Julie Hallet1,2,3,4, Jesse Zuckerman5,6,7, Matthew P Guttman5,6,7, Tyler R Chesney5,8, Barbara Haas5,6,7,9,10,11, Alyson Mahar12, Antoine Eskander6,7,13, Wing C Chan7, Amy Hsu14,15, Victoria Barabash6, Natalie Coburn5,6,7,10. 1. Department of Surgery, University of Toronto, Toronto, ON, Canada. julie.hallet@sunnybrook.ca. 2. Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, ON, Canada. julie.hallet@sunnybrook.ca. 3. Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada. julie.hallet@sunnybrook.ca. 4. Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. julie.hallet@sunnybrook.ca. 5. Department of Surgery, University of Toronto, Toronto, ON, Canada. 6. Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, ON, Canada. 7. Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada. 8. Division of General Surgery, Unity Health, Toronto, ON, Canada. 9. Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 10. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. 11. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 12. Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada. 13. Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada. 14. Ottawa Hospital Research Institute, Ottawa, ON, Canada. 15. Bruyère Research Institute, Ottawa, ON, Canada.
Abstract
BACKGROUND: Older adults have unique needs for supportive care after surgery. We examined symptom trajectories and factors associated with high symptom burden after cancer surgery in older adults. PATIENTS AND METHODS: We conducted a population-level study of patients ≥ 70 years old undergoing cancer surgery (2007-2018) using prospectively collected Edmonton Symptom Assessment System (ESAS) scores. The monthly prevalence of moderate to severe symptoms (ESAS ≥ 4) for anxiety, depression, drowsiness, lack of appetite, nausea, pain, shortness of breath, tiredness, and poor wellbeing was computed over 12 months after surgery. RESULTS: Among 48,748 patients, 234,420 ESAS scores were recorded over 12 months after surgery. Moderate to severe tiredness (57.8%), poor wellbeing (51.9%), and lack of appetite (39.3%) were most common. The proportion of patients with moderate to severe symptoms was stable over the 1 month prior to and 12 months after surgery (< 5% variation for each symptom). There was no clinically significant change (< 5%) in symptom trajectory with the initiation of adjuvant therapy. CONCLUSIONS: Patient-reported symptom burden was stable for up to 1 year after cancer surgery among older adults. Neither surgery nor adjuvant therapy coincided with a worsening in symptom burden. However, the persistence of symptoms at 1 year may suggest gaps in supportive care for older adults. This information on symptom trajectory and predictors of high symptom burden is important to set appropriate expectations and improve patient counseling, recovery care pathways, and proactive symptom management for older adults after cancer surgery.
BACKGROUND: Older adults have unique needs for supportive care after surgery. We examined symptom trajectories and factors associated with high symptom burden after cancer surgery in older adults. PATIENTS AND METHODS: We conducted a population-level study of patients ≥ 70 years old undergoing cancer surgery (2007-2018) using prospectively collected Edmonton Symptom Assessment System (ESAS) scores. The monthly prevalence of moderate to severe symptoms (ESAS ≥ 4) for anxiety, depression, drowsiness, lack of appetite, nausea, pain, shortness of breath, tiredness, and poor wellbeing was computed over 12 months after surgery. RESULTS: Among 48,748 patients, 234,420 ESAS scores were recorded over 12 months after surgery. Moderate to severe tiredness (57.8%), poor wellbeing (51.9%), and lack of appetite (39.3%) were most common. The proportion of patients with moderate to severe symptoms was stable over the 1 month prior to and 12 months after surgery (< 5% variation for each symptom). There was no clinically significant change (< 5%) in symptom trajectory with the initiation of adjuvant therapy. CONCLUSIONS: Patient-reported symptom burden was stable for up to 1 year after cancer surgery among older adults. Neither surgery nor adjuvant therapy coincided with a worsening in symptom burden. However, the persistence of symptoms at 1 year may suggest gaps in supportive care for older adults. This information on symptom trajectory and predictors of high symptom burden is important to set appropriate expectations and improve patient counseling, recovery care pathways, and proactive symptom management for older adults after cancer surgery.
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