| BackgroundChina has the largest number of elderly population in the world.Affected by the physiological hypofunction,increased susceptibility to disease,much complications and longer duration of disease,the nutritional status and psychological condition of elderly people have become more and more significant issues to influence their quality of life and social function.Gastrointestinal(GI)cancer which has high morbidity and mortality poses a great threat to the life and health of residents,and early screening and vital prevention should be carried out actively.Numerous studies have reported that the malnutrition not only has a high incidence,but also brings severe consequence in cancer patients.Meanwhile,patients with cancer often have anxiety or depression,and the degree of anxiety and depression may be correlated with nutritional status.Malnutrition and psychological problems may bring adverse clinical outcomes to cancer patients and interfere the implementation and prognosis of cancer treatment as well,resulting in huge social and economic burdens.At present,there is a lack of systematic research on the relationship between nutritional status and psychological problems and their influence on the prognosis of cancer in elderly GI cancer patients.ObjectiveThis study aims to investigate the malnutrition condition and its influence factors,anxiety and the depression occurrence in GI cancer patients,to analyze their relationship and influence to active state,the quality of life and clinical outcomes,and to discuss whether it is necessary and reasonable to conduct nutrition and psychological intervention in clinical work in order to ensure maximum benefit for patients.MethodsThe study was carried out on the data of268 cases of elderly patients(gae?60 years)with GI carcinoma in the Qilu hospital of Shandong University from Jan.2018 to Feb.2019.Patient-generated subjective global assessment(PG-SGA),Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS),Quality of Life Questionnaire-Core 30(QLQ-C30)were applied for the nutritional,psychological and quality of life assessment respectively within 48 hours at admission.We collected the laboratory and physical examination data and investigate the nutrition support situation and clinical outcome in hospital.Then we analyzed the occurrence and relationship among malnutrition,anxiety and depression,and analyzed their effect to active state,quality of life and clinical outcome.Results1.The occurrence of malnutritionThe overall incidence of malnutrition in elderly GI carcinoma patients was 70.1%,patients with PG-SGA grading?9 who had urgent need of proper nutrition support occupied 44.0%.Only 5.2%of patients whose PG-SGA grading was 0?1 and did not require nutrition support instantly while just needed nutrition risk screening and nutrition assessment regularly.2.The influence factors of malnutrition occurrenceAge was positively correlated with malnutrition occurrence.The patients with upper GI tumor,GI stenosis or obstruction or dentures were more likely to have malnutrition.As the degree of malnutrition aggravating,single nutritional indicators such as LYM,RBC,Hb,ALB,PA,body weight,body mass index(BMI)and calf circumference(CC)decreased,CEA,CA-125 and CA-199 increased.Logistic regression analysis indicated that ALB(OR=1.297,P=0.015).BMI(OR=1.717,P=0.006),CC(OR=1.765,P=0.002)and upper or lower GI tumor(OR=0.230,P=0.046)were the significant influencing factors.3.Relationship among malnutrition,anxiety,depression and quality of lifeAs the severity of malnutrition increased,the patients' SAS and SDS scores increased,the Karnofsky Performance Status(KPS)score decreased,and the condition of quality of life declined in various domains,indicating that as the nutritional status deteriorated.the patients' the severity of anxiety and depression enhanced,the activity status and the quality of life declined.4.Nutrition support current situation49.5%of the malnourished patients failed to receive nutritional support in the hospital,and the malnourished patients did not receive better enteral nutrition(EN)and parenteral nutrition(PN)support.Among 46.3%of patients receiving nutrition support in hospital,the ratio of PN to EN was 6.2:1,and the clinical application of nutrition support still needed to be improved.5.Current analysis of anxiety and depression and its relationship with malnutrition and quality of lifeThe incidence of anxiety was 46.3%.and the incidence of depression was 52.2%.and the patients with anxiety and depression at the same time accounted for 38.8%of the total number.There could be a correlation between the aggravation of anxiety and depression degree.Patients with anxiety or depression are more likely to suffer from malnutrition while active status and quality of life in all domains declined.6.Analysis of factors influencing clinical outcomesPatients with the occurrence of complication had elder age,lower levels of LYM.ALB,PA,and BMI.Patients whose condition could not improve till discharge from hospital had lower level of LYM,ALB,PA,body weight,BMI,CC and KPS.Logistic regression analysis showed that ALB(OR=0.785,P=0.037)was the significant influencing factor of complications,and ALB(OR=1.179,P=0.049)and BMI(OR=1.474,P=0.017)were the significant influencing factors of improved discharge.The patients with malnutrition and depression kept higher incidence of complications and less likely for improved discharge.TP,ALB,and KPS were negatively correlated with the cost of hospitalization,while LYM,TP,ALB,PA,and KPS were negatively correlated with the length of hospital stay(LOS),and the length of hospitalization increased with the increase of anxiety degree.The hospital expenses of malnutrition patients in the department of gastroenterology and radiotherapy were increased,and the LOS of malnutrition patients in the department of radiotherapy was prolonged.Conclusions1.The incidence of malnutrition in elderly GI cancer patients was high,and the proportion of patients in urgent need of nutritional support was large.The current application situation of nutritional support still needed to be improved.2.ALB(OR=1.297,P=0.015),BMI(OR=1.717,P=0.006),CC(OR=1.765,P=0.002)and upper or lower GI tumor(OR=0.230,P=0.046)were significant factors for reflecting the occurrence of malnutrition.3.With the increase of malnutrition degree,the patients' anxiety and depression severity increased,and the active state and quality of life decreased.Malnutrition could enhance the incidence of complications in hospital,reduce the possibility of improved discharge,increase the cost of hospitalization,and prolong the LOS.4.Anxiety and depression had high incidences in elderly GI cancer patients,which could increase the incidence of malnutrition,reduce the patients' quality of life and cause adverse clinical outcomes. |
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