Distress in Older Patients With Cancer

Abstract

A B S T R A C T PurposeTo determine the predictors of distress in older patients with cancer. Patients and MethodsPatients age Ն 65 years with a solid tumor or lymphoma completed a questionnaire that addressed these geriatric assessment domains: functional status, comorbidity, psychological state, nutritional status, and social support. Patients self-rated their level of distress on a scale of zero to 10 using a validated screening tool called the Distress Thermometer. The relationship between distress and geriatric assessment scores was examined. ResultsThe geriatric assessment questionnaire was completed by 245 patients (mean age, 76 years; standard deviation [SD], 7 years; range, 65 to 95 years) with cancer (36% stage IV; 71% female). Of these, 87% also completed the Distress Thermometer, with 41% (n ϭ 87) reporting a distress score of Ն 4 on a scale of zero to 10 (mean score, 3; SD, 3; range, zero to 10). Bivariate analyses demonstrated an association between higher distress (Ն 4) and poorer physical function, increased comorbid medical conditions, poor eyesight, inability to complete the questionnaire alone, and requiring more time to complete the questionnaire. In a multivariate regression model based on the significant bivariate findings, poorer physical function (increased need for assistance with instrumental activities of daily living [P ϭ .015] and lower physical function score on the Medical Outcomes Survey [P ϭ .018]) correlated significantly with a higher distress score. ConclusionSignificant distress was identified in 41% of older patients with cancer. Poorer physical function was the best predictor of distress. Further studies are needed to determine whether interventions that improve or assist with physical functioning can help to decrease distress in older adults with cancer.

Geriatric assessment predicts survival for older adults receiving induction chemotherapy for acute myelogenous leukemia

“…27,28 We used the Distress Thermometer, a single-item rating from 0 (no distress) to 10 (extreme distress) to evaluate distress. [29][30][31] PF was assessed using both self-report and objective measurements. Self-reported PF was assessed with the Pepper Assessment Tool for Disability, [32][33][34] which includes subscales assessing mobility, instrumental and basic activities of daily living.…”

Evaluating the Older Patient with Cancer: Understanding Frailty and the Geriatric Assessment

“…The need for assistance with IADLs has been reported to be correlated significantly with the incidence of psychological distress in a population of older adults with cancer (P Ͻ .0001). 45 …”

Psychische Belastung und psychosoziale Unterstützung älterer Krebspatienten

“…In diesem Zusammenhang sind vor allem die Zunahme an Gebrechlichkeit, komorbiden kör-perlichen Erkrankungen, Funktionseinschränkungen, kognitiven Defiziten und Einschränkungen bei der Alltagsbewäl-tigung zu nennen [14,36]. Durch das gleichzeitige Auftreten mehrerer behandlungsbedürftiger Erkrankungen werden bei älteren Patienten oft mehrere Medikamente verordnet ("Polypharmazie"), deren Wechselwirkungen in der Regel schwer vorhersehbar sind.…”

“…Auf der anderen Seite steigen die psychischen Belastungen in der Gruppe der über 80-Jährigen stark an, was auf den engen Zusammenhang von körperli-chen Komorbiditäten, funktionellen Einschränkungen und psychischer Belastung zurückzuführen ist. So kamen Hurria et al [14] zu dem Ergebnis, dass der körper-liche Funktionsstatus der beste Prädiktor für das Ausmaß an psychischer Belastung bei älteren Krebspatienten ist.…”