title: Differences in Composition of Symptom Clusters Between Older and Younger Oncology Patients.
abstract: BACKGROUND
  Older oncology patients have unique needs associated with the many physical, psychological, and social changes associated with the aging process. The mechanisms underpinning and the impact of these changes are not well understood. Identification of clusters of symptoms is one approach that has been used to elicit hypotheses about the biological and/or psychological basis for variations in symptom experiences.
  
  
  OBJECTIVE
  The purposes of this study were to identify and compare symptom clusters in younger (<60 years) and older (≥60 years) patients undergoing cancer treatment.
  
  
  METHODS
  Symptom data from one Australian study and two U.S. studies were combined to conduct this analysis. A total of 593 patients receiving active treatment were dichotomized into younger (<60 years) and older (≥60 years) groups. Separate exploratory factor analyses (EFAs) were undertaken within each group to identify symptom clusters from occurrence ratings of the 32 symptoms assessed by the Memorial Symptom Assessment Scale.
  
  
  RESULTS
  In both groups, a seven-factor solution was selected. Four partially concordant symptom clusters emerged in both groups (i.e., mood/cognitive, malaise, body image, and genitourinary). In the older patients, the three unique clusters reflected physiological changes associated with aging, whereas in the younger group the three unique clusters reflected treatment-related effects.
  
  
  CONCLUSIONS
  The symptom clusters identified in older patients typically included a larger and more diverse range of physical and psychological symptoms. Differences also may be reflective of variations in treatment approaches between age groups. Findings highlight the need for better understanding of variation in treatment and symptom burden between younger and older adults with cancer.
authors.affiliation: School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
authors.forename: Patsy
authors.initials: P
authors.lastname: Yates
authors.affiliation: School of Nursing, University of California, San Francisco, California, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Miaskowski
authors.affiliation: School of Nursing, University of California, San Francisco, California, USA.
authors.forename: Janine K
authors.initials: JK
authors.lastname: Cataldo
authors.affiliation: School of Nursing, University of California, San Francisco, California, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Paul
authors.affiliation: School of Nursing, University of California, San Francisco, California, USA.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cooper
authors.affiliation: School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Alexander
authors.affiliation: School of Nursing, University of California, San Francisco, California, USA; Institute for Human Genetics, University of California, San Francisco, California, USA.
authors.forename: Bradley
authors.initials: B
authors.lastname: Aouizerat
authors.affiliation: School of Medicine, University of California, San Francisco, California, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Dunn
authors.affiliation: School of Medicine, University of California, San Francisco, California, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Ritchie
authors.affiliation: School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
authors.forename: Alexandra
authors.initials: A
authors.lastname: McCarthy
authors.affiliation: School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia. Electronic address: h.skerman@qut.edu.au.
authors.forename: Helen
authors.initials: H
authors.lastname: Skerman
mesh_terms: D000367:Age Factors; D000368:Aged; D001315:Australia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000503:physiopathology*; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D013577:Syndrome; D014481:United States / Q000453:epidemiology
keywords: Symptom cluster; cancer; factor analysis