School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
BMC Cancer. 2013 Jan 3;13:6. doi: 10.1186/1471-2407-13-6.
Mortality 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.
Data 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.
Data 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.
This 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.
60 岁以下癌症患者的死亡率正在下降，而 60 岁以上患者的死亡率却在上升。这些死亡率差异的原因仍知之甚少。一种解释可能是由于担心不良反应，老年患者接受的治疗不够标准。鉴于对老年肿瘤患者症状体验多个维度的研究甚少，本研究旨在评估接受癌症治疗的年轻（<60 岁）和老年（≥60 岁）成年人在症状发生、严重程度、频率和困扰程度方面的评分差异。我们假设老年患者在四个症状维度上的评分会显著降低。
对来自美国的两项研究和澳大利亚的一项研究的数据进行了合并，以开展这项分析。所有三项研究均使用 MSAS 评估 32 种症状的发生、严重程度、频率和困扰程度。
共评估了 593 名正在接受癌症积极治疗的肿瘤门诊患者的数据（即 44.4%的患者年龄<60 岁，55.6%的患者年龄≥60 岁）。在控制了显著的协变量后，与年轻患者相比，老年患者报告的 32 种 MSAS 症状中，有 15 种（46.9%）症状的发生率较低，6 种（18.9%）症状的严重程度评分较低，4 种（12.5%）症状的频率评分较低，14 种（43.8%）症状的困扰程度评分较低。
本研究首次评估了老年肿瘤患者在多个症状体验维度上的差异。对于 MSAS 症状中的近 50%，老年患者报告的发生率较低。尽管在症状严重程度、频率和困扰程度的评分上，年龄相关的差异较小，但在所有三个维度上均呈现出类似的模式。未来的研究需要重点关注详细评估患者和临床特征（即治疗类型和剂量），以解释本研究中发现的症状体验差异。
