Surbhi Singhal, Ying Wang, Richard F. Dunne, Lee Kehoe, Michael B. Sohn, Marielle Jensen-Battaglia, Beverly Canin, Rachael Tylock, Mostafa Mohamed, Jamil Khatri, James Bearden III, Tony Philip, Supriya Mohile, Kah Poh Loh
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Adults aged <span></span><math>\n \n <semantics>\n \n <mrow>\n \n <mo>≥</mo>\n </mrow>\n </semantics>\n </math> 70 years with <span></span><math>\n \n <semantics>\n \n <mrow>\n \n <mo>≥</mo>\n </mrow>\n </semantics>\n </math> 1 impaired geriatric domain were enrolled (2014–2017). Nutritional impairment was defined as Mini Nutritional Assessment-Short Form score of <span></span><math>\n \n <semantics>\n \n <mrow>\n \n <mo>≤</mo>\n </mrow>\n </semantics>\n </math> 11. The Functional Assessment of Cancer Therapy-General (FACT-G, range 0–108) assessed QOL and the Geriatric Depression Scale-15 (GDS-15, range 0–15) assessed psychological health. We modeled group-based trajectories for FACT-G and GDS-15 via a discrete mixture model that identifies distinct subgroups with similar trajectories or patterns. After identifying distinct groups, we used multinomial logistic regression to assess the association of nutritional impairment with FACT-G and GDS-15 trajectory group membership.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Among 479 patients, mean age was 77 (range 70–93) and 56% had nutritional impairment. We identified four QOL trajectories and four psychological health trajectories. Nutritional impairment was associated with group membership in Lowest (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.0–8.9), Middle-Low (OR 3.8, 95% CI 2.1–6.9), and Middle-High QOL (OR 2.4, 95% CI 1.4–4.2), compared to Highest QOL. For depression, nutritional impairment was associated with membership in Worsening Mild Depression group (OR 3.7, 95% CI 1.8–7.5), compared to No Depression group.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Baseline nutritional impairment was independently associated with membership in every worse QOL trajectory group and with membership in the “Worsening Mild Depression” group. This is the first study, to our knowledge, to examine the association between baseline nutritional impairment and QOL and psychological health trajectory among patients with cancer. Integrating early nutritional assessment with paired supportive care is important for older adults with advanced cancer.</p>\n </section>\n </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 9","pages":"2789-2797"},"PeriodicalIF":4.5000,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Nutritional Impairment and Quality of Life Trajectories Among Older Adults With Advanced Cancer\",\"authors\":\"Surbhi Singhal, Ying Wang, Richard F. Dunne, Lee Kehoe, Michael B. 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Adults aged <span></span><math>\\n \\n <semantics>\\n \\n <mrow>\\n \\n <mo>≥</mo>\\n </mrow>\\n </semantics>\\n </math> 70 years with <span></span><math>\\n \\n <semantics>\\n \\n <mrow>\\n \\n <mo>≥</mo>\\n </mrow>\\n </semantics>\\n </math> 1 impaired geriatric domain were enrolled (2014–2017). Nutritional impairment was defined as Mini Nutritional Assessment-Short Form score of <span></span><math>\\n \\n <semantics>\\n \\n <mrow>\\n \\n <mo>≤</mo>\\n </mrow>\\n </semantics>\\n </math> 11. The Functional Assessment of Cancer Therapy-General (FACT-G, range 0–108) assessed QOL and the Geriatric Depression Scale-15 (GDS-15, range 0–15) assessed psychological health. We modeled group-based trajectories for FACT-G and GDS-15 via a discrete mixture model that identifies distinct subgroups with similar trajectories or patterns. After identifying distinct groups, we used multinomial logistic regression to assess the association of nutritional impairment with FACT-G and GDS-15 trajectory group membership.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Among 479 patients, mean age was 77 (range 70–93) and 56% had nutritional impairment. We identified four QOL trajectories and four psychological health trajectories. Nutritional impairment was associated with group membership in Lowest (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.0–8.9), Middle-Low (OR 3.8, 95% CI 2.1–6.9), and Middle-High QOL (OR 2.4, 95% CI 1.4–4.2), compared to Highest QOL. 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引用次数: 0
摘要
背景：营养不良在老年晚期癌症患者中很常见。在接受姑息性癌症治疗的患者中，基线营养损害与生活质量轨迹（QOL）和心理健康之间的关系尚不清楚。方法：我们对一项全国性临床试验(NCT02107443；PI: Mohile, UG1CA189961)。年龄≥$$ \ge $$ 70岁，≥$$ \ge $$ 1老年区受损的成年人被纳入研究（2014-2017）。营养损害定义为Mini nutrition Assessment-Short Form score≤$$ \le $$ 11。癌症治疗功能评估（FACT-G，范围0-108）评估生活质量，老年抑郁症量表-15 （GDS-15，范围0-15）评估心理健康。我们通过离散混合模型为FACT-G和GDS-15建模基于群体的轨迹，该模型识别具有相似轨迹或模式的不同子群体。在确定不同的组后，我们使用多项逻辑回归来评估营养损害与FACT-G和GDS-15轨迹组成员的关系。结果：479例患者中，平均年龄77岁（70 ～ 93岁），平均年龄56岁% had nutritional impairment. We identified four QOL trajectories and four psychological health trajectories. Nutritional impairment was associated with group membership in Lowest (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.0-8.9), Middle-Low (OR 3.8, 95% CI 2.1-6.9), and Middle-High QOL (OR 2.4, 95% CI 1.4-4.2), compared to Highest QOL. For depression, nutritional impairment was associated with membership in Worsening Mild Depression group (OR 3.7, 95% CI 1.8-7.5), compared to No Depression group.Conclusions: Baseline nutritional impairment was independently associated with membership in every worse QOL trajectory group and with membership in the "Worsening Mild Depression" group. This is the first study, to our knowledge, to examine the association between baseline nutritional impairment and QOL and psychological health trajectory among patients with cancer. Integrating early nutritional assessment with paired supportive care is important for older adults with advanced cancer.
Nutritional Impairment and Quality of Life Trajectories Among Older Adults With Advanced Cancer
Background
Nutritional impairment is common among older adults with advanced cancer. The association between baseline nutritional impairment and the trajectory of quality of life (QOL) and psychological health among patients receiving palliative cancer treatment is not known.
Methods
We performed a secondary analysis of a nationwide clinical trial (NCT02107443; PI: Mohile, UG1CA189961). Adults aged 70 years with 1 impaired geriatric domain were enrolled (2014–2017). Nutritional impairment was defined as Mini Nutritional Assessment-Short Form score of 11. The Functional Assessment of Cancer Therapy-General (FACT-G, range 0–108) assessed QOL and the Geriatric Depression Scale-15 (GDS-15, range 0–15) assessed psychological health. We modeled group-based trajectories for FACT-G and GDS-15 via a discrete mixture model that identifies distinct subgroups with similar trajectories or patterns. After identifying distinct groups, we used multinomial logistic regression to assess the association of nutritional impairment with FACT-G and GDS-15 trajectory group membership.
Results
Among 479 patients, mean age was 77 (range 70–93) and 56% had nutritional impairment. We identified four QOL trajectories and four psychological health trajectories. Nutritional impairment was associated with group membership in Lowest (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.0–8.9), Middle-Low (OR 3.8, 95% CI 2.1–6.9), and Middle-High QOL (OR 2.4, 95% CI 1.4–4.2), compared to Highest QOL. For depression, nutritional impairment was associated with membership in Worsening Mild Depression group (OR 3.7, 95% CI 1.8–7.5), compared to No Depression group.
Conclusions
Baseline nutritional impairment was independently associated with membership in every worse QOL trajectory group and with membership in the “Worsening Mild Depression” group. This is the first study, to our knowledge, to examine the association between baseline nutritional impairment and QOL and psychological health trajectory among patients with cancer. Integrating early nutritional assessment with paired supportive care is important for older adults with advanced cancer.
期刊介绍：
Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.
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