper,Kimberly Alexander,John Merriman,Bradley Aouizerat,Virginia Blackman,Christine Miaskowski,Steven Paul,Patsy Yates,Christine Ritchie,Helen Skerman

doi:10.1186/1471-2407-13-6

Janine K Cataldo, Laura Dunn + Show 10 more

Open Access

https://doi.org/10.1186/1471-2407-13-6

Copy DOI

Abstract

BackgroundMortality rates for cancer are decreasing in patients under 60 and increasing in those over 60 years of age. The reasons for these differences in mortality rates remain poorly understood. One explanation may be that older patients received substandard treatment because of concerns about adverse effects. Given the paucity of research on the multiple dimensions of the symptom experience in older oncology patients, the purpose of this study was to evaluate for differences in ratings of symptom occurrence, severity, frequency, and distress between younger (< 60 years) and older ( ≥ 60 years) adults undergoing cancer treatment. We hypothesized that older patients would have significantly lower ratings on four symptom dimensions.MethodsData from two studies in the United States and one study in Australia were combined to conduct this analysis. All three studies used the MSAS to evaluate the occurrence, severity, frequency, and distress of 32 symptoms.ResultsData from 593 oncology outpatients receiving active treatment for their cancer (i.e., 44.4% were < 60 years and 55.6% were ≥ 60 years of age) were evaluated. Of the 32 MSAS symptoms, after controlling for significant covariates, older patients reported significantly lower occurrence rates for 15 (46.9%) symptoms, lower severity ratings for 6 (18.9%) symptoms, lower frequency ratings for 4 (12.5%) symptoms, and lower distress ratings for 14 (43.8%) symptoms.ConclusionsThis study is the first to evaluate for differences in multiple dimensions of symptom experience in older oncology patients. For almost 50% of the MSAS symptoms, older patients reported significantly lower occurrence rates. While fewer age-related differences were found in ratings of symptom severity, frequency, and distress, a similar pattern was found across all three dimensions. Future research needs to focus on a detailed evaluation of patient and clinical characteristics (i.e., type and dose of treatment) that explain the differences in symptom experience identified in this study.

Highlights

Mortality rates for cancer are decreasing in patients under 60 and increasing in those over 60 years of age
This study is the first to evaluate for differences in multiple dimensions of the symptom experience between older and younger adults undergoing active treatment for cancer
While fewer age-related differences were found in ratings of symptom severity, frequency, and distress, for younger and older patients who reported a specific symptom, a similar pattern was found across all three dimensions, namely when differences occurred older patients reported significantly lower ratings

Summary

Introduction

Mortality rates for cancer are decreasing in patients under 60 and increasing in those over 60 years of age. One reason why mortality rates may be increasing in patients over 60 is that they receive substandard treatment (i.e., lower doses of radiation therapy (RT) or chemotherapy (CTX)) because of the unsubstantiated belief that they will experience a larger number and more severe adverse effects as well as poor functional outcomes and significant decrements in quality of life (QOL) [8,9] The foundations for these beliefs include the normal physiological changes that occur with aging that could influence drug metabolism, the co-occurrence of multiple co-morbidities in the elderly, and the increased risk of adverse effects associated with polypharmacy [2,10,11]. Findings from studies on the impact of co-morbidities and cancer treatment on older people are contradictory [12,13,14]

Objectives

Methods

Results

Discussion

Conclusion