Transcript Type and Prevalence of Symptoms Experienced by Older Adults

Factors Affecting Older Adults’
Symptom Distress Following
Cancer Surgery
Janet H.Van Cleave PhD, RN1
Brian Egleston PhD2
Elizabeth Ercolano DNSc3
Ruth McCorkle PhD, RN, FAAN3
1New York
University College of Nursing
2Fox Chase Cancer Center
3Yale School of Nursing
Background
Older adults 65 and over comprise majority
of persons living with and dying from cancer
 Symptom distress remains a significant health
problem of older adults after cancer surgery
 Little is known about older adults’ symptom
distress following cancer surgery
 Understanding the relationship between age
and symptom distress may help identify
interventions to improve older adults’
outcomes

Specific Aims
1.
Describe older adults undergoing
thoracic, abdominal, and genitourinary
cancer surgery,
1.
Elucidate the relationship of age
categories with symptom distress
following cancer surgery at baseline,
three, and six months controlling for
demographic, biologic, psychological, and
treatment covariates.
Vulnerability/Risk/Human
Response/Care Model
Risk/Support Factors
Vulnerability Factors
Human Responses
Adapted from J. Shaver, Nursing Outlook, 33, pp. 186-191 and B. Steele & J. Shaver, Advances in
Nursing Science, 15, p. 72
Vulnerability
Risk
Human Response
Framework
Vulnerability
Factors
Risk/Support
Factors
Human
Responses
Definition of
Concepts
Present
Within
Individual
Present
Outside
Individual
Change in
Human
Dimensions
Study
Variables
Empirical
Indicators
Demographic
Age Categories
Gender
Race
Marital Status
Education
Income
Biologic
Comorbidities
Type of Cancer
Cancer Stage
Psychological
Mental Health
Treatment
Cancer Treatment
Advanced Practice
Nurse Intervention
Symptom Distress
Symptom Distress
Methods
Secondary analysis
 Combined subsets of data of 326 adults
ages 65 or greater
 Five clinical trials of nurse-directed
interventions targeting patients postsurgery
 Data collection at baseline (post-surgery
period), and 3 and 6 months

Outcome Variable

Symptom distress

Measure: Symptom Distress Scale (McCorkle &
Young, 1978; McCorkle et al., 1998)

Demonstrated reliability and validity with
reported Cronbach alphas 0.70 to 0.89
Symptom Distress Scale (SDS)
(McCorkle et al, 1998)



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






Frequency and severity of nausea
Appetite
Insomnia
Frequency and severity of pain
Fatigue
Bowel pattern
Concentration
Appearance
Breathing
Outlook
Cough
Statistical Analysis

Descriptive Statistics

Multiple linear regression analysis by
Generalized Estimating Equations
controlling for demographic, biologic,
psychological, and treatment covariates
Aim 1: Patient Characteristics
Characteristic
N
%
65 to 69
147
45
70 to 74
108
33
75 and over
71
22
Female
162
50
Male
161
50
White
247
76
Black/Other
57
18
Age
Gender
Race
Aim 1: Study Population Balanced
Across All Types of Cancer
Type of Cancer
22%
27%
28%
23%
Digestive
Thoracic
Gyn
GU
Aim 1: Majority of Patients Received Surgery
With or Without Chemotherapy
Type of Treatment
12%
Surgery
9%
47%
Surg+Chemotx
Surg+Radtx
32%
Surg+Chemotx+Radt
x
Aim 1: Majority of Patients With Three or
Greater Number of Symptoms
Number of Symptoms
10%
14%
64%
12%
None
One
Two
Three or more
Aim 2: Symptom Distress Significantly
Decreased Over Time
Variable
Estimate
P Value
Age
65 to 69
Reference
70 to 74
-0.60
0.489
75 and over
-2.17
0.062
Time
Baseline
Reference
3 months
-2.64
<0.001
6 months
-2.57
0.002
Aim 2: Symptom Distress Significantly
Increased In Ages75 and Over at 6 Months
Variable
Estimate
P Value
Age x Time
Age 65 to 69 x 3 months
Reference
Age 70 to 74 x 3 months
1.405
0.199
Age 75 and over x 3
months
1.45
0.199
Age 65 to 69 x 6 months
Reference
Age 70 to 74 x 6 months
0.803
0.476
Age 75 and over x 6
months
2.491
0.049
Aim 2: Symptom Distress Significantly Associated
with Type of Cancer and Comorbidities
Variable
Estimate
P Value
Digestive
2.83
<0.001
Thoracic
4.45
<0.001
Gynecologic
2.22
0.023
Genitourinary
Reference
Type of Cancer
Comorbidities
None
Reference
One
-0.07
0.939
Two
1.06
0.273
Three or more
1.77
0.044
Aim 2: Symptoms Distress Significantly
Increased with Worse Mental Health and
Function
Variable
Estimate
P Value
-1.34
<0.001
-0.33
<0.001
Psychological
Mental health
Function
Function score
30
Symptom Distress by Age Category
Over Time
Mean Symptom Distress
29
28
27
26
25
24
Ages 75 and
older
23
22
Ages 70 to 74
21
Ages 65 to 69
20
Baseline
3 months
6 months
Symptom Distress By Type of Cancer
Over Time
Mean Symptom Distress
29
27
Thoracic
25
23
Digestive
Gynecologic
21
19
GU
17
15
Baseline
3 Months
6 Months
Limitations

Secondary data analysis

Studies occurred over 20 year span
Conclusion






More older candidates for cancer surgery as population
ages
Older adults experience typical post–operative pattern
Decreasing symptom distress over 6 months despite
type of cancer treatment
Thoracic cancer patients may experience greater
symptom distress
Function, mental health, and number of comorbidities
associated with symptom distress
Study participants age 75 and older experienced greater
symptoms distress over time than those aged 65 to 69
Study Implications
Adoptions of more frequent
appointments for older patients and those
with thoracic cancer
 Monitor for changes in mental health
 Need to investigate novel symptom
assessment interventions including nursedirected clinics and telehealth
interventions

Acknowledgements
New York University College of Nursing, Hartford
Institute of Geriatric Nursing
 University of Pennsylvania Post-Doctoral Fellowship
T32NR009356: Individualized Care for At-Risk Older
Adults, 2008 – present
 John A. Hartford Foundation Building Academic
Geriatric Nursing Capacity Program 2006 – 2008 PreDoctoral Scholar
 Yale School of Nursing Pre-Doctoral Fellowship
T32NR008346 : Self and Family Management, 2004-2006
