Symptom burden and achievement of good death of elderly cancer patients

Background: The aim of this study was to compare the symptom burden and achievement of good death of elderly cancer patients with that of younger patients. Methods: Secondary analysis of three large databases was performed: (1) 7449 cancer outpatients receiving chemotherapy, (2) 1716 outpatients with metastatic cancer, and (3) 1751 terminally ill cancer patients who died in hospitals or at home. Outcome measures used included the M.D. Anderson Symptom Inventory, Brief Pain Inventory, and Good Death Inventory. Results: In cancer outpatients receiving chemotherapy, older patients reported significantly higher levels of dyspnea and fatigue (lung cancer), emotional distress (breast cancer), and unmet needs regarding information and help with decision making (stomach cancer); however, the intensity of nausea was significantly lower across the four primary tumor sites, and intensity of pain was significantly lower in lung cancer. In outpatients with metastatic cancer, older patients reported lower levels of "maintaining hope and pleasure," "a good relationship with the family," and "independence," while there was no significant difference in the pain intensity. In terminally ill cancer patients, proxy family members reported significantly lower levels of "independence," while they reported significantly lower levels of pain, physical discomfort, and psychological discomfort. Conclusions: Older cancer patients need at least the same levels of palliative care; while they experienced generally lower levels of nausea and pain, some older patients experienced higher levels of dyspnea, fatigue, emotional distress, need for information, help with decision making, loss of hope and pleasure, and independence.