Factors Associated with Early Nutritional Status after Radical Gastrectomy in Patients with Gastric Cancer

Bokyoung Kim; Ja Yun Choi

doi:10.5388/aon.2015.15.4.219

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Kim and Choi: Factors Associated with Early Nutritional Status after Radical Gastrectomy in Patients with Gastric Cancer

Original Article

Asian Oncology Nursing 2015; 15(4): 219-227.

Published online: 31 December 2015

DOI: https://doi.org/10.5388/aon.2015.15.4.219

Factors Associated with Early Nutritional Status after Radical Gastrectomy in Patients with Gastric Cancer

Bokyoung Kim¹, Ja Yun Choi²

¹Department of Nursing, Chonnam National University Hwasun Hospital, Hwasun, Korea.

²College of Nursing, Chonnam National University·CRINS, Gwangju, Korea.

Address reprint requests to: Choi, Ja Yun. College of Nursing, Chonnam National University, 5 Hak-dong, Dong-gu, Gwangju 61469, Korea. Tel: +82-62-530-4943, Fax: +82-62-225-3307, choijy@chonnam.ac.kr

Received 25 September 2015 Revised 4 December 2015 Accepted 23 December 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aims of this study was to identify factors associated with nutritional status after radical gastrectomy in patients with gastric cancer at the post 1 month and the post 3-6 months independently.

Methods

Participants consisted of 107 patients at the post 1 month and 131 patients at the post 3-6 months after radical gastrectomy. Data were collected from October 1, 2013 to May 14, 2014 using a Patient-Generated Subjective Global Assessment (PG-SGA), the Hospital Anxiety and Depression Scale (HADS) and the Connor-Davidson Resilience Scale (CD-RISC).

Results

Stepwise multiple regression showed that factors associated with nutritional status at 1 month after radical gastrectomy were age (β=.55, p<.001), anxiety (β=.25, p=.007), and depression (β=.23, p=.017), which explained the 42.6% of total variance of nutritional status. However, factors associated with nutritional status at 3-6 months after radical gastrectomy were depression (β=.41, p=.017), return to work (β=.20, p<.001), and age (β=.29, p=.024), which explained 27.1% of the total variance of nutritional status.

Conclusion

In conclusion, oncology nurses should be sensitive to the risk group of aged, depressed, anxious and delayed return to work patients for nutritional status during the early recovery period after radical gastrectomy.

Keywords: Stomach Neoplasms, Gastrectomy, Nutritional Status

Figures and Tables

Table 1

Continuous Variables after Radical Gastrectomy

Variables	Post 1 month (n=107)		Post 3~6 months (n=131)
Variables	M±SD	Range	M±SD	Range
Nutritional status	8.27±2.65	2~18	4.13±2.52	2~18
Anxiety	2.43±2.53	0~13	2.48±2.69	0~16
Depression	5.81±3.96	0~16	4.74±3.48	0~16
Resilience	79.17±14.75	28~100	78.21±15.56	22~100

Table 2

Nutritional Status according to General and Clinical Characteristics of Participants at the 1 Month and 3~6 Months after Radical Gastrectomy

Characteristics	Categories	Post 1 month (n=107)			Post 3~6 months (n=131)
Characteristics	Categories	n (%) or M±SD (range)	Nutritional status (M±SD)	t or F (p)	n (%) or M±SD (range)	Nutritional status (M±SD)	t or F (p)
General characteristics
Gender	Male	67 (62.6)	8.42 ± 2.83	0.74 (.460)	79 (60.3)	3.80 ± 2.08	- 1.88 (.062)
Gender	Female	40 (37.4)	8.03 ± 2.33	0.74 (.460)	52 (39.7)	4.63 ± 3.02	- 1.88 (.062)
Age (year)		62.6±11.72 (32~80)		12.54 (<.001) a<b	61.4±10.47 (35~80)		5.40 (.002) a<b
	30~49^a	16 (15.0)	6.81 ± 1.87		18 (13.7)	3.22 ± 1.77
	50~59^a	21 (19.6)	7.29 ± 2.00		38 (29.0)	3.66 ± 2.17
	60~69^a	31 (29.0)	7.45 ± 2.29		39 (29.8)	3.77 ± 2.23
	≥ 70^b	39 (36.4)	10.1 ± 2.58		36 (27.5)	5.47 ± 3.00
Level of education	≤ Elementary school^a	46 (43.0)	9.17 ± 2.72	5.26 (.007) a>b	53 (40.5)	5.02 ± 2.89	6.33 (.002) a>b
	Middle~High school^a	45 (42.0)	7.71 ± 2.54		63 (48.1)	3.63 ± 2.12
	≥ College^b	16 (15.0)	7.25 ± 1.98		15 (11.5)	3.07 ± 1.62
Living arrangement	Alone	8 (7.5)	8.88 ± 1.36	5.69 (.005)	18 (13.7)	4.39 ± 3.27	1.22 (.304)
	Spouse or children	59 (55.1)	8.92 ± 2.68		71 (54.2)	4.33 ± 2.25
	Spouse and children	35 (32.7)	7.26 ± 2.62		37 (28.2)	3.89 ± 2.66
	Others	5 (4.7)	6.67 ± 4.70		5 (3.8)	1.91 ± 0.93
Occupation prior to operation	Yes	75 (70.1)	7.96 ± 2.51	1.88 (.063)	106 (80.9)	3.83 ± 2.26	- 2.88 (.005)
Occupation prior to operation	No	32 (29.9)	9.00 ± 2.85	1.88 (.063)	25 (19.1)	5.40 ± 3.16	- 2.88 (.005)
Return-to-work^*	Yes	17 (22.7)	7.56 ± 2.30	- 0.68 (.497)	58 (54.7)	3.43 ± 1.89	- 2.03 (.045)
Return-to-work^*	No	58 (77.3)	8.05 ± 2.59	- 0.68 (.497)	48 (45.3)	4.31 ± 2.57	- 2.03 (.045)
Average monthly income (10,000 won)	< 100^a	61 (57.0)	8.89 ± 2.68	5.00 (.008) a>b	69 (52.7)	4.29 ± 2.47	2.31 (.103)
	100~ < 500^a	36 (33.6)	7.72 ± 2.55		46 (35.1)	4.33 ± 2.75
	≥ 500^b	10 (9.4)	6.50 ± 1.51		16 (12.2)	2.88 ± 1.63
Private insurance for cancer	Covered	51 (47.7)	7.47 ± 2.02	- 3.10 (.002)	77 (58.8)	3.70 ± 2.22	- 2.37 (.019)
Private insurance for cancer	Uncovered	56 (52.3)	9.00 ± 2.94	- 3.10 (.002)	54 (41.2)	4.74 ± 2.80	- 2.37 (.019)
Clinical characteristics
Disease related factors	Surgical approach	33 (30.8)	9.00 ± 2.57	1.93 (.057)	30 (22.9)	4.63 ± 3.12	1.25 (.214)
	Open	74 (69.2)	7.95 ± 2.63		101 (77.1)	3.98 ± 2.31
	Laparoscopic
Type of gastrectomy	Distal gastrectomy	87 (80.3)	8.13 ± 2.68	- 1.17 (.244)	122 (93.1)	4.07 ± 2.51	- 1.14 (.256)
Type of gastrectomy	Total gastrectomy	20 (18.7)	8.90 ± 2.55	- 1.17 (.244)	8 (6.1)	5.13 ± 2.70	- 1.14 (.256)
Operation method	Billroth I GD	13 (12.0)	2.38 ± 0.66	0.54 (.706)	40 (30.5)	4.03 ± 2.56	0.50 (.687)
	Billroth II GD	64 (60.0)	2.74 ± 0.35		75 (57.3)	4.12 ± 2.55
	Roux-en-Y GD	13 (12.1)	7.69 ± 1.38		8 (6.1)	3.75 ± 1.98
	Roux-en-Y EJ	17 (15.9)	9.06 ± 3.27		8 (6.1)	5.13 ± 2.70
Combined organ resection	None	103 (96.3)	8.20 ± 2.64	- 1.34 (.184)	129 (98.5)	4.10 ± 2.52	- 1.06 (.292)
Combined organ resection	Done	4 (3.7)	10.00 ± 2.45	- 1.34 (.184)	2 (1.5)	6.00 ± 1.41	- 1.06 (.292)
Stage by 7th AJCC & UICC	1st	69 (64.5)	7.87 ± 2.48	2.61 (.078)	99 (75.6)	3.92 ± 2.27	1.43 (.243)
	2nd	13 (12.1)	9.46 ± 3.18		15 (11.5)	4.73 ± 3.49
	3rd	25 (23.4)	8.76 ± 2.65		17 (13.0)	4.82 ± 2.86
Chemotherapy	Yes	0 (0.0)			115 (87.8)	4.05 ± 2.47	- 0.94 (.346)
Chemotherapy	No	107 (100.0)			16 (12.2)	4.68 ± 2.89	- 0.94 (.346)
Laboratory results related with nutrition
Hemoglobin (g/dL)^†	Clinical F/U	58 (54.2)	7.70 ± 2.97	- 1.64 (.104)	114 (87.0)	3.83 ± 2.13	- 3.65 ( < .001)
	Normal	47 (45.8)	8.72 ± 2.29		17 (13.0)	6.11 ± 3.82
	Abnormal
Prealbumin (mg/dL)^‡	Clinical F/U	44 (41.1)	7.77 ± 2.58	- 1.59 (.116)	97 (74.0)	3.86 ± 2.41	- 2.13 (.035)
	Normal	63 (57.9)	8.60 ± 2.68		24 (26.0)	4.91 ± 2.69
	Abnormal
Transferin (mg/dL)^§	Clinic F/U	96 (89.7)	8.20 ± 2.71	- 0.62 (.535)	128 (97.7)	4.10 ± 2.53	- 0.84 (.405)
	Normal	11 (10.3)	8.73 ± 2.20		3 (2.3)	5.33 ± 1.53
	Abnormal

^*Participants who they've had an occupation before operation; ^†Normal level of Hemglobin=Male≥13mg/dL, Female≥12mg/dL; ^‡Normal level of Prealbumin= ≥20mg/dL; ^§Normal level of Transferrin = ≥200mg/dL; AJCC=The American joint committee on cancer; UICC =The Union for international cancer control; GD=Gastroduodenostomy; EJ=Esophagojejunostomy

Table 3

Correlation between Psychological Variables and Nutritional Status at the 1 Month and 3~6 Months after Radical Gastrectomy

Variables	Post 1 month (n=107)				Post 3~6 months (n=131)
	Nutritional status	Anxiety	Depression	Resilience	Nutritional status	Anxiety	Depression	Resilience
	r (p)	r (p)	r (p)	r (p)	r (p)	r (p)	r (p)	r (p)
Anxiety	.41 (< .001)	1			.43 (< .001)	1
Depression	.25 (.009)	.57 (< .001)	1		.25 (.004)	.45 (< .001)	1
Resilience	- .12 (.236)	- .40 (< .001)	- .32 (.001)	1	- .18 (.039)	- .44 (< .001)	- .31 (< .001)	1

Table 4

Factors Associated with Nutritional Status on 1 Month after Radical Gastrectomy (N =107)

Variables	B	SE	β	t	p
(Constant)	5.60	0.38		14.82	< .001
Age (≥ 70)	3.02	0.42	.55	7.15	< .001
Anxiety	0.17	0.06	.25	2.76	.007
Depression	0.24	0.10	.23	2.40	.017
	R²=.442, Adj. R²=.426, F=27.24, p<.001

Note. Stepwise method including variables: Age, level of education, average monthly income, private insurance for cancer, anxiety, depression.

Table 5

Factors Associated with Nutritional Status on 3~6 Month after Radical Gastrectomy (N =131)

Variables	B	SE	β	t	p
(Constant)	1.80	0.41		4.44	<.001
Depression	0.30	0.06	.41	5.05	<.001
Return to work	1.03	0.42	.20	2.46	.016
Age (≥70)	1.17	0.51	.19	2.30	.024
	R²=.290, Adj. R²=.271, F=15.14, p<.001

Note. Stepwise method including variables: Age, level of education, occupation prior to operation, return-to-work, private insurance for cancer, pre-operation hemoglobin level, postoperation hemoglobin level, post-operation prealbumin level, anxiety, depression, resilience.

Notes

This article is a condensed form of the first author's master's thesis from Chonnam National University.

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