Comparison of Depression and Quality of Life according to Nutritional Status in Elderly Cancer Patients Receiving Chemotherapy

Su Yeon Lee; Lae Hee Kim; Su Yeon Kim; Shin Kim; Hwa Jeong Yang; Kyoun Min Lee; Soon Ja Shin; Jeong Hye Kim

doi:10.5388/aon.2018.18.2.55

Journal List > Asian Oncol Nurs > v.18(2) > 1108981

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Lee, Kim, Kim, Kim, Yang, Lee, Shin, and Kim: Comparison of Depression and Quality of Life according to Nutritional Status in Elderly Cancer Patients Receiving Chemotherapy

Original Article

Asian Oncol Nurs 2018;18(2):55-65.

Published online: 5 June 2018

DOI: https://doi.org/10.5388/aon.2018.18.2.55

Comparison of Depression and Quality of Life according to Nutritional Status in Elderly Cancer Patients Receiving Chemotherapy

Su Yeon Lee¹, Lae Hee Kim¹, Su Yeon Kim¹, Shin Kim¹, Hwa Jeong Yang¹, Kyoun Min Lee¹, Soon Ja Shin¹, Jeong Hye Kim²

¹Department of Nursing, Asan Medical Center, Seoul, Korea

²Department of Clinical Nursing, University of Ulsan, Seoul, Korea

^∗ This article was financially supported by the Council of Korean Oncology Nurisng Society.

Address reprint requests to: Kim Jeong Hye Department of Clinical Nursing, University of Ulsan, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-5335 Fax: +82-2-3010-5332 E-mail: kimjh@amc.seoul.kr

Received 26 Feb 201827 Mar 2018 Accepted 12 Jun 2018

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.

초록

Purpose

The purpose of this study was to compare depression and quality of life (QOL) according to nutritional status of elderly cancer patients receiving chemotherapy.

Methods

A sample of 144 elderly cancer patients receiving chemotherapy was recruited for the cross-sectional survey design. The instruments were the Mini Nutritional Assessment-Short Form (MNA-SF), Geriatric Depression Scale Short Form-Korea (GDSSF-K), European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ ELD14. Data were analyzed using the SPSS/WIN program.

Results

Nutrition had mean of 10.17 points out of 14 and depression had mean of 6.72 points (out of 15). In quality of life, global health status/QoL was 50.06 points, 66.68 for the functional scale, and 29.77 for the symptom scale based on 100 points. The quality of life of elderly cancer patients was 36.52~70.14. There was a significant difference between the well-nourished and malnourished group in depression and QoL. There were significant correlations among the variables, nutritional status, depression and quality of life.

Conclusion

We found that patients with cancer of the elderly receiving chemotherapy had poor nutritional status, depression, and poor QoL. It is necessary to evaluate the nutritional status of elderly cancer patients receiving chemotherapy and to develop interventions.

Keywords: Aged, Nutrition Status, Depression, Quality of Life, Neoplasms

REFERENCES

1. National Cancer Information Center (KR). Cancer statistics [Internet]. Available from. https://www.cancer.go.kr/lay1/S1T639C640/contents.do. [Accessed February 19, 2018].

2. Korea National Statistical Office. Future population estimation 2010–2060 [Internet]. Available from. http://kostat.go.kr/portal/korea/kor_nw/2/2/1/index.board?bmode=read&bSeq=&aSeq=252623&pageNo=1&rowNum=10&navCount=10&currPg=&sTarget=exp&sTxt=%E B%85%B8%EC%9D%B8. [Accessed May 19, 2017].

3. Park S, Hong J, Hwang I, Ahn JY, Cho EY, Park J, et al. Comprehensive geriatric assessment in elderly patients with newly diagnosed aggressive non-Hodgkin lymphoma treated with multi-agent chemotherapy. J Geriatr Oncol. 2015; 6:470–8.

4. NCCN Clinical Practice Guidelines in Oncology (US). Older adult oncology [Internet]. Available from. https://www.nccn.org/store/login/login.aspx?ReturnURL=https. [Accessed May 19, 2017].

5. Kim MJ, Kim JW. Assessment of elderly cancer patients and its clinical importance. Korean J Obstet Gynecol. 2008; 51:691–706.

6. Lee HS, Kang JH, Kim EM, Kim WG. Prevalence of malnutrition in hospitalized elderly Korean patients based on mini nutritional assessment-short form. J Clin Nutr. 2014; 6:24–9.

7. Mun JH. The relationships between nutritional status, fatigue and quality of life in elderly cancer patients receiving chemotherapy [dissertation]. Pusan: Kosin Univ.;2014.

8. Duc S, Rainfray M, Soubeyran P, Fonck M, Blanc JF, Ceccaldi J, et al. Predictive factors of depressive symptoms of elderly patients with cancer receiving first-line chemotherapy. Psychooncology. 2017; 26:15–21.

9. Rasheed S, Woods RT. An investigation into the association between nutritional status and quality of life in older people admitted to hospital. J Hum Nutr Diet. 2014; 27:142–51.

10. Wedding U, Pientka L, Höffken K. Quality-of-life in elderly patients with cancer: a short review. Eur J Cancer. 2007; 43:2203–10.

11. Nestle Nutrition Institute (CH). MNA® mini nutritional assessment [Internet]. Available from. http://www.mna-elderly.com/. [Accessed May 19, 2017].

12. Ranhoff AH, Gj⊘en AU, Mowé M. Screening for malnutrition in elderly acute medical patients: the usefulness of MNA-SF. J Nutr Health Aging. 2005; 9:221–5.

13. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982-1983; 17:37–49.

14. Cho MJ, Bae JN, Suh GH, Hahm BJ, Kim JK, Lee DW, et al. 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.

15. Yun YH, Park YS, Lee ES, Bang SM, Heo DS, Park SY, et al. Validation of the Korean version of the EORTC QLQ-C30. Qual Life Res. 2004; 13:863–8.

16. Wheelwright S, Darlington AS, Fitzsimmons D, Fayers P, Arraras JI, Bonnetain F, et al. International validation of the EORTC QLQ-ELD14 questionnaire for assessment of health-related quality of life elderly patients with cancer. Br J Cancer. 2013; 109:852–8.

17. Singh N, Singh PS, Aggarwal AN, Behera D. Comorbidity assessment using Charlson comorbidity index and simplified comorbidity score and its association with clinical outcomes during first-line chemotherapy for lung cancer. Clin Lung Cancer. 2016; 17:205–13.e1.

18. Gajra A, Klepin HD, Feng T, Tew WP, Mohile SG, Owusu C, et al. Pre-dictors of chemotherapy dose reduction at first cycle in patients age 65 years and older with solid tumors. J Geriatr Oncol. 2015; 6:133–40.

19. Yanagi A, Murase M, Sumita YI, Taniguchi H. Investigation of nutritional status using the mini nutritional assessment-short form and analysis of the relevant factors in patients with head and neck tumour. Gerodontology. 2017; 34:227–31.

20. Kee BS. A preliminary study for the standardization of geriatric depression scale short form-Korea version. J Korean Neuropsychiatr Assoc. 1996; 35:298–307.

21. Jee YJ, Lee YB. Factors influencing depression among elderly patients in geriatric hospitals. J Phys Ther Sci. 2013; 25:1445–9.

22. Kang IO, Yun YH. Preliminary investigation of the quality of life in the elderly with cancer. J Korean Acad Fam Med. 2004; 25:678–86.

23. Kim JH, Choi KS, Kim TW, Hong YS. Quality of life in colorectal cancer patients with chemotherapy-induced peripheral neuropathy. J Korean Oncol Nurs. 2011; 11:254–62.

24. Goo AJ, Shin DW, Yang HK, Park JH, Kim SY, Shin JY, et al. Cross-cul-tural application of the Korean version of the EORTC QLQ-ELD14 questionnaire for elderly patients with cancer. J Geriatr Oncol. 2017; 8:271–6.

25. Nho JH, Kim SR, Kwon YS. Depression and appetite: predictors of malnutrition in gynecologic cancer. Support Care Cancer. 2014; 22:3081–8.

26. Giannousi Z, Gioulbasanis I, Pallis AG, Xyrafas A, Dalliani D, Kalbakis K, et al. Nutritional status, acute phase response and depression in met-astatic lung cancer patients: correlations and association prognosis. Support Care Cancer. 2012; 20:1823–9.

27. Daudt HM, Cosby C, Dennis DL, Payeur N, Nurullah R. Nutritional and psychosocial status of colorectal cancer patients referred to an outpatient oncology clinic. Support Care Cancer. 2012; 20:1417–23.

28. Langius JA, Zandbergen MC, Eerenstein SE, van Tulder MW, Leemans CR, Kramer MH, et al. Effect of nutritional interventions on nutritional status, quality of life and mortality in patients with head and neck cancer receiving (chemo)radiotherapy: a systematic review. Clin Nutr. 2013; 32:671–8.

29. Hopkinson JB. Nutritional support of the elderly cancer patient: the role of the nurse. Nutrition. 2015; 31:598–602.

Table 1.

Demographic and Clinical Characteristics in Elderly Cancer Patients (N = 144)

Variables	Categories	n (%) or M ± SD	Min~Max
Age (year)		70.7 ± 4.72	65~88
Gender	Male	80 (55.6)
	Female	64 (44.4)
Education	≤ Middle school High school	72 (50.0) 38 (26.4)
	High school	38 (26.4)
	≥ College	34 (23.6)
Family living together	Yes	127 (88.2)
	No	17 (11.8)
Main caregiver^∗	Spouse Offspring	88 (65.7) 48 (35.8)
	Offspring Others	48 (35.8) 6 (4.4)
	Others	6 (4.4)
Perceived financial status	High Middle	6 (4.1) 93 (64.6)
	Middle	93 (64.6)
	Low	45 (31.3)
ECOG	≤ 1	126 (87.5)
	2, 3	18 (12.5)
Types of cancer	Lung	18 (12.5)
	Stomach, colorectal	38 (26.4)
	Pancbiliary Lymphoma	51 (35.4) 19 (13.2)
	Others	18 (1.5)
Cancer stage	I,II III	13 (9.0) 24 (16.7)
	III IV	24 (16.7)107 (74.3)
	IV	107 (74.3)
Surgery	Yes	54 (37.5)
	No	90 (62.5)
Radiotherapy	Yes	23 (16.0)
	No	121 (84.0)
Purpose of chemotherapy	Adjuvant Palliative	19 (13.2)121 (84.0)
	Palliative Others	121 (84.0)4 (2.8)
	Others	4 (2.8)
Treatment steps of chemotherapy	1st line 2nd line	89 (61.8) 39 (27.1)
	2nd line ≥ 3rd line	39 (27.1) 16 (11.1)
	≥ 3rd line	16 (11.1)
Number of chemotherapy cycle		3.67 ± 3.61	1~24
Chemotherapy dose reduction	Yes No	98 (68.1) 46 (31.9)
	No	46 (31.9)
Pain	Yes No	41 (28.5)103 (71.5)
	No	103 (71.5)
Fall experience	Yes No	8 (5.6)134 (94.4)
	No	134 (94.4)
CCI		5.14 ± 2.04

^∗ Multiple response; ECOG= Eastern cooperative oncology group; CCI= Charlson comobidity index.

Table 2.

Nutritional Status, Depression, EORTC QLQ C30 and QLQ ELD14 in Elderly Cancer Patients (N =144)

Variables	Categories	n (%) or M ± SD	Range
Nutrition status	Well nourished (≥ 12)	57 (39.6)	3~14
	(Risk of) malnourished (＜12)	80 (60.4)10.17 2.76
		10.17 ± 2.76
Depression	≤ 4 (normal)	56 (38.4)	0~15
	5~9 (mild)	49 (33.6)
	≥ 10 (severe)	41 (28.0)
		6.72 ± 4.21
QLQ C30	Global health status/QOL	50.06 ± 25.00	0~100
	Functional scale	66.68 ± 21.88	3.33~100
	Physical functioning	63.50 ± 23.96	0~100
	Role functioning	60.87 ± 33.21	0~100
	Emotional functioning	72.50 ± 24.64	0~100
	Cognitive functioning	73.19 ± 23.07	0~100
	Social functioning	61.85 ± 30.34	0~100
	Symptom scales	29.77 ± 17.15	3.70~79.63
	Fatigue	41.80 ± 23.73	0~100
	Nausea and vomiting	18.40 ± 24.28	0~100
	Pain	26.92 ± 28.45	0~100
	Dyspnea	25.64 ± 28.99	0~100
	Insomnia	35.92 ± 33.94	0~100
	Appetite loss	35.90 ± 33.82	0~100
	Constipation	36.11 ± 36.24	0~100
	Diarrhea	16.67 ± 34.93	0~100
	Financial difficulties	33.33 ± 32.62	0~100
QLQ ELD14	Mobility	36.52 ± 29.09	0~100
	Worries	55.79 ± 29.71	0~100
	Worries about others	48.15 ± 30.61	0~100
	Maintaining purpose	50.47 ± 27.40	0~100
	Burden of illness	70.14 ± 28.89	0~100
	Joint stiffness	26.11 ± 29.38	0~100
	Family support	55.71 ± 33.28	0~100

EORTC QLQ C30= European Organization for Research and Treatment of Cancer quality of life questionnaire core 30; QOL= Quality of life; QLQ ELD14= Quality of life questionnaire for elderly cancer patients.

Table 3.

Demographic and Clinical Charateristics between Well Nourished Group and Malnourished Group

Variables	Categories	Well nourished (n=57)	Malnourished (n=87)	χ² or t (p)
Variables	Categories	n (%) or M ± SD	n (%) or M ± SD	χ² or t (p)
Age (year)		69.77 ± 4.26	71.33 ± 4.90	−1.97 (.051)
Gender	Male	33 (57.9)	47 (54.0)	0.21 (.732)
	Female	24 (42.1)	40 (46.0)
Education	≤ Middle schoo	ol 30 (52.6)	42 (48.3)	0.39 (.835)
	High school	15 (26.3)	23 (26.4)
	≥ College	12 (21.1)	22 (25.3)
Family living together	Yes	49 (86.0)	78 (89.7)	0.45 (.600)
	No	8 (12.0)	9 (10.3)
Perceived financial status	High	2 (3.5)	4 (4.6)	0.31 (.909)
	Middle	36 (63.2)	57 (65.5)
	Low	19 (33.3)	26 (29.9)
ECOG	≤ 1	52 (91.2)	74 (85.1)	1.20 (.314)
	2, 3	5 (8.8)	13 (14.9)
Types of cancer	Lung	9 (15.8)	9 (10.4)	7.26 (.124)
	Stomach, color	ectal 19 (33.3)	19 (21.8)
	Pancbiliary	13 (22.8)	38 (43.7)
	Lymphoma	9 (15.8)	10 (11.5)
	Others	7 (12.3)	11 (12.6)
Cancer stage	I,II	3 (5.3)	10 (11.5)	1.98 (.620)^†
	III	10 (17.5)	14 (16.1)
	IV	44 (77.2)	63 (72.4)
Surgery	Yes	23 (40.4)	31 (35.6)	0.33 (.601)
	No	34 (59.6)	56 (64.4)
Radiotherapy	Yes	10 (17.5)	13 (14.9)	0.17 (.817)
	No	47 (82.5)	74 (85.1)
Purpose of chemotherapy	Adjuvant	7 (12.3)	12 (13.8)	0.41 (1.000)^†
	Palliative	48 (84.2)	73 (83.9)
	Others	2 (3.5)	2 (2.3)
Treatment steps of chemotherapy	1st line	29 (50.9)	60 (69.0)	4.78 (.092)
	2nd line	20 (35.1)	19 (21.8)
	≥ 3rd line	8 (14.0)	8 (9.2)
Number of chemotherapy cycle (n=118)		4.26 ± 3.12	3.29 ± 3.87	1.43 (.156)
Chemotherapy dose reduction	Yes	36 (63.2)	62 (71.3)	1.04 (.362)
	No	21 (36.8)	25 (28.7)
Pain	Yes	11 (19.3)	30 (34.5)	3.90 (.059)
	No	46 (80.7)	57 (65.5)
Fall experience	Yes	2 (3.6)	6 (7.0)	0.78 (.480)^†
	No	54 (96.4)	80 (93.0)
CCI		5.00 ± 2.05	5.21 ± 2.04	−0.59 (.553)

ECOG= Eastern cooperative oncology group; CCI= Charson comobidity index

^† Fisher exact test

Table 4.

Depression, QLQ C30 and QLQ ELD14 between Well Nourished Group and Malnourished Group (N = 144)

Variables	Categories	Well nourished (n=57)	Malnourished (n=87)	t (p)
Variables	Categories	M ± SD	M ± SD	t (p)
Depression		5.04 ± 3.94	7.66 ± 4.11	−4.03 (＜.001)
QLQ C30	Global healthstatus/QOL	58.77 ± 23.91	44.35 ± 24.16	3.52 (.001)
	Functional scale	73.61 ± 18.61	62.33 ± 22.74	3.00 (.003)
	Physical functioning	70.48 ± 20.65	59.00 ± 4.96	2.87 (.005)
	Role functioning	71.82 ± 30.58	53.88 ± 33.10	3.23 (.002)
	Emotional functioning	80.86 ± 18.78	67.25 ± 26.47	3.55 (.001)
	Cognitive functioning	78.07 ± 15.48	69.96 ± 26.55	2.30 (.023)
	Social functioning	65.77 ± 29.37	59.30 ± 30.85	1.25 (.215)
	Symptom scales	23.10 ± 12.52	34.05 ± 18.38	−4.16 (＜.001)
	Fatigue	32.14 ± 18.55	48.02 ± 24.70	−4.38 (＜.001)
	Nausea and vomiting	12.28 ± 13.56	22.41 ± 28.62	−2.85 (.005)
	Pain	16.08 ± 18.36	34.11 ± 31.61	−4.31 (＜.001)
	Dyspnea	23.81 ± 28.22	26.82 ± 29.57	−0.61 (.546)
	Insomnia	28.57 ± 33.29	40.70 ± 33.68	−2.11 (.037)
	Appetite loss	20.83 ± 24.26	45.59 ± 35.62	−4.94 (＜.001)
	Constipation	28.07 ± 31.36	41.37 ± 38.37	−2.28 (.024)
	Diarrhea	12.87 ± 17.54	19.16 ± 28.59	−1.64 (.104)
	Financial difficulties	29.82 ± 29.33	35.66 ± 34.60	−1.05 (.297)
QLQ ELD14	Mobility	27.78 ± 23.69	42.15 ± 30.93	−3.13 (.002)
	Worries	50.79 ± 30.62	59.00 ± 28.82	−1.62 (.107)
	Worries about others	43.86 ± 29.65	50.96 ± 31.08	−1.37 (.171)
	Maintaining purpose	55.56 ± 26.42	47.09 ± 27.68	1.82 (.070)
	Burden of illness	65.79 ± 26.80	72.99 ± 29.99	−1.47 (.144)
	Joint stiffness	22.62 ± 27.05	28.35 ± 30.72	−1.14 (.256)
	Family support	48.54 ± 34.54	60.47 ± 31.73	−2.12 (.035)

QLQ C30= Cancer quality of life questionnaire core 30; QOL= Quality of life; QLQ ELD14= Quality of life questionnaire for elderly cancer patients.

Table 5.

Correlation among Nutritional Status, Depression, QLQ C30 and QLQ ELD14 (N =144)

Variables	Categories	Nutrition status
Variables	Categories	r (p)
Depression		−.33 (＜.001)
QLQ C30	Global health status/QOL	.38 (＜.001)
	Functional scale	.40 (＜.001)
	Symptom scales	−.43 (＜.001)
QLQ ELD14	Mobility	−.43 (＜.001)
	Worries	−.23 (.006)
	Worries about others	−.19 (.023)
	Maintaining purpose	.11 (.202)
	Burden of illness	−.16 (.059)
	Joint stiffness	−.26 (.002)
	Family support	−.25 (.003)

EORTC QLQ C30= European Organization for Research and Treatment of Cancer quality of life questionnaire core30; QOL= Quality of life; QLQ-ELD14= Quality of life questionnaire for elderly cancer patients.

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