Routine assessment of the core symptoms associated with symptom clusters typical of older patients with cancer warrants consideration, as it may help to provide more targeted and effective symptom management for these patients, according to data presented at the Oncology Nursing Society (ONS) Congress on April 25, 2024 by Lisa Morse MS, RN, AGCNS-BC, Stanford Health Care, University of California, San Francisco, California.

By 2035, the number of new cancer cases will double, with over half in older adults. Given this demographic breakdown, study authors identified a need to analyze how age influences oncology patients’ symptom burden.

Morse and coauthors explained that they aimed to “evaluate for differences in the occurrence, severity, and distress of 38 symptoms in younger (<60 years) versus older (≥60 years) patients undergoing chemotherapy and to evaluate for differences in the stability and consistency of symptom clusters across the [2] age groups. We hypothesized that older patients would have lower symptom occurrence, severity, and distress ratings and that common and distinct symptom clusters would be identified between the [2] age groups.”

This analysis included 1,329 patients undergoing chemotherapy, split into younger (<60 years) and older (≥60 years) groups. Participants completed demographic and clinical questionnaires prior to the initiation of their second or third cycle of chemotherapy. It was noted that a modified version of the 32-item Memorial Symptom Assessment Scale (MSAS) was used to evaluate the occurrence, severity, and distress of 38 common symptoms that are associated with cancer and its treatment. Differences between the 2 age groups regarding demographic and clinical characteristics, including ratings of occurrence, severity, and distress for the 38 MSAS symptoms, were evaluated using parametric and nonparametric tests, while distinct exploratory factor analyses were undertaken within each group to identify symptom clusters using occurrence ratings.

Results demonstrated that, compared to the younger patient group (14.8 [± 7.0]), older adults reported a lower mean number of symptoms (12.9 [± 7.2]), and a lower occurrence rates for almost 50% of the symptoms. However, multiple symptoms were discovered to be more severe and distressing among older patients. An 8-factor solution was selected for both age groups in order to measure symptom clusters. Across the 2 age groups, the symptom clusters (i.e., physical and cognitive fatigue, respiratory, psychological, hormonal, chemotherapy-related toxicity, weight gain, gastrointestinal, and epithelial) were stable, although symptoms within the physical and cognitive, chemotherapy-related toxicity, and gastrointestinal clusters were not consistent across the age groups.

Morse and colleagues concluded, “In order to provide tailored and effective symptom management interventions to older oncology patients, routine assessment of the core symptoms unique to the symptom clusters identified for this group warrants consideration.”

“The underlying mechanism(s) for these inconsistencies is an important focus for future studies,” they added.

Source:

Morse L, Cooper B, Paul S, et al. Consistency and stability of symptom clusters in younger versus older patients receiving chemotherapy. Presented at the Oncology Nursing Society Congress, Washington, D.C. April 24-28, 2024.