Risk Factors Determine Symptom Burden Profiles by Age Group
Emetogenic chemotherapy regimens and back pain were associated with higher symptom burden in older, vs younger, patients with cancer.
Metastatic disease and breast cancer were both associated with moderate to high symptom burden in older patients.
Although common risk factors associated with higher symptom burden exist across age groups, treatment with a toxic and/or emetogenic chemotherapy regimen increased symptom burden in older patients, according to data presented at the 50th Annual Oncology Nursing Society Congress.
For younger patients, the presence of psychological symptoms differentiated symptom burden profiles, and for older patients, those with higher symptom burden used more disengagement coping strategies.
“Both age groups may benefit from interventions aimed at reducing stress, enhancing resilience, and the use of engagement coping strategies,” wrote Lisa Morse, MS, RN, AGCNS-BC, of the University of California, San Francisco, and study co-authors in the poster presented at the Congress.
The study divided patients with gynecologic, breast, lung, or gastrointestinal cancers (n = 1329) into 2 groups: those aged 60 years or older and those younger than 60.
Investigators evaluated the occurrence of 25 symptoms associated with cancer and its treatment using the Memorial Symptom Assessment Scale (MSAS) and identified 3 distinct symptom burden profiles in the older group: low (34.4%), moderate (47.9%), and high (14.7%).
Likewise, researchers identified 4 symptom burden profiles in the younger group: all low (28.8%), moderate physical and low psychological (21.9%), moderate physical and high psychological (34.6%), and all high (14.7%).
Risk Factors and Symptom Burden
Notably, lack of energy was the highest or second highest symptom for all symptom burden profiles across age groups. The high symptom burden profile in older patients and all-high profile in younger patients both had higher rates of each symptom than each of their respective counterpart groups.
In both age groups, being female, having a higher comorbidity burden, having a lower functional status, and self-reported diagnosis of depression were linked with the all-high and high symptom burden profiles.
For the older group, receiving a highly emetogenic chemotherapy regimen, back pain, and having a higher MAX2 score were all linked with a higher symptom burden profile. Metastatic disease was also associated with moderate and high profiles in the older group.
Additionally, all-high and high profiles had higher scores for all stress measures, venting, and self-blame, and lower scores for resilience, compared with all-low and low profiles, respectively. Further, those with a high symptom burden profile reported higher self-distraction, denial, and behavioral disengagement.
Across the board, all stress characteristics were tied to the moderate physical and high psychological, all-high, moderate, and high symptom burden profiles.
Having breast cancer was associated with moderate or high symptom burden in the older group. Gastrointestinal cancer was linked with moderate physical symptom burden and higher psychological symptom burden in younger patients.
Lower likelihood of employment and higher likelihood of having lower annual household income were associated with the all-high symptom burden profile. Lower likelihood of employment was also associated with high symptom burden in older patients.
In the younger group, younger age was linked to moderate physical and higher psychological as well as all-high symptom burden.
Study Design
According to the abstract, the study is the “[first] to identify distinct symptom burden profiles in younger vs older oncology patients receiving chemotherapy.”
Before beginning second or third cycles of chemotherapy, patients completed clinical and demographic questionnaires, as well as measures of cancer-specific, global, and cumulative life stress along with resilience and coping.
Within the 2 age groups, additional latent class analyses were performed to identify distinct symptom profiles. Investigators used parametric and nonparametric tests to assess differences in clinical and demographic traits, stress, resilience, and coping among age groups.
Reference
- Morse L, Paul S, Cooper B, Miaskowski C. Common and distinct risk factors are associated with worse symptom profiles in younger versus older oncology patients receiving chemotherapy. Presented at: 50th Annual Oncology Nursing Society Congress; April 9-13, 2025; Denver, CO. Poster RS41.
