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Symptom Distress in Older Adults Following Cancer Surgery

Van Cleave, Janet H. PhD, RN; Egleston, Brian L. PhD; Ercolano, Elizabeth DNSc, RN; McCorkle, Ruth PhD, RN

doi: 10.1097/NCC.0b013e31826dd517

Background: Symptom distress remains a significant health problem among older adults with cancer following surgery. Understanding factors influencing older adults’ symptom distress may lead to early identification and interventions, decreasing morbidity and improving outcomes.

Objective: We conducted this study to identify factors associated with symptom distress following surgery among 326 community-residing patients 65 years or older with a diagnosis of thoracic, digestive, gynecologic, and genitourinary cancers.

Methods: This secondary analysis used combined subsets of data from 5 nurse-directed intervention clinical trials targeting patients after surgery at academic cancer centers in northwest and northeastern United States. Symptom distress was assessed by the Symptom Distress Scale at baseline and at 3 and 6 months.

Results: A multivariable analysis, using generalized estimating equations, showed that symptom distress was significantly less at 3 and 6 months (3 months: P < .001, 6 months: P = .002) than at baseline while controlling for demographic, biologic, psychological, treatment, and function covariates. Thoracic cancer, comorbidities, worse mental health, and decreased function were, on average, associated with increased symptom distress (all P < .05). Participants 75 years or older reported increased symptom distress over time compared with those aged 65 to 69 years (P < .05).

Conclusions: Age, type of cancer, comorbidities, mental health, and function may influence older adults’ symptom distress following cancer surgery.

Implications for Practice: Older adults generally experience decreasing symptom distress after thoracic, abdominal, or pelvic cancer surgery. Symptom management over time for those with thoracic cancer, comorbidities, those with worse mental health, those with decreased function, and those 75 years or older may prevent morbidity and improve outcomes of older adults following surgery.

Author Affiliations: College of Nursing, New York University (Dr Van Cleave); Biostatistics Facility, Fox Chase Cancer Center, Philadelphia, Pennsylvania (Dr Egleston); Yale School of Nursing, New Haven, Connecticut (Drs Ercolano and McCorkle).

This study was funded in part by a University of Pennsylvania Postdoctoral Fellowship (T32NR009356), the John A. Hartford Foundation: Building Academic Geriatric Nursing Capacity Award Program, and a Yale School of Nursing Predoctoral Fellowship (T32NR008346) (to Dr Van Cleave); and NIH grant P30 CA006927 and an appropriation from the Commonwealth of Pennsylvania (to Dr Egleston).

The authors have no conflicts of interest to disclose.

Correspondence: Janet H. Van Cleave, PhD, RN, College of Nursing, New York University, 726 Broadway, 10th Floor, New York, NY 10003 (

Accepted for publication August 3, 2012.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins