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Symptom Attribution of Older Cancer Patients with Comorbid Conditions during Chemotherapy Treatment
Midwest Nursing Research Conference (2014)
  • Sandra Spoelstra, Grand Valley State University
Background:Over  60% of those who are diagnosed with cancer are older adults, and 75% have comorbid conditions. 15% of cancer treatment is now in pill form; and it is expected to grow to 25% within 3-years.  Having comorbid conditions in addition to cancer may exacerbate symptom severity. As a consequence of these symptoms, some patients adjust, interrupt, or stop dosages of the oral agent, which may affect cancer treatment.
Purpose: This study describes the attribution of symptoms (fatigue, pain, numbness/tingling, sleep disturbance, diarrhea, distress, swelling in hands/feet, lack of appetite, constipation, shortness of breath, redness/swelling/pain in hands or feet, constipation, skin rash or sore, sores in mouth, or fever) to the cancer, cancer treatment, or comorbid conditions in patients undergoing treatment with oral agents, and if those with comorbid conditions have more severe symptoms.
Conceptual Framework: A synthesized model from the Health Belief Model, the Theory of Reasoned Action, and Social Cognitive Theory guided this study. 
Methods: Phone interviews with 30-cancer patients taking oral agents from 6-centers were conducted 5-times over 8-weeks. Cancer site, stage, treatment, comorbidities, symptom severity and attribution were obtained. Generalized Estimating Equations with compound symmetry covariance structure were employed to examine associations between attributions and factors.
Results: Mean age was 65; 50% (N=15) female/male; 83% (N=25) Caucasian and 17% (N=5) African American. 77% (N=23) had comorbid conditions (mean of 2.0, Standard Deviation [SD] 1.7). Nine types of oral agents were taken and 43% (N=13) also had IV chemotherapy.  Patients had a mean of 5.3 of the 15 symptoms. Symptom attribution at baseline was 57% (N=16) to cancer and treatment, 36% (N=11) to comorbidities plus cancer and treatment, and 7% (N=3) to comorbidities. No evidence was found that attribution was associated with race, gender, age, cancer stage or type; nor was there change over time. Minimal symptom change was found over the 5-interviews in those with or without comorbid conditions. Models that included attribution to comorbid conditions were more likely in older, female, African Americans.
Implications: One-third of patients associated symptoms with comorbid conditions in addition to their cancer and treatment.Clinicians caring for cancer patients undergoing treatment need to consider all conditions (e.g., diabetes and hypertension) that may influence symptom severity, not just the cancer.
Publication Date
Spring 2014
Citation Information
Sandra Spoelstra. "Symptom Attribution of Older Cancer Patients with Comorbid Conditions during Chemotherapy Treatment" Midwest Nursing Research Conference (2014)
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