Hossain Nazia, Prashad Michael, Huszti Ella, Li Madeline, Alibhai Shabbir
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Medicine, University Health Network, Toronto, Ontario, Canada.
J Geriatr Oncol. 2023 Nov;14(8):101601. doi: 10.1016/j.jgo.2023.101601. Epub 2023 Aug 18.
Differences in symptom distress among older (age 65-74) and very old (age 75+) patients with cancer, compared to younger patients, remain to be well explored. These differences are important to understand given the heterogeneity of older populations and may have implications for age-appropriate symptom detection and management.
We examined routinely collected Edmonton Symptom Assessment System Revised (ESAS-r) scores from 9,143 patients age 40+ initiating chemotherapy for solid malignancies at a single academic cancer centre, between September 2011 and May 2019. We used multivariable logistic regression models to determine associations between the most common symptoms and age group (ages 40-64, 65-74, 75-84, and 85+), cancer site, clinical stage, sex, and income levels. We focused our findings on patients with the five most common cancers, breast (n = 1,532), prostate (n = 923), lung (n = 889), pancreatic (n = 429), and colorectal (n = 368), prior to receiving treatment.
Within our sample, 58.0% were age 40-64, 27.3% age 65-74, 11.8% age 75-84, and 2.9% age 85+. Among the nine symptoms in the ESAS-r (anxiety, depression, tiredness, wellbeing, nausea, pain, drowsiness, appetite, and shortness of breath), the most common symptoms overall were anxiety (moderate-severe scores [ESAS-r 4 or higher] were reported by 33.8% of patients), lack of well-being (38.3%), and tiredness (38.3%). Older age was associated with lower odds of moderate/severe anxiety (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.73-0.90 for age 65-74; OR 0.81, 95%CI 0.70-0.93 for age 75-84; OR 0.62, 95%CI 0.47-0.82 for age 85+; referent is 40-64-year-olds for all analyses), and increased odds of tiredness (OR 1.00, 95%CI 0.90-1.11 for age 65-74; OR 1.19, 95%CI 1.04-1.37 for age 75-84; and OR 1.34, 95%CI 1.04-1.72 for age 85+). Advanced stage, female sex, and lower income levels were associated with higher odds of moderate/severe tiredness, anxiety, and lack of well-being in adjusted models. Patients with pancreatic and lung cancers reported worse scores for these three symptoms than patients with other cancers.
Older age was associated with differences in symptom experiences such as increased tiredness and reduced anxiety. Supportive care interventions and future research should focus on addressing these symptoms to improve patient quality of life.
与年轻患者相比，老年（65 - 74岁）和高龄（75岁及以上）癌症患者在症状困扰方面的差异仍有待深入探究。鉴于老年人群的异质性，了解这些差异很重要，并且可能对适合年龄的症状检测和管理产生影响。
我们检查了2011年9月至2019年5月期间在一家学术癌症中心开始接受实体恶性肿瘤化疗的9143名40岁及以上患者的常规收集的埃德蒙顿症状评估系统修订版（ESAS - r）评分。我们使用多变量逻辑回归模型来确定最常见症状与年龄组（40 - 64岁、65 - 74岁、75 - 84岁和85岁及以上）、癌症部位、临床分期、性别和收入水平之间的关联。我们将研究结果聚焦于五种最常见癌症（乳腺癌，n = 1532；前列腺癌，n = 923；肺癌，n = 889；胰腺癌，n = 429；结直肠癌，n = 368）且尚未接受治疗的患者。
在我们的样本中，40 - 64岁的占58.0%，65 - 74岁的占27.3%，75 - 84岁的占11.8%，85岁及以上的占2.9%。在ESAS - r的九种症状（焦虑、抑郁、疲倦、幸福感、恶心、疼痛、嗜睡、食欲和呼吸急促）中，总体上最常见的症状是焦虑（33.8%的患者报告有中度至重度评分[ESAS - r为4或更高]）、缺乏幸福感（38.3%）和疲倦（38.3%）。高龄与中度/重度焦虑的较低几率相关（65 - 74岁的优势比[OR]为0.81，95%置信区间[CI]为0.73 - 0.90；75 - 84岁的OR为0.81，95%CI为0.70 - 0.93；85岁及以上的OR为0.62，95%CI为0.47 - 0.82；所有分析的参照组为40 - 64岁人群），以及疲倦几率增加（65 - 74岁的OR为1.00，95%CI为0.90 - 1.11；75 - 84岁的OR为1.19，95%CI为1.04 - 1.37；85岁及以上的OR为1.34，95%CI为1.04 - 1.72）。在调整模型中，晚期、女性性别和较低收入水平与中度/重度疲倦、焦虑和缺乏幸福感的较高几率相关。胰腺癌和肺癌患者在这三种症状上的评分比其他癌症患者更差。
高龄与症状体验的差异相关，如疲倦增加和焦虑减少。支持性护理干预措施和未来研究应专注于解决这些症状以改善患者生活质量。
