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.

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

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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)
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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