Physical and Mental Health Factors Associated with Poor Nutrition in Elderly Cancer Survivors: Insights from a Nationwide Survey
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Patient Selection and Study Design
2.3. Measurements
2.3.1. Nutrition
2.3.2. Individual Factors
2.3.3. Physical Health Factors
2.3.4. Mental Health Factors
2.4. Statistical Analysis
3. Results
3.1. Prevalence of Poor Nutrition in Elderly Cancer Survivors
3.2. Differences in Individual Variables between Good and Poor Nutrition Groups
3.3. Differences in Physical and Psychological Variables between Good and Poor Nutrition Groups
3.4. Multivariable Logistic Regression Analysis of Factors in Elderly Cancer Survivors with Poor Nutrition Using Individual Variables-Adjusted Models
4. Discussion
4.1. Nutrition Is Significant in Old Cancer Survivors but Is Overlooked or Undermanaged in the Real World
4.2. Old Cancer Survivors Are at Risk of Malnutrition If They Complain of IADL Limitation or If They Feel Unhealthy
4.3. Limitations and Strengths of Our Study
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Chung, K. 2017 National Survey of Older Koreans: Findings and Implications; The Korean Institute for Health and Social Affairs: Seoul, Koera, 2018. [Google Scholar]
- Statistics Korea (KOSTAT). Population Projections for Korea (2017–2067); Statistics Korea (KOSTAT): Daejeon, Korea, 2019. [Google Scholar]
- Fitzmaurice, C.; Allen, C.; Barber, R.M.; Barregard, L.; Bhutta, Z.A.; Brenner, H.; Dicker, D.J.; Chimed-Orchir, O.; Dandona, R.; Dandona, L.; et al. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived with Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015: A systematic analysis for the global burden of disease study. JAMA Oncol. 2017, 3, 524–548. [Google Scholar] [CrossRef]
- Jung, K.-W.; Won, Y.-J.; Kong, H.-J.; Lee, E.S. Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2016. Cancer Res. Treat. 2019, 51, 417–430. [Google Scholar] [CrossRef] [Green Version]
- Anand, P.; Kunnumakkara, A.B.; Sundaram, C.; Harikumar, K.; Tharakan, S.T.; Lai, O.S.; Sung, B.; Aggarwal, B.B. Cancer is a Preventable Disease that Requires Major Lifestyle Changes. Pharm. Res. 2008, 25, 2200. [Google Scholar] [CrossRef] [Green Version]
- Viganò, A.; Morais, J.A. The elderly patient with cancer: A holistic view. Nutrition 2015, 31, 587–589. [Google Scholar] [CrossRef] [PubMed]
- Kurtz, J.-E.; Heitz, D.; Kurtz-Illig, V.; Dufour, P. Geriatric Oncology: How Far Have We Gone and What Are the Next Steps? Oncology 2009, 77, 147–156. [Google Scholar] [CrossRef]
- Vrettos, I.; Kamposioras, K.; Kontodimopoulos, N.; Pappa, E.; Georgiadou, E.; Haritos, D.; Papadopoulos, A.A.; Niakas, D. Comparing Health-Related Quality of Life of Cancer Patients under Chemotherapy and of Their Caregivers. Sci. World J. 2012, 2012, 135283. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Schneider, S.M.; Hébuterne, X. Nutritional support of the elderly cancer patient: Long-term nutritional support. Nutrition 2015, 31, 617–618. [Google Scholar] [CrossRef]
- Santarpia, L.; Contaldo, F.; Pasanisi, F. Nutritional screening and early treatment of malnutrition in cancer patients. J. Cachex-Sarcopenia Muscle 2011, 2, 27–35. [Google Scholar] [CrossRef] [Green Version]
- Blanc-Bisson, C.; Fonck, M.; Rainfray, M.; Soubeyran, P.-L.; Bourdel-Marchasson, I. Undernutrition in elderly patients with cancer: Target for diagnosis and intervention. Crit. Rev. Oncol. 2008, 67, 243–254. [Google Scholar] [CrossRef] [PubMed]
- Chantragawee, C.; Achariyapota, V. Utilization of a Scored Patient-Generated Subjective Global Assessment in Detecting a Malnourished Status in Gynecologic Cancer Patients. Asian Pac. J. Cancer Prev. 2016, 17, 4401–4404. [Google Scholar]
- Van Cutsem, E.; Arends, J. The causes and consequences of cancer-associated malnutrition. Eur. J. Oncol. Nurs. 2005, 9 (Suppl. 2), S51–S63. [Google Scholar] [CrossRef] [PubMed]
- Newman, A.B.; Yanez, D.; Harris, T.; Duxbury, A.; Enright, P.L.; Fried, L.P.; Cardiovascular Study Research Group. Weight Change in Old Age and its Association with Mortality. J. Am. Geriatr. Soc. 2001, 49, 1309–1318. [Google Scholar] [CrossRef] [PubMed]
- Dwyer, J. Strategies to Detect and Prevent Malnutrition in the Elderly: The Nutrition Screening Initiative. Nutr. Today 1994, 29, 14–24. [Google Scholar] [CrossRef]
- WHO. WHO Guidelines Approved by the Guidelines Review Committee. In Global Recommendations on Physical Activity for Health; World Health Organization: Geneva, Switzerland, 2010. [Google Scholar]
- Allen, J.P. Assessing Alcohol Problems: A Guide for Clinicians and Researchers, 2nd ed.; NIH Publications: Bethesda, MD, USA, 2003. [Google Scholar]
- Won, C.W.; Yang, K.Y.; Rho, Y.G.; Kim, S.Y.; Lee, E.J.; Yoon, J.L.; Cho, K.H.; Shin, H.C.; Cho, B.R.; Oh, J.R.; et al. The Development of Korean Activities of Daily Living (K-ADL) and Korean Instrumental Activities of Daily Living(K-IADL) Scale. J. Korean Geriatr. Soc. 2002, 6, 107–120. [Google Scholar]
- Cho, M.J.; Bae, J.N.; Suh, G.H.; Hahm, B.J.; Kim, J.K.; Lee, D.W.; Kang, M.H. Validation of Geriatric Depression Scale, Korean Version(GDS) in the Assessment of DSM-III-R Major Depression. J. Korean Neuropsychiatr. Assoc. 1999, 38, 48–63. [Google Scholar]
- Arends, J.; Baracos, V.; Bertz, H.; Bozzetti, F.; Calder, P.C.; Deutz, N.E.P.; Erickson, N.; Laviano, A.; Lisanti, M.P.; Lobo, D.N.; et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clin. Nutr. 2017, 36, 1187–1196. [Google Scholar] [CrossRef] [Green Version]
- Attar, A.; Malka, D.; Sabaté, J.M.; Bonnetain, F.; LeComte, T.; Aparicio, T.; Locher, C.; Laharie, D.; Ezenfis, J.; Taieb, J. Malnutrition Is High and Underestimated During Chemotherapy in Gastrointestinal Cancer: An AGEO Prospective Cross-Sectional Multicenter Study. Nutr. Cancer 2012, 64, 535–542. [Google Scholar] [CrossRef]
- Neo, J.; Fettes, L.; Gao, W.; Higginson, I.J.; Maddocks, M. Disability in activities of daily living among adults with cancer: A systematic review and meta-analysis. Cancer Treat. Rev. 2017, 61, 94–106. [Google Scholar] [CrossRef] [Green Version]
- Silver, J.K.; Baima, J.; Mayer, R.S. Impairment-driven cancer rehabilitation: An essential component of quality care and survivorship. CA A Cancer J. Clin. 2013, 63, 295–317. [Google Scholar] [CrossRef]
- Lawton, M.P.; Brody, E.M. Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living. Gerontologist 1969, 9, 179–186. [Google Scholar] [CrossRef]
- Sikkes, S.; Klerk, E.S.M.D.L.-D.; Pijnenburg, Y.; Scheltens, P.; Uitdehaag, B. A systematic review of Instrumental Activities of Daily Living scales in dementia: Room for improvement. J. Neurol. Neurosurg. Psychiatry 2008, 80, 7–12. [Google Scholar] [CrossRef] [Green Version]
- Cahn-Weiner, D.A.; Boyle, P.A.; Malloy, P.F. Tests of Executive Function Predict Instrumental Activities of Daily Living in Community-Dwelling Older Individuals. Appl. Neuropsychol. 2002, 9, 187–191. [Google Scholar] [CrossRef]
- Mohile, S.G.; Xian, Y.; Dale, W.; Fisher, S.G.; Rodin, M.; Morrow, G.R.; Neugut, A.; Hall, W. Association of a Cancer Diagnosis with Vulnerability and Frailty in Older Medicare Beneficiaries. J. Natl. Cancer Inst. 2009, 101, 1206–1215. [Google Scholar] [CrossRef] [Green Version]
- Whittle, H.; Goldenberg, D. Functional health status and instrumental activities of daily living performance in noninstitutionalized elderly people. J. Adv. Nurs. 1996, 23, 220–227. [Google Scholar] [CrossRef] [PubMed]
- Lesser, G.T. Social and productive activities in elderly people. Self rated health is important predictor of mortality. BMJ 2000, 320, 185. [Google Scholar] [PubMed]
- Yu, E.S.H.; Kean, Y.M.; Slymen, D.J.; Liu, W.T.; Zhang, M.; Katzman, R. Self-perceived Health and 5-Year Mortality Risks among the Elderly in Shanghai, China. Am. J. Epidemiol. 1998, 147, 880–890. [Google Scholar] [CrossRef] [PubMed]
- Shadbolt, B.; Barresi, J.; Craft, P. Self-Rated Health as a Predictor of Survival Among Patients With Advanced Cancer. J. Clin. Oncol. 2002, 20, 2514–2519. [Google Scholar] [CrossRef]
- Hinz, A.; Krauss, O.; Hauss, J.P.; Höckel, M.; Kortmann, R.D.; Stolzenburg, J.U.; Schwarz, R. Anxiety and depression in cancer patients compared with the general population. Eur. J. Cancer Care 2010, 19, 522–529. [Google Scholar] [CrossRef]
- Jacobsen, R.; Møldrup, C.; Christrup, L.; Sjøgren, P.; Hansen, O.B. Psychological and behavioural predictors of pain management outcomes in patients with cancer. Scand. J. Caring Sci. 2010, 24, 781–790. [Google Scholar] [CrossRef]
- Osler, M.; Heitmann, B.L.; Høidrup, S.; Jørgensen, L.M.; Schroll, M. Food intake patterns, self rated health and mortality in Danish men and women. A prospective observational study. J. Epidemiol. Community Heal. 2001, 55, 399–403. [Google Scholar] [CrossRef] [Green Version]
- Lainscak, M.; Farkas, J.; Frantal, S.; Singer, P.; Bauer, P.; Hiesmayr, M.; Schindler, K. Self-rated health, nutritional intake and mortality in adult hospitalized patients. Eur. J. Clin. Investig. 2014, 44, 813–824. [Google Scholar] [CrossRef] [PubMed]
Individual Variables | Classification | Good Nutrition | Poor Nutrition | χ2 | p | |
---|---|---|---|---|---|---|
(n = 154) | (n = 206) | |||||
n (%) or | n (%) or | |||||
M ± SD * | M ± SD * | |||||
Demographic | Age | 73.3 ± 5.9 | 74.6 ± 5.8 | 2.02 | 0.045 | |
Sex | Male | 87 (56.5) | 93 (45.1) | 4.54 | 0.043 | |
Female | 67 (43.5) | 113 (54.9) | ||||
Marital status | Living with spouse | 120 (77.9) | 118 (57.3) | 16.76 | <0.001 | |
Living without spouse | 34 (22.1) | 88 (42.7) | ||||
Socio-economic | Education | 0–6 years | 79 (51.3) | 123 (59.7) | 3.43 | 0.331 |
7–9 years | 29 (18.8) | 30 (14.6) | ||||
10–12 years | 32 (20.8) | 41 (19.9) | ||||
≥13 years | 14 (9.1) | 12 (5.8) | ||||
Quantiles of household income | Q1 (lowest) | 20 (13.0) | 47 (22.8) | 7.97 | 0.093 | |
Q2 | 32 (20.7) | 40 (19.4) | ||||
Q3 | 30 (19.5) | 46 (22.4) | ||||
Q4 | 36 (23.4) | 39 (18.9) | ||||
Q5 (highest) | 36 (23.4) | 34 (16.5) | ||||
Health status | Disease | Hypertension | 60 (39.0) | 115 (55.8) | 10.03 | 0.002 |
Diabetes | 33 (21.4) | 61 (29.6) | 3.06 | 0.080 | ||
Arthritis | 36 (23.4) | 70 (34.0) | 4.77 | 0.029 | ||
BMI ** | Underweight (<18.5) | 6 (3.9) | 17 (8.3) | 4.58 | 0.205 | |
Normal (≥18.5, <25) | 113 (73.4) | 132 (64.1) | ||||
Overweight (≥25) | 35 (22.7) | 57 (27.6) | ||||
Number of medication(s) | 0 | 25 (16.2) | 8 (3.9) | 44.03 | <0.001 | |
1 | 18 (11.7) | 7 (3.4) | ||||
2 | 23 (14.9) | 10 (4.8) | ||||
≥3 | 88 (57.1) | 181 (87.9) | ||||
Health-relatedBehavior | Exercise | None | 39 (25.3) | 68 (33.0) | 4.74 | 0.093 |
<150 min. a week | 30 (19.5) | 48 (23.3) | ||||
≥150 min. a week | 85 (55.2) | 90 (43.7) | ||||
Smoking | Past/Never | 8 (5.2) | 16 (7.8) | 0.94 | 0.333 | |
Current | 146 (94.8) | 190 (92.2) | ||||
Drinking | None | 131 (85.1) | 179 (86.9) | 4.36 | 0.113 | |
≤1 standard drink/day | 8 (5.2) | 3 (1.4) | ||||
>1 standard drink/day | 15 (9.7) | 24 (11.7) |
Physical and Psychological Variables | Classification | Good Nutrition | Poor Nutrition | χ2 | p | |
---|---|---|---|---|---|---|
(n = 154) | (n = 206) | |||||
n (%) | n (%) | |||||
Physical | Visual discomfort | No | 89 (57.8) | 121 (58.7) | 0.03 | 0.857 |
Yes | 65 (42.2) | 85 (41.3) | ||||
Hearing discomfort | No | 121 (78.6) | 168 (81.6) | 0.50 | 0.482 | |
Yes | 33 (21.4) | 38 (18.4) | ||||
ADL * limitation | No | 150 (97.4) | 167 (81.1) | 22.36 | <0.001 | |
Yes | 4 (2.6) | 39 (18.9) | ||||
IADL ** limitation | No | 131 (85.1) | 117 (56.8) | 32.86 | <0.001 | |
Yes | 23 (14.9) | 89 (43.2) | ||||
Muscle strength | Good | 135 (87.7) | 138 (67.0) | 20.55 | <0.001 | |
Poor | 19 (12.3) | 68 (33.0) | ||||
Psychological | Insomnia | No | 152 (98.7) | 191 (92.7) | 7.01 | 0.008 |
Yes | 2 (1.3) | 15 (7.3) | ||||
Depression | No | 36 (23.4) | 91 (44.2) | 16.70 | <0.001 | |
Yes | 118 (76.6) | 115 (55.8) | ||||
Subjective health status | Positive | 76 (49.4) | 54 (26.2) | 20.45 | <0.001 | |
Negative | 78 (50.6) | 152 (73.8) |
Variables | Model I | Model II | Model III | Model IV |
---|---|---|---|---|
OR (95% CI) | OR (95% CI) | OR (95% CI) | OR (95% CI) | |
Visual discomfort | 0.67 (0.41–1.10) | 0.68 (0.42–1.12) | 0.76 (0.45–1.28) | 0.75 (0.45–1.27) |
Hearing discomfort | 0.65 (0.35–1.20) | 0.64 (0.35–1.19) | 0.62 (0.32–1.17) | 0.62 (0.33–1.19) |
ADL * limitation | 2.98 (0.90–9.90) | 2.90 (0.87–9.65) | 2.69 (0.78–9.29) | 2.48 (0.72–8.96) |
IADL ** limitation | 2.13 (1.12–4.06) *** | 2.16 (1.13–4.12) *** | 2.09 (1.05–4.16) *** | 2.15 (1.08–4.28) *** |
Poor muscle strength | 1.64 (0.85–3.19) | 1.64 (0.84–3.18) | 1.51 (0.75–3.03) | 1.53 (0.75–3.08) |
Insomnia | 3.94 (0.82–18.88) | 3.88 (0.81–18.58) | 3.02 (0.62–14.72) | 3.09 (0.63–15.02) |
Depreesion | 1.49 (0.87–2.56) | 1.51 (0.87–2.62) | 1.60 (0.88–2.87) | 1.56 (0.86–2.82) |
Negative subjective health | 1.84 (1.10–3.07) *** | 1.89 (1.13–3.18) *** | 1.77 (1.02–3.06) *** | 1.74 (1.02–3.02) *** |
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Byun, M.; Kim, E.; Kim, J. Physical and Mental Health Factors Associated with Poor Nutrition in Elderly Cancer Survivors: Insights from a Nationwide Survey. Int. J. Environ. Res. Public Health 2021, 18, 9313. https://doi.org/10.3390/ijerph18179313
Byun M, Kim E, Kim J. Physical and Mental Health Factors Associated with Poor Nutrition in Elderly Cancer Survivors: Insights from a Nationwide Survey. International Journal of Environmental Research and Public Health. 2021; 18(17):9313. https://doi.org/10.3390/ijerph18179313
Chicago/Turabian StyleByun, Mikyong, Eunjung Kim, and Jieun Kim. 2021. "Physical and Mental Health Factors Associated with Poor Nutrition in Elderly Cancer Survivors: Insights from a Nationwide Survey" International Journal of Environmental Research and Public Health 18, no. 17: 9313. https://doi.org/10.3390/ijerph18179313