Identification of Comprehensive Geriatric Assessment Based Risk Factors for Malnutrition in Elderly Asian Cancer Patients

Abstract

PurposeElderly cancer patients are at increased risk for malnutrition. We aim to identify comprehensive geriatric assessment (CGA) based clinical factors associated with increased nutritional risk and develop a clinical scoring system to identify nutritional risk in elderly cancer patients.Patients and MethodsCGA data was collected from 249 Asian patients aged 70 years or older. Nutritional risk was assessed based on the Nutrition Screening Initiative (NSI) checklist. Univariate and multivariate logistic regression analyses were applied to assess the association between patient clinical factors together with domains within the CGA and moderate to high nutritional risk. Goodness of fit was assessed using Hosmer-Lemeshow test. Discrimination ability was assessed based on the area under the receiver operating characteristics curve (AUC). Internal validation was performed using simulated datasets via bootstrapping.ResultsAmong the 249 patients, 184 (74%) had moderate to high nutritional risk. Multivariate logistic regression analysis identified stage 3–4 disease (Odds Ratio [OR] 2.54; 95% CI, 1.14–5.69), ECOG performance status of 2–4 (OR 3.04; 95% CI, 1.57–5.88), presence of depression (OR 5.99; 95% CI, 1.99–18.02) and haemoglobin levels <12 g/dL (OR 3.00; 95% CI 1.54–5.84) as significant independent factors associated with moderate to high nutritional risk. The model achieved good calibration (Hosmer-Lemeshow test’s p = 0.17) and discrimination (AUC = 0.80). It retained good calibration and discrimination (bias-corrected AUC = 0.79) under internal validation.ConclusionHaving advanced stage of cancer, poor performance status, depression and anaemia were found to be predictors of moderate to high nutritional risk. Early identification of patients with these risk factors will allow for nutritional interventions that may improve treatment tolerance, quality of life and survival outcomes.

Impact of Nutritional Status on Caregiver Burden of Elderly Outpatients. A Cross-Sectional Study

“…Namely, we found that the presence of components of physical frailty such as malnutrition risk, as evaluated by a low MNA-SF score, increases significantly the caregiver burden, independently from the other factors such as cognitive and physical disability. Previously, some authors aimed at identifying risk factors for caregiver burden, and they found that only a reduced performance status and hemoglobin values <12 g/dL, a proxy of poor nutritional status, were associated with an increased risk of caregiver burden in older patients with cancer at a multivariate analysis [ 41 , 42 ].…”

Use of machine learning in geriatric clinical care for chronic diseases: a systematic literature review

“…Geriatric patients are also prone to inadequate nutritional intake because of factors, including polypharmacy, decreased mobility, and physiological changes. 15 Often such patients experience deterioration of mental 16 or physical health during their hospital stay, even if they recover from the primary chief of concern for the admission. 17 Studies have also shown that hospitalized geriatric patients have a 60-fold increased risk of developing permanent disabilities 18 making them more susceptible to other adverse ailments.…”

Nutritional Status and Its Contributing Factors among Older Adults with Cancer Receiving Chemotherapy

“…Such results might be due to that half of the studied patients were taking three or more drugs daily; this may cause many side effects that influence the intake and utilization of food. In the same vein, Tan et al (2016) carried out a study in Singapore on older adults with cancer to determine the associated factors of increased nutritiional risk and reported that having more than four prescribed drugs was significantly associated with moderate to high nutritional risk.…”

“…This result is in harmony with a study carried out in USA by Klute et al (2016) which reported that malnutrition is common in those with advanced cancer than in the early stages. Additionally, a study conducted in Singapore by Tan et al (2016) found that advanced cancer stage at diagnosis was statistically significant predictor for moderate to high nutritional risk.…”