Risk Factors in Older Adults With Cancer May Increase Symptom Burden Following Surgery, Highlighting Need for Supportive Care


Several factors including female sex, lower socioeconomic status and high intensity surgery were associated with a higher risk of moderate-to-severe symptoms in older adults with cancer following surgery.

Data presented at a recent medical conference demonstrated that older adults with cancer who undergo surgery experience moderate-to-severe symptoms such as tiredness and lack of appetite up to one year after surgery.

The results, according to study author Dr. Jesse Zuckerman, highlight the need to address any possible gaps in supportive care.

“Older adults are expected to account for a large majority of new cancer diagnoses over the next 10 years. Because of advances in patient selection in perioperative management demand-driven therapies, older adults are increasingly likely to have cancer surgery,” Zuckerman, a general surgery resident at the University of Toronto, explained during a presentation at the virtual Society of Surgical Oncology 2021 International Conference on Surgical Cancer Care. He added that it has become evident that many older adults place a higher importance on post-operative outcomes, such as functional independence or quality-of-life, compared with short-term outcomes, such as morbidity and mortality.

Therefore, the investigators conducted a population-level study of 48,748 patients (64% female) aged older than 70 years; 28% of which were 80 years or older. These patients had all undergone cancer surgery between 2007 and 2018. More than half (54%) of the patients underwent a high surgical intensity procedure and 51% of patients received adjuvant therapy (additional treatment administered after initial treatment). The goal of the study was to determine symptoms over time and identify factors associated with high symptom burden after cancer surgery in older adults.

The investigators collected data prospectively from Edmonton Symptom Assessment System (ESAS) scores — a system used to address the severity or absence of pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being and shortness of breath — to calculate the monthly prevalence of moderate-to-severe symptoms over one year after surgery. Symptoms were analyzed 90 days prior to surgery and 180 days after surgery.

One year after surgery, most common symptoms patients reported as moderate-to-severe included tiredness (57.8%), poor well-being (51.9%), and lack of appetite (39.3%). However, the study authors noted that those patients with moderate-to-severe symptoms were stable for over one year after surgery, meaning that the surgery neither improved nor worsened the patients’ cancer symptoms.

“However, these trajectories may be influenced by common, yet less intense, procedures such as breast and prostate resections,” Zuckerman said.

Therefore, the authors also examined patients who underwent higher intensity procedures.

Although similar patterns were observed for all procedures, those who underwent high-intensity procedures for lung and upper gastrointestinal/hepato-pancreato-biliary resections showed an initial rise in symptoms one month after surgery. These symptoms were resolved by three months after surgery.

Older age, female sex, lower socioeconomic status, frailty, high comorbidities, receipt of adjuvant chemotherapy within two weeks and high intensity surgery were associated with a higher risk of moderate-to-severe symptoms. Living in a rural area was the only factor that was associated with a lower risk of moderate-to-severe symptom burden.

“These findings are encouraging as neither surgery nor adjuvant therapies lead to important symptom worsening, even among patients who required high intensity surgery and experienced higher initial symptom burden. Their trajectory stabilized in the long-term, suggesting either that surgery and adjuvant therapies do not significantly increase older adults’ experience of symptoms, or that current support mechanisms are effective in getting patients back to their perceived baseline,” Zuckerman said.

However, he concluded, patients are still experiencing a certain level of moderate-to-severe symptoms for up to a year after surgery, “highlighting the potential gaps in supportive care for older adults after surgery.”

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A version of this article originally appeared on CancerNetwork® as, “Study Highlights Gaps in Supportive Care for Older Patients With Cancer Undergoing Surgery.”

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