Supportive Care in Cancer

, Volume 19, Issue 3, pp 417–423 | Cite as

Age and gender differences in symptom intensity and symptom clusters among patients with metastatic cancer

  • Winson Y. Cheung
  • Lisa W. Le
  • Lucia Gagliese
  • Camilla Zimmermann
Original Article
First Online:
Received:
Accepted:

Abstract

Background

Few studies have explored demographic variations in symptom patterns. Our goals were to examine age and gender differences in symptom intensity and symptom clusters among outpatients with advanced cancer.

Methods

Symptom scores by the Edmonton Symptom Assessment System (ESAS) were collected for patients attending the Oncology Palliative Care Clinics at Princess Margaret Hospital from 2005 to 2007. Symptom intensity was compared between individuals aged ≤60 and >60 years and between males and females. Principal component analysis (PCA) was performed to determine inter-relationships of the nine ESAS symptoms and to compare symptom clusters within age and gender subgroups.

Results

From a total of 1,358 patients, 49.8% were male and 50.2% were female. The median age was 64 (range 19 to 99): 39.6% were ≤60 and 60.4% were >60. The most common primary cancer sites were gastrointestinal (27%), lung (15%), and breast (11%). Younger patients reported worse pain (4.9 vs. 4.5, p = 0.02) and better appetite (4.7 vs. 5.3, p = 0.002) than older patients. Females reported poorer scores than males for nausea (2.6 vs. 2.2, p = 0.02). Analyses of symptom clusters revealed that fatigue and drowsiness were included in the cluster of pain, nausea, and appetite in younger but not older patients. In men, pain clustered together with depression and anxiety; for women, physical and psychological symptoms formed separate clusters.

Conclusions

In patients with advanced cancers, symptom patterns differ according to age and gender. Palliative interventions tailored for symptoms that are more prominent in specific patient subgroups may offer greater therapeutic benefit.

Keywords

Symptom clusters Advanced cancer Age Gender Palliative care 
This is a preview of subscription content, log in to check access.

References

  1. 1.
    Doorenbos AZ, Given CW, Given B, Verbitsky N (2006) Symptom experience in the last year of life among individuals with cancer. J Pain Symptom Manage 32:403–412PubMedCrossRefGoogle Scholar
  2. 2.
    Teunissen SC, Wesker W, Kruitwagen C, de Haes HC, Voest EE, de Graeff A (2007) Symptom prevalence in patients with incurable cancer: a systematic review. J Pain Symptom Manage 34:94–104PubMedCrossRefGoogle Scholar
  3. 3.
    McCarthy EP, Phillips RS, Zhong Z, Drews RE, Lynn J (2000) Dying with cancer: patients’ function, symptoms, and care preferences as death approaches. J Am Geriatr Soc 48(5 Suppl):S110–S121PubMedGoogle Scholar
  4. 4.
    Cheung WY, Barmala N, Zarinehbaf S, Rodin G, Le LW, Zimmermann C (2009) The association of physical and psychological symptom burden with time to death among palliative cancer outpatients. J Pain Symptom Manage 37:297–304PubMedCrossRefGoogle Scholar
  5. 5.
    Husain AF, Stewart K, Arsenault R, Moineddin R, Cellarius V, Librach SL et al (2007) Women experience higher levels of fatigue than men at the end of life: a longitudinal home palliative care study. J Pain Symptom Manage 33:389–397PubMedCrossRefGoogle Scholar
  6. 6.
    Jordhoy MS, Fayers P, Loge JH, Saltnes T, Ahlner-Elmqvist M, Kaasa S (2001) Quality of life in advanced cancer patients: the impact of sociodemographic and medical characteristics. Br J Cancer 85:1478–1485PubMedCrossRefGoogle Scholar
  7. 7.
    Walsh D, Donnelly S, Rybicki L (2000) The symptoms of advanced cancer: relationship to age, gender, and performance status in 1,000 patients. Support Care Cancer 8:175–179PubMedCrossRefGoogle Scholar
  8. 8.
    Zimmermann C, Burman D, Follwell M, Wakimoto K, Seccareccia D, Bryson J, Le L, Rodin G. Predictors of symptom severity and response in patients with metastatic cancer. Am J Hosp Palliat Med. 2010 Oct 16. [Epub ahead of print] in pressGoogle Scholar
  9. 9.
    Cheung WY, Le LW, Zimmermann C (2009) Symptom clusters in patients with advanced cancers. Support Care Cancer 17(9):1223–1230PubMedCrossRefGoogle Scholar
  10. 10.
    Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K (1991) The Edmonton symptom assessment system (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 7:6–9PubMedGoogle Scholar
  11. 11.
    Fan G, Filipczak L, Chow E (2007) Symptom clusters in cancer patients: a review of the literature. Curr Oncol 14:173–179PubMedCrossRefGoogle Scholar
  12. 12.
    Kim HJ, McGuire DB, Tulman L, Barsevick AM (2005) Symptom clusters: concept analysis and clinical implications for cancer nursing. Cancer Nurs 28:270–284PubMedGoogle Scholar
  13. 13.
    Dodd MJ, Miaskowski C, Paul SM (2001) Symptom clusters and their effect on the functional status of patients with cancer. Oncol Nurs Forum 28:465–470PubMedGoogle Scholar
  14. 14.
    Zimmermann C, Seccareccia D, Clarke A, Warr D, Rodin G (2006) Bringing palliative care to a Canadian cancer center: the palliative care program at Princess Margaret Hospital. Support Care Cancer 14:982–987PubMedCrossRefGoogle Scholar
  15. 15.
    Chang VT, Hwang SS, Feuerman M (2000) Validation of the Edmonton symptom assessment scale. Cancer 88:2164–2171PubMedCrossRefGoogle Scholar
  16. 16.
    Dudgeon D, Vaitonis V, Seow H et al (2007) Ontario, Canada: using networks to integrate palliative care province-wide. J Pain Symptom Manage 33:640–644PubMedCrossRefGoogle Scholar
  17. 17.
    Webster K, Cella D, Yost K (2003) The Functional Assessment of Chronic Illness Therapy (FACIT) measurement system: properties, applications, and interpretation. Health Qual Life Outcomes 1:79PubMedCrossRefGoogle Scholar
  18. 18.
    Fayers PM, Aaronson NK, Bjordal K et al (2001) European Organisation for Research and Treatment of Cancer QLQ-C30 Scoring Manual, ed 3rd edn. EORTC Quality of Life Group, BrusselsGoogle Scholar
  19. 19.
    Miaskowski C, Aouizerat BE, Dodd M, Cooper B (2007) Conceptual issues in symptom clusters research and their implications for quality-of-life assessment in patients with cancer. J Natl Cancer Inst Monogr 37:39–46PubMedCrossRefGoogle Scholar
  20. 20.
    Barsevick AM, Whitmer K, Nail LM, Beck SL, Dudley WN (2006) Symptom cluster research: conceptual design, measurement, and analysis issues. J Pain Symptom Manage 31:85–95PubMedCrossRefGoogle Scholar
  21. 21.
    Gagliese L, Melzack R (2003) Age-related differences in the qualities but not the intensity of chronic pain. Pain 104:597–608PubMedCrossRefGoogle Scholar
  22. 22.
    Gagliese L, Katz J (2003) Age differences in post-operative pain are scale dependent: a comparison of measures of pain intensity and quality in younger and older surgical patients. Pain 103:11–20PubMedCrossRefGoogle Scholar
  23. 23.
    Gagliese L, Jovellanos M, Zimmermann C, Shobbrook C, Warr D, Rodin G (2009) Age-related patterns in adaptation to cancer pain. Pain Med 10:1050–1061Google Scholar
  24. 24.
    Ringash J, O’Sullivan B, Bezjak A et al (2007) Interpreting clinically significant changes in patient reported outcomes. Cancer 110:196–202PubMedCrossRefGoogle Scholar
  25. 25.
    Osoba D, Rodrigues G, Myles J et al (1998) Interpreting the significance of changes in health-related quality-of-life socres. J Clin Oncol 16:139–144PubMedGoogle Scholar
  26. 26.
    Barrett B, Brown D, Mundt M et al (2005) Sufficiently important difference: expanding the framework of clinical significance. Med Decis Making 25:250–261PubMedCrossRefGoogle Scholar
  27. 27.
    Riechelmann RP, Zimmermann C, Chin SN, Wang L, O’Carroll A, Zarinehbaf S et al (2008) Potential drug interactions in cancer patients receiving supportive care exclusively. J Pain Symptom Manage 35:535–543PubMedCrossRefGoogle Scholar
  28. 28.
    Riechelmann RP, Krzyzanowska MK, O’Carroll A, Zimmermann C (2007) Symptom and medication profiles among cancer patients attending a palliative care clinic. Support Care Cancer 15:1407–1412PubMedCrossRefGoogle Scholar
  29. 29.
    Bekelman DB, Rumsfeld JS, Havranek EP, Yamashita TE, Hutt E, Gottlieb SH et al (2009) Symptom burden, depression, and spiritual well-being: a comparison of heart failure and advanced cancer patients. J Gen Intern Med 24:592–598PubMedCrossRefGoogle Scholar
  30. 30.
    Habraken JM, ter Riet G, Gore JM, Greenstone MA, Weersink EJ, Bindels PJ et al (2009) Health-related quality of life in end-stage COPD and lung cancer patients. J Pain Symptom Manage 37:973–981PubMedCrossRefGoogle Scholar
  31. 31.
    Baumann R, Putz C, Rohrig B, Hoffken K, Wedding U (2009) Health-related quality of life in elderly cancer patients, elderly non-cancer patients and an elderly general population. Eur J Cancer Care (Engl) 18:457–465Google Scholar
  32. 32.
    Schmidt CE, Bestmann B, Kuchler T, Longo WE, Kremer B (2005) Impact of age on quality of life in patients with rectal cancer. World J Surg 29:190–197PubMedCrossRefGoogle Scholar
  33. 33.
    Cleary JF, Carbone PP (1997) Palliative medicine in the elderly. Cancer 80:1335–1347PubMedCrossRefGoogle Scholar
  34. 34.
    Holzner B, Kemmler G, Cella D, De Paoli C, Meraner V, Kopp M et al (2004) Normative data for functional assessment of cancer therapy—general scale and its use for the interpretation of quality of life scores in cancer survivors. Acta Oncol 43:153–160PubMedCrossRefGoogle Scholar
  35. 35.
    Hjermstad MJ, Fayers PM, Bjordal K, Kassa S (1998) Health-related quality of life in the general Norwegian population assessed by the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionniare: the QLQ = C30(+3). J Clin Oncol 16:1188–1196PubMedGoogle Scholar
  36. 36.
    Carlson LE, Angen M, Cullum J, Goodey E, Koopmans J, Lamont L et al (2004) High levels of untreated distress and fatigue in cancer patients. Br J Cancer 90:2297–2304PubMedGoogle Scholar
  37. 37.
    Strong V, Waters R, Hibberd C, Rush R, Cargill A, Storey D et al (2007) Emotional distress in cancer patients: the Edinburgh Cancer Centre symptom study. Br J Cancer 96:868–874PubMedCrossRefGoogle Scholar
  38. 38.
    Pascoe S, Edelman S, Kidman A (2000) Prevalence of psychological distress and use of support services by cancer patients at Sydney hospitals. Aust N Z J Psychiatry 34:785–791PubMedGoogle Scholar
  39. 39.
    Aass N, Fossa SD, Dahl AA, Moe TJ (1997) Prevalence of anxiety and depression in cancer patients seen at the Norwegian Radium Hospital. Eur J Cancer 33:1597–1604PubMedCrossRefGoogle Scholar
  40. 40.
    Hamadani M, Chaudhary L, Awan FT et al (2007) Management of platinum-based chemotherapy-induced acute nausea and vomiting: is there a superior serotonin receptor antagonist? J Oncol Pharm Pract 13:69–75PubMedCrossRefGoogle Scholar
  41. 41.
    Shih V, Wan HS, Chan A (2009) Clinical predictors of chemotherapy-induced nausea and vomiting in breast cancer patients receiving adjuvant doxorubicin and cyclophosphamide. Ann Pharmacother 43:444–452PubMedCrossRefGoogle Scholar
  42. 42.
    Pollera CF, Giannarelli D (1989) Prognostic factors influencing cisplatin-induced emesis. Definition and validation of a predictive logistic model. Cancer 64:1117–1122PubMedCrossRefGoogle Scholar
  43. 43.
    Liaw CC, Wang CH, Chang HK, Liau CT, Yeh KY, Huang JS et al (2001) Gender discrepancy observed between chemotherapy-induced emesis and hiccups. Support Care Cancer 9:435–441PubMedCrossRefGoogle Scholar
  44. 44.
    Liaw CC, Chang HK, Liau CT, Huang JS, Lin YC, Chen JS (2003) Reduced maintenance of complete protection from emesis for women during chemotherapy cycles. Am J Clin Oncol 26:12–15PubMedCrossRefGoogle Scholar
  45. 45.
    Follwell M, Burman D, Le LW, Wakimoto K, Seccareccia D, Bryson J et al (2009) Phase II study of an outpatient palliative care intervention in patients with metastatic cancer. J Clin Oncol 27:206–213PubMedCrossRefGoogle Scholar
  46. 46.
    McCaughan E, Prue G, Parahoo K (2009) A systematic review of quantitative studies reporting selected patient experienced outcomes with a specific focus on gender differences in people with colorectal cancer. Eur J Oncol Nurs 13:376–385Google Scholar
  47. 47.
    Chow E, Fan G, Hadi S, Wong J, Kirou-Mauro A, Filipczak L (2008) Symptom clusters in elderly patients with lung cancer. Clin Oncol (R Coll Radiol) 20:76–82Google Scholar
  48. 48.
    Chow E, Fan G, Hadi S, Filipczak L (2007) Symptom clusters in cancer patients with bone metastases. Support Care Cancer 15:1035–1043PubMedCrossRefGoogle Scholar
  49. 49.
    Chen ML, Tseng HC (2006) Symptom clusters in cancer patients. Support Care Cancer 14:825–830PubMedCrossRefGoogle Scholar
  50. 50.
    Walsh D, Rybicki L (2006) Symptom clustering in advanced cancer. Support Care Cancer 14:831–836PubMedCrossRefGoogle Scholar
  51. 51.
    Ridner SH (2005) Quality of life and a symptom cluster associated with breast cancer treatment-related lymphedema. Support Care Cancer 13:904–911PubMedCrossRefGoogle Scholar
  52. 52.
    Bender CM, Ergyn FS, Rosenzweig MQ, Cohen SM, Sereika SM (2005) Symptom clusters in breast cancer across 3 phases of disease. Cancer Nurs 28:219–225PubMedCrossRefGoogle Scholar
  53. 53.
    Gifts AG, Jablonski A, Stommel M, Given CW (2004) Symptom clusters in elderly patients with lung cancer. Oncol Nurs Forum 31:202–212Google Scholar
  54. 54.
    Fillingim RB, Ness TJ, Glover TL, Campbell CM, Hastie BA, Price DD et al (2005) Morphine responses and experimental pain: sex differences in side effects and cardiovascular responses but not analgesia. J Pain 6:116–124PubMedCrossRefGoogle Scholar
  55. 55.
    Bijur PE, Esses D, Birnbaum A, Chang AK, Schechter C, Gallagher EJ (2008) Response to morphine in male and female patients: analgesia and adverse events. Clin J Pain 24:192–198PubMedCrossRefGoogle Scholar
  56. 56.
    Barsky AJ, Peekna HM, Borus JF (2001) Somatic symptom reporting in women and men. J Gen Intern Med 16:266–275PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Winson Y. Cheung
    • 1
  • Lisa W. Le
    • 4
  • Lucia Gagliese
    • 2
    • 5
  • Camilla Zimmermann
    • 3
    • 5
  1. 1.Division of Medical Oncology, British Columbia Cancer AgencyUniversity of British ColumbiaVancouverCanada
  2. 2.Department of Kinesiology and Health ScienceYork UniversityTorontoCanada
  3. 3.Division of Medical Oncology and HematologyUniversity of TorontoTorontoCanada
  4. 4.Department of BiostatisticsUniversity Health NetworkTorontoCanada
  5. 5.Department of Psychosocial Oncology and Palliative CarePrincess Margaret HospitalTorontoCanada

Personalised recommendations