Differences In Symptom Distress Research Articles

Age-related differences in symptom distress among patients with cancer

IntroductionDifferences in symptom distress among older (age 65–74) and very old (age 75+) patients with cancer, compared to younger patients, remain to be well explored. These differences are important to understand given the heterogeneity of older populations and may have implications for age-appropriate symptom detection and management. Materials and MethodsWe examined routinely collected Edmonton Symptom Assessment System Revised (ESAS-r) scores from 9,143 patients age 40+ initiating chemotherapy for solid malignancies at a single academic cancer centre, between September 2011 and May 2019. We used multivariable logistic regression models to determine associations between the most common symptoms and age group (ages 40–64, 65–74, 75–84, and 85+), cancer site, clinical stage, sex, and income levels. We focused our findings on patients with the five most common cancers, breast (n = 1,532), prostate (n = 923), lung (n = 889), pancreatic (n = 429), and colorectal (n = 368), prior to receiving treatment. ResultsWithin our sample, 58.0% were age 40–64, 27.3% age 65–74, 11.8% age 75–84, and 2.9% age 85+. Among the nine symptoms in the ESAS-r (anxiety, depression, tiredness, wellbeing, nausea, pain, drowsiness, appetite, and shortness of breath), the most common symptoms overall were anxiety (moderate-severe scores [ESAS-r 4 or higher] were reported by 33.8% of patients), lack of well-being (38.3%), and tiredness (38.3%). Older age was associated with lower odds of moderate/severe anxiety (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.73–0.90 for age 65–74; OR 0.81, 95%CI 0.70–0.93 for age 75–84; OR 0.62, 95%CI 0.47–0.82 for age 85+; referent is 40–64-year-olds for all analyses), and increased odds of tiredness (OR 1.00, 95%CI 0.90–1.11 for age 65–74; OR 1.19, 95%CI 1.04–1.37 for age 75–84; and OR 1.34, 95%CI 1.04–1.72 for age 85+). Advanced stage, female sex, and lower income levels were associated with higher odds of moderate/severe tiredness, anxiety, and lack of well-being in adjusted models. Patients with pancreatic and lung cancers reported worse scores for these three symptoms than patients with other cancers. DiscussionOlder age was associated with differences in symptom experiences such as increased tiredness and reduced anxiety. Supportive care interventions and future research should focus on addressing these symptoms to improve patient quality of life.

SIOG2021-0056* - Age-related differences in symptom distress among patients with metastatic cancer

SIOG2021-0056* - Age-related differences in symptom distress among patients with metastatic cancer

High pre- and postoperative symptom burden in non-responders to total knee arthroplasty.

ObjectivesOne in five patients does not improve in pain with walking (non-responders) 12 months after total knee arthroplasty (TKA). This longitudinal study investigated a broad range of symptoms before and after TKA and evaluated possible differences in symptom distress between responders and non-responders with regards to pain with walking after TKA.MethodsPrior to TKA surgery, 182 patients completed a demographic questionnaire and the Memorial Symptom Assessment Scale—Short Form (MSAS-SF). The MSAS-SF was repeated 12 months following TKA. Clinical data were extracted from medical records. Patients were categorized as responders or non-responders based on their trajectories of pain with walking assessed prior to surgery, on postoperative day 4, at 6 weeks, and at 3 and 12 months.ResultsOverall, the most distressful preoperative symptoms were pain, lack of energy, difficulty sleeping, feeling drowsy, worrying, feeling bloated, and problems with sexual interest or activity. However, compared with patients classified as responders to TKA, non-responders had higher total symptom distress scores both preoperatively and 12 months postoperatively. Preoperatively, non-responders scored higher than responders on five of the seven most distressing symptoms (i.e., all except difficulty sleeping and feeling bloated), and 12 months postoperatively, non-responders scored higher than responders on six of the seven most distressing symptoms (i.e., all but feeling bloated). In a multivariate analysis, higher preoperative distress scores for pain and problems with sexual interest or activity were significant predictors of non-response to TKA, controlling for other relevant factors.ConclusionsPatients’ preoperative symptom burden may be a useful indicator of their risk for non-improvement following TKA surgery. Future studies need to evaluate the effect of reducing patients’ preoperative symptom burden on TKA outcomes.

The Effect of Incontinence Severity on Symptom Distress, Quality of Life, and Pelvic Floor Muscle Function in Turkish Women with Urinary Incontinence

Objective: The aim of the present study was to compare the differences in symptom distress, quality of life, and pelvic floor muscle function among Turkish women with mild, moderate, or severe urinary incontinence.Study design: One hundred and twenty women with a diagnosis of urinary incontinence (54.2% stress urinary incontinence and 45.8% mixed-urinary incontinence) participated in the present study. The severity of the urinary incontinence was stratified by the Incontinence Severity Index. The Turkish versions of the Urinary Distress Inventory-6 and the Incontinence Impact Questionnaire-7 were used to assess symptom distress and quality of life, respectively. Pelvic floor muscle strength and endurance were measured using a non-invasive vaginal perineometer.Results: Symptom distress and quality of life significantly differed among the mild, moderate, and severe urinary incontinence groups (p<0.001). Patients with severe stress urinary incontinence displayed a higher decrease in quality of life than those with mild stress urinary incontinence (p<0.001). Furthermore, severe mixed urinary incontinence had a greater impact on symptom distress and quality of life compared to mild and moderate mixed urinary incontinence (p<0.05). The Incontinence Severity Index score was significantly associated with the Urinary Distress Inventory-6 and Incontinence Impact Questionnaire-7 scores (p<0.001).Conclusion: Urinary incontinence affected the symptom distress and quality of life of patients in proportion to the severity of the symptoms. Therefore, the relationship between the severity of urinary incontinence and patients’ quality of life should be evaluated in clinical settings. To prevent the greater influence of incontinence on the quality of life of women with urinary incontinence, early detection of urinary incontinence and early management strategies are essential.

Fecal Incontinence Symptoms and Impact in Older Versus Younger Women Seeking Care.

The differential impact of aging on fecal incontinence symptom severity and condition-specific quality of life remains unclear. The purpose of this study was to characterize differences in symptom distress, quality of life, and anorectal physiology assessments in older versus younger women with fecal incontinence. This was a cross-sectional study. This study was conducted at a tertiary genitorectal disorder clinic. Women presenting for fecal incontinence evaluation between 2003 and 2016 were classified as older or younger based on age ≥65 or <65 years. The main outcomes were symptom-specific quality of life and distress measured by validated questionnaires (the Modified Manchester Health Questionnaire containing the Fecal Incontinence Severity Index); anorectal physiology and anatomy were assessed by manometry and endoanal ultrasound. Of 879 subjects, 286 and 593 were classified as older and younger (mean ages, 71.4 ± 5.3 y and 51.3 ± 10.5 y). Solid stool leakage was more frequent in older women (83.2% vs 76.7%; p = 0.03), whereas liquid stool leakage (83.2% vs 82.8%; p = 0.88) and fecal urgency (76.9% vs 78.8%; p = 0.54) did not differ between groups. Mean symptom severity scores were similar between groups (28.0 ± 11.9 and 27.6 ± 13.5; p = 0.69); however, there was greater negative impact on quality of life among younger women (46.3 ± 22.0 vs 51.8 ± 21.8; p < 0.01). Multivariable linear regression controlling for pertinent covariates revealed younger age as an independent predictor for worse condition-specific quality-of-life scores (p < 0.01). Squeeze pressures were similar between groups, whereas younger women had greater resting pressures and higher rates of sphincter defects (external, 7.7% vs 20.2%; internal, 12.2% vs 26.8%; both p < 0.01). This study was limited by its lack of patient obstetric history and the duration of their incontinence symptoms. Characteristics differ between older and younger women seeking care for fecal incontinence. The differential impact and age-related phenotypes may provide useful information for patient counseling and developing management algorithms for women with fecal incontinence. See Video Abstract at http://links.lww.com/DCR/A910.

Transformation of quality of life in prenatal women with nausea and vomiting

ProblemNausea and vomiting not only cause physical discomfort in pregnant women but also impact their quality of life. BackgroundFew longitudinal studies have been conducted to investigate QOL of women over the course of pregnancy. AimTo examine the transformation of health-related QOL and related factors among pregnant women with NV during three trimesters. MethodsA longitudinal research design with convenience sampling was used. A structural questionnaire was used to repeatedly measure the data of 101 pregnant women with NV during the first, second, and third trimesters. A generalized estimating equation (GEE) was used to analyze the collecting data. FindingsThe results showed significant differences in symptom distress, prenatal stress, and health-related QOL among the three trimesters in pregnant women with NV (p<0.001). The scores of symptom distress, prenatal stress, and health-related QOL in the first trimester were significantly higher than those in the second and third trimesters (p<0.001). The GEE indicated that the trimester of pregnancy, severity of NV, symptom distress, and prenatal stress were key factors for the transformation of health-related QOL of women with NV during pregnancy. DiscussionThe findings of this study are seminal in terms of understanding the relationships between symptom distress, prenatal stress and health-related QOL in pregnant women with NV over the course of a pregnancy. ConclusionThis study can serve as a reference for designing interventions (i.e., professional support) for women in different pregnancy stages to improve their health-related QOL during pregnancy.

Differences in symptom occurrence, severity, and distress ratings between patients with gastrointestinal cancers who received chemotherapy alone or chemotherapy with targeted therapy.

Approximately 28% of patients with gastrointestinal (GI) cancers will receive targeted therapy (TT) because of the associated increases in survival. Only four studies have examined the symptom experience of these patients. To date, no studies have evaluated for differences in symptom occurrence, severity, and distress between patients who received chemotherapy (CTX) alone (n=304) or CTX with TT (n=93). Patients completed self-report questionnaires, approximately one week after they received CTX. A modified version of the Memorial Symptom Assessment Scale (MSAS) was used to obtain data on symptom occurrence, severity, and distress. Binary logistic regression analyses were used to test for differences in symptom occurrence rates between the two treatment groups. Ordinal logistic regression analyses were used to test for differences in severity and distress ratings between the two treatment groups. Patients who received CTX with TT were significantly younger (P=0.009); were diagnosed with cancer longer (P=0.004); had a higher number of prior treatments (P=0.024); had metastatic disease, specifically to the liver (P<0.001); had a diagnosis of anal, colon, rectum, or colorectal cancer (CRC) (P<0.001); and were positive for detection of B-Raf proto-oncogene, serine/threonine kinase (BRAF) and Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations (both P<0.001). In addition, CTX treatment regimens were significantly different between the two groups (P<0.001). After controlling for significant covariates, patients who received TT reported lower occurrence rates for lack of energy, cough, feeling drowsy, and difficulty sleeping (all, P<0.05). Patients who received TT reported lower severity scores for dry mouth (P=0.034) and change in the way food tastes (P=0.035). However, they reported higher severity scores for "I don't look like myself" (P=0.026). No differences in symptom distress scores were found between the two treatment groups. This study is the first to evaluate for differences in the symptom experience of GI cancer patients who received CTX alone or CTX with TT using a multidimensional symptom assessment scale. While between group differences in patients' symptom experiences were identified, both treatment groups warrant ongoing assessments to optimally manage their symptoms.

Differences in the symptom distress between young adult and adult patients with advanced cancer admitted to acute palliative care unit.

99 Background: Understanding about young adults with advanced cancer in palliative care was still insufficient. The purpose of this study was to identify the differences in symptom distress between young (20-39 years) and older (≥ 40 years) adults with advanced cancer who were admitted to acute palliative care unit. Methods: We retrospectively analyzed 502 consecutive patients admitted to acute palliative care unit between April 2015 and March 2016 in two tertiary cancer centers. Descriptive statistics, analysis of Edmonton Symptom Assessment Scale (ESAS), and Symptom Distress Scale (SDS) were performed. Results: Among 502 patients, 33 (7%) were aged 20-39 years, and 469 (93%) were aged ≥ 40 years. The most common malignancies among the young adult patients were stomach and colorectal cancers. SDS was similar between young adult (38.7 ± 15.1) and old adult (41.5 ± 13.7) patients. However, pain, nausea, poor feeling of well-being sense, sleep disturbance, and financial distress were numerically higher in young adult group than older adult group. Especially, sleep disturbance (5.72 vs. 4.56, p = 0.030) and financial distress (4.44 vs. 2.87, p = 0.008) showed statistically significant difference. Conclusions: Young adult advanced cancer patients appear to show different symptom profiles. Further research is needed to identify determinants and to provide timely integration of palliative care services for this unique patient cohort.

Differences in Symptom Distress Based on Gender and Palliative Care Designation Among Hospitalized Patients.

To explore patient-reported symptom distress in relation to documentation of symptoms and palliative care designation in hospital inpatients. This cross-sectional study analyzed data from 710 inpatients at two large hospitals in Sweden using the Edmonton Symptom Assessment Scale and the Memorial Symptom Assessment Scale. Chart reviews focused on nurses' and physicians' symptom documentation and palliative turning point. Descriptive statistics were calculated for all variables and provided summaries about the sample. Patients were grouped according to gender, age, palliative care designation, and symptom documentation. The t test and chi-square test were used to calculate whether symptom distress varied between groups. A two-way analysis of variance was conducted for multiple comparisons to explore the impact of gender and age on mean symptom distress. Females reported higher levels of symptom distress than did males related to pain, fatigue, and nausea. When comparing symptom distress between males and females with documentation pertaining to symptoms, there were significant differences implying that females had to report higher levels of symptom distress than males in order to have their symptoms documented. Females need to report higher levels of symptom distress than do males for healthcare professionals to identify and document their symptoms. It can be hypothesized that females are not receiving the same attention and symptom alleviation as men. If so, this highlights a serious inequality in care that requires further exploration. Considering that common reasons why people seek health care are troublesome symptoms of illness, and that the clinical and demographic characteristics of inpatients are changing towards more advanced ages with serious illnesses, inadequate symptom assessment and management are a serious threat to the care quality.

The Differential Impact of Flatal Incontinence in Women With Anal Versus Fecal Incontinence.

The differential impact on quality of life (QOL) that leakage of both stool and flatus confers on women compared with stool only is unclear. Our aim was to characterize differences in symptom distress, impact on QOL, and anorectal testing among women with leakage of stool and flatus, stool only, and flatus only. A retrospective review was conducted of women undergoing evaluation of at least monthly bowel incontinence symptoms. Subjects were divided into the following 3 groups: liquid/solid stool and flatus (anal incontinence [AI]), liquid/solid stool only (fecal incontinence [FI]), and flatal only (FL). Baseline assessment included the Modified Manchester Health Questionnaire (MMHQ) including the Fecal Incontinence Severity Index (FISI), Short Form-12 (SF-12), as well as anorectal manometry and endoanal ultrasound evaluations. Of 436 subjects, 381 had AI, 45 FI, and 10 FL. Significant between-group differences were noted in MMHQ (P = 0.0002) and FISI total scores (P < 0.0001) where women with AI reflected greater negative impact than women with FI. The Short Form-12 (mental and physical component summary scores) scores were similar in all 3 groups (P = 0.22, 0.08). Resting/squeeze pressures were significantly lower in AI and FI groups compared with FL (P = 0.0004), whereas rectal capacity was similar in all 3 groups. Although exploratory, MMHQ scores were similar between FI and FL groups, although FISI scores were higher in the FI group (P < 0.0001). Women with AI have higher symptom specific distress and greater negative impact on QOL compared with women with FI. Treatment of all bowel incontinence symptoms is important to improve symptom-specific and general QOL.

Change and predictors of symptom distress in breast cancer patients following the first 4 months after diagnosis

Breast cancer patients may encounter a wide range of physical and psychosocial distress symptoms during diagnosis, while awaiting treatment, and during treatment. This study of newly diagnosed breast cancer patients explores: (1) changes in symptom distress over 4 months; and (2) factors predicting changes in symptom distress. A prospective longitudinal design was used to collect data from breast cancer patients in northern Taiwan. A set of questionnaires was used to measure anxiety, symptom distress, social support, and demographic and treatment-related characteristics. Repeated measures analysis of variance (RM-ANOVA) with least significant difference (LSD) was used to examine differences in symptom distress, state anxiety, and social-support levels across four time-points. Generalized estimating equation (GEE) is used to determine predictors for the change in symptom distress. Participants showed mild overall symptom distress during treatment that increased from cancer diagnosis to treatment phases, with a peak at 4 months after diagnosis. Insomnia was the most commonly identified distressful symptom over time. Changes in overall symptom distress were significantly predicted by state anxiety, health professional support, and time since cancer diagnosis. Change in symptom distress following the first 4 months after diagnosis was predicted by state anxiety, health professional support, and time. Patients should receive social support and be trained in problem-solving skills to relieve distressful symptoms from diagnosis through treatment.

Effectiveness of a Self-Care Program in Improving Symptom Distress and Quality of Life in Congestive Heart Failure Patients

Prevalence of heart failure is increasing among older adults. Most heart failure patients experience distressing symptoms that lead to decreased physical functioning, poor quality of life, and a high incidence of rehospitalization. Health education about heart failure self-care (HFSC) is very important during hospitalization for these patients. However, lack of ongoing follow-up after discharge makes evaluation and disease management difficult. This is a significant problem in Taiwan. This study was undertaken to determine if participants with heart failure who were managed under the HFSC program had fewer distressing symptoms, better functional status, improved quality of life, and reduced hospital and emergency readmission rates compared with control group participants. This study used a quasi-experimental design with a control group that received usual care and an intervention group that received usual care plus the HFSC program. Twenty-seven participants were recruited from 2 cardiac general wards at 1 medical center in Taipei City, Taiwan, and were randomized into intervention (n = 14) and control (n = 13) groups. : After 3 months, there were significant differences in symptom distress (p < .01), 6-minute walk test results (p < .01), and quality of life (using Short Form 36, Taiwan version, p < .05) between the HFSC and control groups but no significant differences in hospital readmission and emergency department visits. The HFSC program for patients with heart failure improved their heart failure symptoms and resulted in increased functional status and better quality of life. HFSC is a workable program in the clinical environment. Advanced nurse practitioners can use HFSC methods and principles to provide improved education and follow-up to heart failure patients.

Gender and age differences in symptom distress and functional disability one year after heart transplant surgery

Objective Symptoms and functional status are major concerns for heart transplant (HT) recipients. The study objective was to examine gender and age differences in symptom distress and functional disability 1 year after HT surgery. Methods The sample (N = 237) consisted of 44 female and 193 male patients who were divided into younger (n = 66) and older (n = 171) groups with the breakpoint at age 50 years. Data from chart review and 2 questionnaires (Heart Transplant Symptom Checklist and Sickness Impact Profile) were analyzed with chi-square test, t tests, analysis of variance, and multivariate analysis of variance. Results Women reported worse symptom distress (overall, plus cardiovascular, gastrointestinal, dermatologic symptoms) and more functional disability (overall, plus disability in ambulation, mobility, self-care, home management). Older patients reported more disability in ambulation and work. Gender by age interactions showed that older men reported worse genitourinary symptoms and younger women reported worse dermatologic symptoms. Conclusion There were more gender than age differences in symptoms and disability.

Impact of a Pivot Nurse in Oncology on Patients With Lung or Breast Cancer: Symptom Distress, Fatigue, Quality of Life, and Use of Healthcare Resources

To examine the impact on continuity of nursing care delivered by a pivot nurse in oncology to improve symptom relief and outcomes for patients with lung or breast cancer. Randomized controlled trial in which participants were randomly assigned to an intervention group (n = 93) with care by a pivot nurse in oncology and usual care by clinic nurses or to a control group (n = 97) with usual care only. Three outpatient ambulatory oncology clinics in a large university health center in Quebec, Canada. 113 patients with lung cancer and 77 patients with breast cancer. Participants in both groups completed the Symptom Distress Scale, Brief Fatigue Inventory, and Functional Assessment of Cancer Therapy Scale-General version 4 at eight intervals over six months. Healthcare usage was evaluated through a review of hospital records. Symptom distress, fatigue level, quality of life, and healthcare usage. Researchers found no significant differences in symptom distress, fatigue, quality of life, and healthcare usage between groups. The new nursing role did not have an impact on the patient outcomes under study. Experienced nurses with specialized knowledge of oncology symptom assessment and management may reduce the symptom burden experienced by ambulatory patients with breast or lung cancer during active treatment.

Virtual reality: a distraction intervention for chemotherapy.

To explore virtual reality (VR) as a distraction intervention to relieve symptom distress in adults receiving chemotherapy treatments for breast, colon, and lung cancer. Crossover design in which participants served as their own control. Outpatient clinic at a comprehensive cancer center in the southeastern United States. 123 adults receiving initial chemotherapy treatments. Participants were randomly assigned to receive the VR distraction intervention during one chemotherapy treatment and then received no intervention (control) during an alternate matched chemotherapy treatment. The Adapted Symptom Distress Scale-2, Revised Piper Fatigue Scale, and State Anxiety Inventory were used to measure symptom distress. The Presence Questionnaire and an open-ended questionnaire were used to evaluate the subjects' VR experience. The influence of type of cancer, age, and gender on symptom outcomes was explored. Mixed models were used to test for differences in levels of symptom distress. Virtual reality and symptom distress. Patients had an altered perception of time (p < 0.001) when using VR, which validates the distracting capacity of the intervention. Evaluation of the intervention indicated that patients believed the head-mounted device was easy to use, they experienced no cyber-sickness, and 82% would use VR again. However, analysis demonstrated no significant differences in symptom distress immediately or two days following chemotherapy treatments. Patients stated that using VR made the treatment seem shorter and that chemotherapy treatments with VR were better than treatments without the distraction intervention. However, positive experiences did not result in a decrease in symptom distress. The findings support the idea that using VR can help to make chemotherapy treatments more tolerable, but clinicians should not assume that use of VR will improve chemotherapy-related symptoms. Patients found using VR during chemotherapy treatments to be enjoyable. VR is a feasible and cost-effective distraction intervention to implement in the clinical setting.

Operationalizing Symptom Distress in Adults With Cancer: A Literature Synthesis

To address inconsistencies in the definition and operationalization of symptom distress by synthesizing the literature on cancer-related symptom distress in adults. Electronic nursing, psychology, and medicine databases; online meeting abstracts; and various print sources. Eight distinct methods of operationalizing the concept were identified. Gender, ethnic, developmental, cultural, and individual differences in symptom distress have not been identified. Relationships among symptom frequency, intensity, and distress are unclear. Lack of clarity and consensus in defining and operationalizing symptom distress hinder meta-analysis, research synthesis, and research utilization. Symptom distress may be emerging as a component of the multidimensional symptom experience. Defining and operationalizing symptom distress consistently will enhance research synthesis and assist clinicians with more effectively meeting the needs of people with cancer. Research is needed to identify the meanings of symptom distress to patients with cancer and to differentiate symptom distress from symptom frequency and intensity.

Sex role attributes, symptom distress, and defensive style among college men and women.

Eighty-four male and 90 female college students completed the PRF-Andro masculinity and femininity scales, a symptom checklist, and a defense mechanism inventory. Results indicated that interrelations among sex role attributes, defense preferences, and symptom distress differed for men and women. Cross-sex-typed persons mostly accounted for differences in symptom distress within each sex: Masculine women reported relatively low and feminine men reported relatively high degrees of symptom distress. In addition, sex roles interacted with sex in determining defense preferences. We also explored the possibility that defensive styles mediated between sex role attributes and symptom distress. Among women, an association between masculine attributes and a rejection of self-blaming defenses accounted for the negative relation between masculinity and symptom distress. Among men, sex role attributes and defensive styles, for the most part, contributed independently to symptom distress.