Supportive care needs among older Mexican adults with metastatic cancer.
Authors: Torres Ana Cristina , Sánchez-Román Sofia , Covarrubias-Gómez Alfredo , Quiroz Paulina , Alcocer Natasha , Milke Pilar , Carrillo Monica , Aguilar-Velazco Jose Carlos , de la O Murillo Andrea , Medina-Palma Mildred E , Monroy Chargoy Javier , de la O Murillo Andrea , Ramos-Lopez Wendy Alicia , Chavarri Guerra Yanin , Soto Perez De Celis Enrique 
Published: September 2021

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Background: Supportive care (SC) in oncology includes the prevention and management of cancer- and treatment-related symptoms and adverse effects. Previous studies have shown that SC needs may differ depending on clinical stage, patients’ gender, comorbidities, and chronological age. The goal of this study was to describe the SC needs of older adults with metastatic cancer enrolled in a SC patient navigation program at Instituto Nacional Ciencias Medicas Salvador Zubiran, an academic, public hospital in Mexico City, and to compare them with those of their younger counterparts. Methods: This was a secondary analysis of a prospective study which included adult patients with newly diagnosed metastatic solid tumors. The patients’ SC needs and symptoms were assessed by a patient navigator using validated questionnaires, and then a multidisciplinary team created a personalized SC plan to address those needs. Potential SC interventions included pain management, physical therapy, geriatric assessment/intervention, mitigation of caregiver burden, depression/anxiety management, and nutritional assessment/intervention. Patients were divided into two age groups (≥65 and < 65 years), and differences in SC needs between groups were compared using Chi square, Student’s T and Mann-Whitney tests. Results: Out of 337 patients with metastatic solid tumors included between April 2018 and October 2020 (median age 64 years, range 19-94 years), 164 (48%) were aged ≥65 years. Among older patients (≥65 years), 130 (79%) had an abnormal geriatric screening and were referred for a comprehensive geriatric assessment. Older adults were more likely than younger patients to report malnutrition needing nutritional assessment/intervention (81 vs. 65%, p < 0.01) and to experience fatigue needing a referral to physical therapy (77 vs. 66%, p = 0.03). We found no differences in moderate/severe pain (45 vs 47%, p = 0.79), depression/anxiety (69 vs 77%, p = 0.09), caregiver burden (42 vs 34%, p = 0.12) or sleep disturbances (54 vs 64%, p = 0.07) between groups. However, the total number of SC needs was significantly higher for older adults than for their younger counterparts (4.9 vs. 3.9, p < 0.01). Conclusions: The results of this study show that older adults with metastatic solid tumors have more SC needs and require more symptom management interventions than their younger counterparts. The need for nutritional interventions and physical therapy was significantly higher among older patients, thus, these components should be considered an essential part of geriatric oncology multidisciplinary programs. Oncologists treating older adults with advanced cancer should screen for SC needs among older patients in order to provide targeted interventions.