1. 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

2. 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

3. Specific Aims
Describe older adults undergoing thoracic, abdominal, and genitourinary cancer surgery,
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.

4. Vulnerability/Risk/Human Response/Care Model
Risk/Support Factors
Vulnerability Factors
Human Responses
Adapted from J. Shaver, Nursing Outlook, 33, pp and B. Steele & J. Shaver, Advances in Nursing Science, 15, p. 72

5. Vulnerability Risk Human Response Framework Risk/Support Factors Human
Responses
Vulnerability
Factors
Present
Outside
Individual
Change in
Human
Dimensions
Present
Within
Individual
Definition of
Concepts
Study
Variables
Demographic
Biologic
Psychological
Treatment
Symptom Distress
Age Categories
Gender
Race
Marital Status
Education
Income
Comorbidities
Type of Cancer
Cancer Stage
Mental Health
Cancer Treatment
Advanced Practice
Nurse Intervention
Empirical
Indicators
Symptom Distress

6. 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

7. 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

8. 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

9. Statistical Analysis Descriptive Statistics
Multiple linear regression analysis by Generalized Estimating Equations controlling for demographic, biologic, psychological, and treatment covariates

10. Aim 1: Patient Characteristics%
Age
65 to 69
147 45
70 to 74
108 33
75 and over 71 22
Gender
Female
162 50
Male
161
Race
White
247 76
Black/Other 57 18

11. Aim 1: Study Population Balanced Across All Types of Cancer

12. Aim 1: Majority of Patients Received Surgery With or Without Chemotherapy

13. Aim 1: Majority of Patients With Three or Greater Number of Symptoms

14. 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
3 months
-2.64
<0.001
6 months
-2.57
0.002

15. 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
Age 65 to 69 x 6 months
Age 70 to 74 x 6 months
0.803
0.476
Age 75 and over x 6 months
2.491
0.049

16. 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
Gynecologic
2.22
0.023
Genitourinary
Reference
Comorbidities
None
One
-0.07
0.939
Two
1.06
0.273
Three or more
1.77
0.044

17. 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

18. Symptom Distress by Age Category Over Time

19. Symptom Distress By Type of Cancer Over Time

20. Limitations
Secondary data analysis
Studies occurred over 20 year span

21. 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

22. 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

23. 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 T32NR : Self and Family Management,