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

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.

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.

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.

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.