超过一半的新癌症病例发生在老年人中。老年癌症患者尤其面临身体、心理存在或社会家庭痛苦的风险，其定义为严重健康相关痛苦 (SHS) 的概念。旨在评估身体、心理存在和社会家庭痛苦的直接和间接影响。家庭因素对癌症治疗的可治疗性、支持性护理需求和老年癌症患者 12 个月死亡率的影响。我们纳入了来自老年癌症患者队列（ELCAPA，法兰西岛）的 70 岁及以上癌症患者， 2007 年至 2019 年癌症治疗前的老年评估。结构方程模型检查了 SHS 维度（潜在变量）、患者特征（年龄、性别、肿瘤位置和转移状态、合并症、护理周期）和结果之间的直接和间接关系。该分析包括 4,824 名患者（平均年龄： 82.2±4岁；女性：56%；主要癌症部位：乳腺癌[22.3%]、结直肠癌[15.2%]、前列腺癌[8.5%]和肺癌[6.8%]；身体上的痛苦对癌症的可治疗性和死亡率有直接的负面影响（标准化系数[SC]=0.12[P<0.001]，SC=0.27[P<0.001]）。心理存在和社会家庭痛苦通过降低癌症可治疗性对生存产生间接负面影响（分别为 SC=0.08 [P<0.001]、SC=0.03 [P<0.001]）。心理存在维度对支持性护理需求具有主要的直接影响大小（SC=0.35 [P<0.001]），并且与身体痛苦相关。身体痛苦对生存有直接的贬义影响。由于癌症治疗能力较差，所有维度都间接降低了生存率。我们的研究结果支持对身体和心理存在痛苦进行同步管理。版权所有 © 2024。由 Elsevier Inc. 出版。

More than half of new cancer cases occurred in older adults. Older patients with cancer are particularly at risk of physical, psycho-existential or socio-familial suffering as defined by the concept of Serious Health-related Suffering (SHS).To assess the direct and indirect effects of physical, psycho-existential and socio-familial dimensions of suffering on cancer treatability, supportive care needs and 12-month mortality in older patients with cancer.We included patients with cancer aged 70 years and over from the Elderly Cancer Patients cohort (ELCAPA, Ile-de-France), referred for geriatric assessment between 2007 and 2019 before cancer treatment. Structural equation modelling examined the direct and indirect relationships between SHS dimensions (latent variables), patients' characteristics (age, sex, tumor location and metastatic status, comorbidity, period of care), and outcomes.The analysis included 4,824 patients (mean age: 82.2 ± 4 years; women: 56%; main cancer sites: breast [22.3%], colorectal [15.2%], prostate [8.5%], and lung [6.8%]; metastatic cancer: 46%). Physical suffering had direct pejorative effects on cancer treatability, and mortality (standardized coefficient [SC] = 0.12 [P<0.001], SC = 0.27 [P<0.001], respectively). Psycho-existential and socio-familial sufferings had indirect pejorative effects on survival through decreased cancer treatability (SC = 0.08 [P<0.001], SC = 0.03 [P<0.001], respectively). Psycho-existential dimension had the main direct effect size on supportive care needs (SC = 0.35 [P<0.001]) and was interrelated with physical suffering.Physical suffering has direct pejorative effect on survival. All dimensions indirectly decrease survival due to poorer cancer treatability. Our findings support concomitant management of physical and psycho-existential suffering.Copyright © 2024. Published by Elsevier Inc.