We elucidated three key findings in this cross-sectional study using patient-reported distress and problems among the elderly with HMs. First, elderly patients with HMs have a high burden of distress and problems, revealing that 62.1% of patients were distressed, with an average of nine problems. Second, the significant sources of distress were transportation, depression, and constipation, suggesting that their distress was affected by unique sources, compared to patients with general cancer. Finally, the most common five problems were fatigue, worry, tingling, getting around, and memory/concentration. Ultimately, these results can provide deeper understanding of distress in elderly patients with HMs, which may validate or contrast the findings of previous studies.
In comparison, our patients were more distressed than patients with varying cancer types and ages in previous studies, which reported distress prevalence of 24–62% [10–15]. Despite having no prior studies that confirmed our results, several studies have suggested that the characteristics of elderly patients with HMs can negatively affect distress. In particular, the dynamic characteristics of HM treatment [4–5] and the decline in physical and social functions caused by aging were found to cause distress . Therefore, our findings consistently showed that elderly patients with HMs may be more vulnerable to distress than younger patients with other types of cancer.
The results of this study aid in the understanding of the unique sources of distress among elderly patients with HMs. Specifically, housing, transportation, and problems with a partner were significant sources of distress, and transportation remained significant on multivariate logistic analysis, which has rarely been reported in prior studies [7, 13, 15, 21, 24]. This can be explained by the fact that physical disabilities and the family’s caregiving burden can disrupt independence and familiar interactions among elderly patients with cancer, thereby leading to distress [3, 6, 31]. Our findings also suggest that the loss of autonomy and role changes in families may affect distress, especially in elderly patients with HMs, although further research is needed to confirm this.
Notably, our study found that depression was the most powerful influencer, resulting in seven-fold higher levels of distress. However, previous studies reported other emotions that affect distress among patients with cancer, which include nervousness [13–14], loss of interest , sadness [14–15], and worry [12–13]. Although no studies have explained this inconsistency among studies, one possible explanation is that elderly patients with cancer can be more affected by depression than younger patients . Additionally, given the strong association between depression and distress in the present study, it may be important for healthcare professionals to weigh the reports of depression symptoms more heavily than those of the other items when assessing distress in this population.
Another essential finding of this study was that distressed elderly patients with HMs were affected by constipation, which was not found in prior studies [7, 13, 15, 20–21, 24]. This implies that distressing factors may differ according to patient age, as constipation is a common complaint that occurs in 30% of the elderly and is a deteriorating factor for distress in this population . This explanation is further supported by the fact that our study focused only on the elderly, whereas previous studies included patients of differing ages. Thus, assessing and modifying bowel function may be important to minimize distress in elderly patients with HMs .
Moreover, although this study found fatigue to be prevalent, similar to in previous studies [11, 13–15, 17, 20–21, 24], a significant association between fatigue and distress was not found [12, 14–15, 19]. An explanation for this discrepancy might be due to the fact that elderly patients with cancer often regard fatigue as part of aging, possibly minimizing the severity and life-threatening impact of symptoms . However, further research is needed to confirm the relationship between fatigue and distress in older adults with HMs.
Additionally, the prevalence of pain (30.3%) and sleep (32.6%) problems in this study was similar to or lower than those in previous studies, reporting pain prevalence of 29.8–64.5% and sleep problem prevalence of 36.6–61.5% [7, 12, 14–15, 20, 24]. The reason for these discrepancies is yet to be confirmed; however, one study indicated that pain was reported less frequently in older patients with cancer than in younger patients . Elderly patients may also develop higher pain tolerance over time, leading them to report symptoms that are newer, more serious, or more specifically related to cancer treatment . Therefore, our results indicated that pain and sleep might be high priority problems that should be assessed and managed in elderly patients with HMs due to their association with distress. Further research is required to validate this assertion.
Furthermore, this study found unique features of physical problems among elderly patients with HMs. Specifically, some physical problems, such as tingling, getting around, and memory/concentration, were reported to be 5–13% higher than those of other cancer patients in prior studies [7, 13–14, 20–21]. This discrepancy can be explained by the effects of aging and HM treatment on physical problems. In particular, patients with HMs, especially lymphoma and multiple myeloma, frequently experience tingling due to neurotoxic treatments (e.g., bortezomib, thalidomide, brentuximab vedotin, vinca alkaloid) . Moreover, our prevalence of memory impairment and difficulty in getting around was comparable to other elderly patients with cancer that was measured using a different diagnostic tool (e.g., Mini-Mental State Examination) . Given their circumstances, it can be asserted that elderly patients with HMs have higher prevalence of tingling, getting around, and memory/concentration than other patients with cancer.
Despite these findings, some limitations of the study should be noted. Since the study data were collected using a convenience sample and the participants were diagnosed with diverse types of HMs, our results may not be generalizable to a particular type of HM. In addition, distress and problem burden were measured using PROM, which may have different results from objective measurements by healthcare professionals. It is also possible that patients provided more socially acceptable responses than truthful ones. Lastly, the PL questionnaire only collects binary answers on whether patients have a specific problem. Therefore, it does not represent the severity of the reported problems.
Elderly patients with HMs had a high level of distress in this study. Considering the low level of disclosure of psychological symptoms by elderly patients with cancer [6, 15] and the lack of understanding of distress in elderly patients with HMs among healthcare professionals , this study suggests that greater attention should be given when screening and managing distress in this population.
This study found unique features of distress and problems among elderly patients with HMs due to aging and HM treatment. First, loss of autonomy and changing roles within the family were found to lead to distress among this population. As such, focusing on supporting functional independence and familial interaction is needed. Second, regarding the distinct physical problems experienced in this population, we recommend that health care professionals pay particular attention to constipation, mobility, depression, tingling, and memory/concentration problems. Lastly, it is necessary to assess the distress of elderly patients with HMs with consideration of their unique needs. Further research on distress should also consider the distinct characteristics of distress and problems according to cancer type and patient age.