Hallet Julie, Zuckerman Jesse, Guttman Matthew P, Chesney Tyler R, Haas Barbara, Mahar Alyson, Eskander Antoine, Chan Wing C, Hsu Amy, Barabash Victoria, Coburn Natalie
Department of Surgery, University of Toronto, Toronto, ON, Canada.
Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, ON, Canada.
Ann Surg Oncol. 2023 Feb;30(2):694-708. doi: 10.1245/s10434-022-12486-0. Epub 2022 Sep 6.
Older adults have unique needs for supportive care after surgery. We examined symptom trajectories and factors associated with high symptom burden after cancer surgery in older adults.
We conducted a population-level study of patients ≥ 70 years old undergoing cancer surgery (2007-2018) using prospectively collected Edmonton Symptom Assessment System (ESAS) scores. The monthly prevalence of moderate to severe symptoms (ESAS ≥ 4) for anxiety, depression, drowsiness, lack of appetite, nausea, pain, shortness of breath, tiredness, and poor wellbeing was computed over 12 months after surgery.
Among 48,748 patients, 234,420 ESAS scores were recorded over 12 months after surgery. Moderate to severe tiredness (57.8%), poor wellbeing (51.9%), and lack of appetite (39.3%) were most common. The proportion of patients with moderate to severe symptoms was stable over the 1 month prior to and 12 months after surgery (< 5% variation for each symptom). There was no clinically significant change (< 5%) in symptom trajectory with the initiation of adjuvant therapy.
Patient-reported symptom burden was stable for up to 1 year after cancer surgery among older adults. Neither surgery nor adjuvant therapy coincided with a worsening in symptom burden. However, the persistence of symptoms at 1 year may suggest gaps in supportive care for older adults. This information on symptom trajectory and predictors of high symptom burden is important to set appropriate expectations and improve patient counseling, recovery care pathways, and proactive symptom management for older adults after cancer surgery.
老年人术后对支持性护理有独特需求。我们研究了老年癌症患者术后的症状轨迹以及与高症状负担相关的因素。
我们对2007年至2018年接受癌症手术的70岁及以上患者进行了一项基于人群的研究，使用前瞻性收集的埃德蒙顿症状评估系统（ESAS）评分。计算术后12个月内焦虑、抑郁、嗜睡、食欲不振、恶心、疼痛、呼吸急促、疲劳和幸福感差等中度至重度症状（ESAS≥4）的月度患病率。
在48748例患者中，术后12个月记录了234420个ESAS评分。中度至重度疲劳（57.8%）、幸福感差（51.9%）和食欲不振（39.3%）最为常见。术后1个月前和术后12个月内中度至重度症状患者的比例保持稳定（每种症状变化<5%）。辅助治疗开始后，症状轨迹无临床显著变化（<5%）。
老年癌症患者术后长达1年的患者报告症状负担稳定。手术和辅助治疗均未导致症状负担加重。然而，术后1年症状持续存在可能表明老年患者支持性护理存在不足。这些关于症状轨迹和高症状负担预测因素的信息对于设定适当预期、改善患者咨询、康复护理途径以及癌症手术后老年患者的主动症状管理非常重要。
