Symptom frequency and change of oldest old cancer patients

The oldest old, described as those aged 85 and older, is a growing cancer population. There are limited studies evaluating the symptoms of the oldest old cancer patient population. Our study aimed to evaluate symptom frequency and clinical symptom change as assessed by the Edmonton Symptom Assessment System (ESAS) of the oldest old (≥ 85) compared to older adult (65-84) and general adult (18-64) outpatient cancer patients on initial consult and follow-up visit.

Retrospective review of a total of 441 patients, 200 randomly sampled patients in the general and older adult group and 41 consecutive patients in the oldest old group. Chart review was performed for demographic and clinical information including ESAS.

The oldest old group had less advanced tumors and worse performance status and was receiving less cancer therapy. Eighty percent or more of these patients reported fatigue, sleep disturbance, appetite, and drowsiness. They experienced lower frequencies of pain (p < 0.0001), fatigue (p = 0.0338), nausea (p = 0.0151), feeling of well-being (p = 0.0245), sleep disturbance (p = 0.0484), financial distress (p = 0.0002), and spiritual distress (p = 0.0010) compared to the younger groups. Twenty-six to fifty-one percent of the oldest old patients' symptoms improved on the first follow-up visit.

Oldest old cancer patients have high frequencies of multiple symptoms on initial referral. However, these symptom frequencies are lower when compared to younger age groups. Additionally, many of their symptoms improved on first follow-up visit in the palliative care clinic. More research is needed to address the needs of this growing cancer population and focus symptoms that can improve with palliative care intervention.