cans2012.2280448.NORMAL by babbian

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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                          Vulnerability                      Risk/Support             Human
Human Response                        Factors                             Factors              Responses
   Framework


                                      Present                            Present               Change in
  Definition of                                                          Outside                 Human
                                       Within
   Concepts                                                             Individual             Dimensions
                                     Individual


    Study
                  Demographic          Biologic        Psychological      Treatment           Symptom Distress
   Variables



                   Age Categories
                      Gender
                        Race          Comorbidities                      Cancer Treatment
   Empirical       Marital Status     Type of Cancer                     Advanced Practice
                                                       Mental Health
                     Education         Cancer Stage                      Nurse Intervention    Symptom Distress
   Indicators         Income
Methods
 Secondary analysis
 Combined subsets of data of 326 adults
  ages 65 or greater
 Five clinical trials of nurse-directed
  interventions targeting patients post-
  surgery
 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     %
Age
65 to 69         147   45
70 to 74         108   33
75 and over      71    22


Gender
Female           162   50
Male             161   50


Race
White            247   76
Black/Other      57    18
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%            None
                                  One
                                  Two
                   12%
    64%                           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       1.45        0.199
months


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       2.491       0.049
months
Aim 2: Symptom Distress Significantly Associated
with Type of Cancer and Comorbidities

Variable         Estimate        P Value
Type of Cancer
Digestive        2.83            <0.001
Thoracic         4.45            <0.001
Gynecologic      2.22            0.023
Genitourinary    Reference


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
 Psychological
 Mental health    -1.34       <0.001


 Function
 Function score   -0.33       <0.001
                             Symptom Distress by Age Category
                             Over Time
                        30
                        29
                        28
Mean Symptom Distress




                        27
                        26
                        25
                        24                                   Ages 75 and
                        23                                      older

                        22
                                                            Ages 70 to 74
                        21
                                                            Ages 65 to 69
                        20
                                Baseline     3 months     6 months
                             Symptom Distress By Type of Cancer
                             Over Time
                        29

                        27
Mean Symptom Distress




                        25                                   Thoracic

                        23
                                                             Digestive
                        21                                   Gynecologic

                        19

                        17                                   GU

                        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 nurse-
  directed 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 Pre-
  Doctoral Scholar
 Yale School of Nursing Pre-Doctoral Fellowship
  T32NR008346 : Self and Family Management, 2004-2006

								
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