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

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

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.

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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)
n (%) or M ± SD n (%) or M ± SD
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)
M ± SD M ± SD
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
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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