title: Differences in the symptom experience of older versus younger oncology outpatients: a cross-sectional study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
authors.forename: Janine K
authors.initials: JK
authors.lastname: Cataldo
authors.forename: Steven
authors.initials: S
authors.lastname: Paul
authors.forename: Bruce
authors.initials: B
authors.lastname: Cooper
authors.forename: Helen
authors.initials: H
authors.lastname: Skerman
authors.forename: Kimberly
authors.initials: K
authors.lastname: Alexander
authors.forename: Bradley
authors.initials: B
authors.lastname: Aouizerat
authors.forename: Virginia
authors.initials: V
authors.lastname: Blackman
authors.forename: John
authors.initials: J
authors.lastname: Merriman
authors.forename: Laura
authors.initials: L
authors.lastname: Dunn
authors.forename: Christine
authors.initials: C
authors.lastname: Ritchie
authors.forename: Patsy
authors.initials: P
authors.lastname: Yates
authors.forename: Christine
authors.initials: C
authors.lastname: Miaskowski
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001315:Australia / Q000453:epidemiology; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008495:Medical Oncology; D008603:Mental Health; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D016017:Odds Ratio; D010146:Pain / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D011788:Quality of Life; D011878:Radiotherapy / Q000009:adverse effects; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents