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

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.

Differences in Composition of Symptom Clusters Between Older and Younger Oncology Patients

“…6,16 In brief, demographic, clinical, and symptom data from one Australian study (i.e., Symptom Clusters) and two U.S. studies (i.e., Fatigue, Pain, and Sleep Study [FPS study] and Symptom Prevalence Study) were combined to conduct this analysis. To evaluate the effect of age, patients were dichotomized into younger (<60) and older ($60) groups.…”

“…6,16 Symptom Clusters in Older Versus Younger Patients Table 2 provides a summary of the occurrence rates for symptoms with severity ratings $1 (i.e., slight, moderate, severe, or very severe). In both age groups, the most common symptoms were fatigue, pain, difficulty sleeping, and feeling drowsy.…”

“…In addition, a similar pattern was found across ratings of frequency, severity, and distress, with older patients reporting lower ratings compared with younger patients. 6 Numerous plausible explanations exist for the inconsistent findings related to the symptom experiences in older oncology patients, including systematic biases in the inclusion of older patients in clinical trials, variations in treatment approaches for this group, and the substantial heterogeneity within the older population itself.…”

“…7e9 In addition, it is possible that response shifts occur in how patients experience and report symptoms, 6 and differences between studies in samples and the ways in which symptoms are measured. Notwithstanding these explanations, in the absence of large population-based studies or rigorous trials that compare treatment regimens and responses in older and younger patients, the impact of physiological and psychological changes associated with aging on treatment responses are not well understood.…”

A prospective study of changes in anxiety, depression, and problems in living during chemotherapy treatments: effects of age and gender

“…For example, younger adults (18 to 40 years) have reported greater levels of anxiety and depression [14,15] and significantly more difficulties with concentration, pain, nervousness, nausea/vomiting, sleep, worry, sadness, and sexual interest [16]. Female patients have also reported greater levels of anxiety and depression [15,17,18] and higher numbers of emotional and physical problems [4,18].…”