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Factors Affecting Older Adults’ Symptom Distress Following Cancer Surgery Janet H.Van Cleave PhD, RN1 Brian Egleston PhD2 Elizabeth Ercolano DNSc3 Ruth McCorkle PhD, RN, FAAN3 1New York University College of Nursing 2Fox Chase Cancer Center 3Yale School of Nursing Background Older adults 65 and over comprise majority of persons living with and dying from cancer Symptom distress remains a significant health problem of older adults after cancer surgery Little is known about older adults’ symptom distress following cancer surgery Understanding the relationship between age and symptom distress may help identify interventions to improve older adults’ outcomes Specific Aims 1. Describe older adults undergoing thoracic, abdominal, and genitourinary cancer surgery, 1. Elucidate the relationship of age categories with symptom distress following cancer surgery at baseline, three, and six months controlling for demographic, biologic, psychological, and treatment covariates. Vulnerability/Risk/Human Response/Care Model Risk/Support Factors Vulnerability Factors Human Responses Adapted from J. Shaver, Nursing Outlook, 33, pp. 186-191 and B. Steele & J. Shaver, Advances in Nursing Science, 15, p. 72 Vulnerability Risk Human Response Framework Vulnerability Factors Risk/Support Factors Human Responses Definition of Concepts Present Within Individual Present Outside Individual Change in Human Dimensions Study Variables Empirical Indicators Demographic Age Categories Gender Race Marital Status Education Income Biologic Comorbidities Type of Cancer Cancer Stage Psychological Mental Health Treatment Cancer Treatment Advanced Practice Nurse Intervention Symptom Distress Symptom Distress Methods Secondary analysis Combined subsets of data of 326 adults ages 65 or greater Five clinical trials of nurse-directed interventions targeting patients postsurgery Data collection at baseline (post-surgery period), and 3 and 6 months Outcome Variable Symptom distress Measure: Symptom Distress Scale (McCorkle & Young, 1978; McCorkle et al., 1998) Demonstrated reliability and validity with reported Cronbach alphas 0.70 to 0.89 Symptom Distress Scale (SDS) (McCorkle et al, 1998) Frequency and severity of nausea Appetite Insomnia Frequency and severity of pain Fatigue Bowel pattern Concentration Appearance Breathing Outlook Cough Statistical Analysis Descriptive Statistics Multiple linear regression analysis by Generalized Estimating Equations controlling for demographic, biologic, psychological, and treatment covariates Aim 1: Patient Characteristics Characteristic N % 65 to 69 147 45 70 to 74 108 33 75 and over 71 22 Female 162 50 Male 161 50 White 247 76 Black/Other 57 18 Age Gender Race Aim 1: Study Population Balanced Across All Types of Cancer Type of Cancer 22% 27% 28% 23% Digestive Thoracic Gyn GU Aim 1: Majority of Patients Received Surgery With or Without Chemotherapy Type of Treatment 12% Surgery 9% 47% Surg+Chemotx Surg+Radtx 32% Surg+Chemotx+Radt x Aim 1: Majority of Patients With Three or Greater Number of Symptoms Number of Symptoms 10% 14% 64% 12% None One Two Three or more Aim 2: Symptom Distress Significantly Decreased Over Time Variable Estimate P Value Age 65 to 69 Reference 70 to 74 -0.60 0.489 75 and over -2.17 0.062 Time Baseline Reference 3 months -2.64 <0.001 6 months -2.57 0.002 Aim 2: Symptom Distress Significantly Increased In Ages75 and Over at 6 Months Variable Estimate P Value Age x Time Age 65 to 69 x 3 months Reference Age 70 to 74 x 3 months 1.405 0.199 Age 75 and over x 3 months 1.45 0.199 Age 65 to 69 x 6 months Reference Age 70 to 74 x 6 months 0.803 0.476 Age 75 and over x 6 months 2.491 0.049 Aim 2: Symptom Distress Significantly Associated with Type of Cancer and Comorbidities Variable Estimate P Value Digestive 2.83 <0.001 Thoracic 4.45 <0.001 Gynecologic 2.22 0.023 Genitourinary Reference Type of Cancer Comorbidities None Reference One -0.07 0.939 Two 1.06 0.273 Three or more 1.77 0.044 Aim 2: Symptoms Distress Significantly Increased with Worse Mental Health and Function Variable Estimate P Value -1.34 <0.001 -0.33 <0.001 Psychological Mental health Function Function score 30 Symptom Distress by Age Category Over Time Mean Symptom Distress 29 28 27 26 25 24 Ages 75 and older 23 22 Ages 70 to 74 21 Ages 65 to 69 20 Baseline 3 months 6 months Symptom Distress By Type of Cancer Over Time Mean Symptom Distress 29 27 Thoracic 25 23 Digestive Gynecologic 21 19 GU 17 15 Baseline 3 Months 6 Months Limitations Secondary data analysis Studies occurred over 20 year span Conclusion More older candidates for cancer surgery as population ages Older adults experience typical post–operative pattern Decreasing symptom distress over 6 months despite type of cancer treatment Thoracic cancer patients may experience greater symptom distress Function, mental health, and number of comorbidities associated with symptom distress Study participants age 75 and older experienced greater symptoms distress over time than those aged 65 to 69 Study Implications Adoptions of more frequent appointments for older patients and those with thoracic cancer Monitor for changes in mental health Need to investigate novel symptom assessment interventions including nursedirected clinics and telehealth interventions Acknowledgements New York University College of Nursing, Hartford Institute of Geriatric Nursing University of Pennsylvania Post-Doctoral Fellowship T32NR009356: Individualized Care for At-Risk Older Adults, 2008 – present John A. Hartford Foundation Building Academic Geriatric Nursing Capacity Program 2006 – 2008 PreDoctoral Scholar Yale School of Nursing Pre-Doctoral Fellowship T32NR008346 : Self and Family Management, 2004-2006