ANAHEIM, CALIF. – Compared with older cancer patients, younger adults battling the disease reported more pain, more severe pain, and more distress on almost every psychological variable measured by researchers at the University of South Florida, Tampa.
The findings were notable because older patients, defined as those over age 55, were more likely than their younger counterparts to have stage IV disease (56.8% vs. 36.7%) and be receiving palliative care rather than active treatment (63.3% vs. 37.8%) in the 232-patient study.
Patients ranged in age from 21 to 84 years, and participated in the study a mean 3.2 years following diagnosis. About half of the patients, 49%, were younger than 55 years. The most common diagnoses were lymphoma, leukemia, lung cancer, breast cancer, and prostate cancer.
Significant differences were seen in younger and older patients’ reports of pain (82.5% vs. 73.9%, respectively), pain severity on a 0- to 10-point Likert scale (2.63 vs. 2.30), and distress associated with their pain, according to scores on the Memorial Symptom Assessment Scale (2.82 vs. 2.35).
Significantly more young adults reported problems with sleep difficulties, sadness, worry, irritability, and sexual concerns, reported Jessica Krok, a doctoral candidate in the university’s School of Aging Studies, during a podium session at the annual conference of the American Psychosocial Oncology Society.
Difficulty sleeping and worrying were especially common, being reported by 62.8% and 60.2% of young adult cancer patients surveyed, respectively. These were concerns of 47.9% and 42.9% of older adult patients.
A highly significant difference was seen in patients reporting that they felt irritable: 54% of younger adults, compared with 35% of older adults with the disease.
Numerically, younger patients were more likely to report difficulty concentrating and feeling nervous, although differences in those categories did not reach significance.
The only psychological variable reported more by older than younger patients was the statement, "I don’t look like myself," which was answered affirmatively by 48.7% of older patients and 43.4% of younger patients; again, the difference was not significant.
Ms. Krok emphasized that pain was a problem for 78% of all patients in the study. After controlling for psychological variables, she and her colleagues found that women, unmarried patients, less religiously active patients, and those reporting sleep disturbances reported higher pain severity.
When only younger patients’ responses were analyzed, age was still significantly correlated with pain severity, again with the youngest patients reporting higher levels of pain. Higher levels of worry were also associated with higher pain severity among younger adults.
For both younger and older patients, being female and having sleep difficulties correlated with higher pain severity scores.
Among older patients, more intense pain was also associated with being less actively involved with religion or being on a palliative care plan rather than active treatment of their disease.
Several theories have been postulated to contribute to younger adults reporting more severe physical and psychological symptoms arising from their cancer diagnoses. Their disease might be more aggressive, or might be treated more aggressively. Psychosocial context may also play a role. Pain, for example, is experienced multidimensionally, with emotional and psychological contextualization of physical sensations. "Older patients may have developed more effective coping mechanisms ... a lifetime of experiences and the knowledge to deal with both positive and negative events," said Ms. Krok.
Joel Marcus, Psy.D., director of psychosocial oncology at the Nevada Cancer Institute, Las Vegas, and the moderator of the session, also wondered whether perspective might contribute to patients’ experiencing of symptoms and emotionally interpreting their impact. Younger patients, he said, may see cancer as the primary barrier to fulfillment of their lives, whereas older patients "may see it as one of life’s obstacles."
Ms. Krok also noted that cancer might be seen by older patients as an "on-time" event, that is, a life circumstance not unexpected at their age, and one shared by peers as well, whereas for younger patients, cancer might seem shocking, unexpected, and highly disruptive to their life stage.
Ms. Krok and her coinvestigators, Tamara Baker, Ph.D., and Susan McMillan, Ph.D., reported no relevant financial conflicts of interest.