Are depression and anxiety disorders associated with adductor pollicis muscle thickness, sleep duration, and protein intake in cancer patients?

Associations of nutrition impact symptoms with depression in patients with advanced cancer

PURPOSE

Advanced cancer patients have nutrition impact symptoms (NISs), while many of them have depressive moods. This study aimed to determine the associations of NISs with depression.

METHODS

This study was a secondary analysis. The dietary intake and 19 NISs in patients receiving palliative care were evaluated using 10-point scales, and the patients were categorized into two groups (non-depression and depression groups) using the cutoff based on the Patient Health Questionnaire-9 (PHQ-9). To determine associations between depression and the number of NISs with a score of ≥ 4, the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the logistic regression model were calculated.

RESULTS

A total of 225 participants were divided into the non-depression group (n = 148) and the depression group (n = 77). The prevalence of depression was 34.2%. Dietary intake was lower, and the number of NISs with a score of ≥ 4 was higher in the depression group (both p < 0.001). All NISs were more severe in the depression group. Significant differences were observed in 15 of the 19 NISs. In the logistic regression model, significantly higher adjusted ORs were observed in the groups with 4-6 NISs and 7 or more NISs with a score of ≥ 4 (10.76 [95% CI, 2.07-55.91], p = 0.016; 17.02 [95% CI, 3.08-94.22], p < 0.001) than in the group with no NISs with a score of ≥ 4.

CONCLUSION

Having four or more NISs with a score ≥ 4 was associated with depression.

Clinical Effect of Tumor-Specific Total Nutrients in Patients with Adjuvant Chemotherapy After Radical Gastric Cancer Resection: A Randomized Controlled Trial

BACKGROUND

In this study, we combined adjuvant chemotherapy after radical gastric cancer resection with tumor-specific total nutrient therapy to analyze how it affects the nutritional state and immune function of the patient.

METHOD

We collected data from 106 patients having undergone adjuvant chemotherapy after radical gastric cancer resection between January 2020 and December 2021. We divided the patients into experimental and control groups (with 53 cases in each group) through single-blinded simple randomization using a random number table and the sealed envelope system. The control group received chemotherapy and the regular nutritional diet at the same time while the experimental group received tumor-specific total nutrients based on the control group. We analyzed the index results for the physical examination, nutritional status, and immune function of the patients in both groups recorded before and after one chemotherapeutic cycle.

RESULTS

The control and experimental group compositions were as follows: 58.5% and 52.8% males with a mean age ± standard deviation of 54.36 ± 12.68 and 55.15 ± 12.32 years, respectively. After one chemotherapeutic cycle and the nutritional intervention, the experimental group displayed better physical examination indicators than the control group concerning the weight (55.8 ± 5.41 vs. 54.8 ± 6.94, p = 0.621), body fat mass (13.3 ± 0.88 vs. 13.1 ± 0.91, p = 0.253), upper arm circumference (21.9 ± 0.94 vs. 21.2 ± 1.23 cm, p = 0.001), triceps skinfold thickness (15.1 ± 1.36 vs. 14.3 ± 1.62 cm, p = 0.007), and grip strength (23.0 ± 1.30 vs. 22.3 ± 1.33, p = 0.007). In addition, the experimental group yielded better nutritional-status indicators than the control, including albumin (35.2 ± 1.60 vs. 33.7 ± 1.44 g/L, p = 0.001), hemoglobin (115.7 ± 9.28 vs. 111.5 ± 10.56 g/L, p = 0.032), total protein (63.7 ± 5.85 vs. 60.5 ± 5.27 g/L, p = 0.004), transferrin (2.5 ± 0.53 vs. 2.2 ± 0.58 g/L, p = 0.007), and immune-function indicators CD4+ (32.8 ± 4.82 vs. 28.8 ± 3.76, p = 0.001), CD8+ (34.1 ± 3.36 vs. 37.2 ± 3.85, p = 0.001), CD4/CD8 (1.0 ± 0.28 vs. 0.8 ± 0.34, p = 0.001), IgA (2.7 ± 1.43 vs. 4.1 ± 1.47, p = 0.001), and IgG (8.8 ± 1.74 vs. 10.9 ± 1.28, p = 0.001).

CONCLUSION

Combined tumor-specific total nutrient and adjuvant chemotherapy application after radical gastric cancer surgery effectively improves the nutritional state and immune function of the patients and could be applied in clinical practice.

Factors associated with depressive symptoms among cancer patients: a nationwide cross-sectional study

OBJECTIVE

Research on factors contributing to depressive symptoms in cancer patients at a national level, encompassing a comprehensive set of variables was limited. This study aimed to address this gap by identifying the factors associated with depressive symptoms among cancer patients through a nationwide cross-sectional analysis.

METHODS

Various factors, including demographic, socioeconomic, behavioral patterns, general and self-rated health status, chronic conditions, dietary habits, and cancer-related factors, were examined. Data was from the National Health and Nutrition Examination Survey. Univariate and multivariate logistic regression analyses were performed to identify associated factors. The receiver-operating characteristic (ROC) curve was used to evaluate the performance of the logistic model.

RESULTS

The findings showed that five sociodemographic factors, two behavioral styles, self-rated health status, comorbid arthritis, two dietary factors and two cancer-related factors were strongly associated with depressive symptoms. Compared with those aged 20-39 years, cancer individuals aged 40-59 years (OR = 0.48, P < 0.05) and those 60 years or older (OR = 0.18, P < 0.05) had lower odds of depression. Positive factors included being never married (OR = 1.98, P < 0.05), widowed, divorced or separated (OR = 1.75, P < 0.05), unemployment (OR = 1.87, P < 0.05), current smoking (OR = 1.84, P < 0.05), inadequate sleep (OR = 1.96, P < 0.05), comorbid arthritis (OR = 1.79, P < 0.05), and poor self-rated health status (OR = 3.53, P < 0.05). No significant association was identified between the Healthy Eating Index 2015 and the Dietary Inflammatory Index with depression (P > 0.05). Shorter cancer diagnosis duration was associated with reduced odds of depression (P < 0.05). The logistic model had an area under the curve of 0.870 (95% CI: 0.846-0.894, P < 0.05).

CONCLUSIONS

Cancer patients should receive enhanced family and social support while cultivating a healthy lifestyle and diet. Incorporating plenty of fruits, greens, and beans is highly recommended, along with establishing a comprehensive health management framework.

Associations of frailty with symptoms, and HRQOL in older cancer survivors after cancer treatments: a systematic review and meta-analyses

PURPOSE

Frailty in older adult cancer survivors after cancer treatments is associated with various health outcomes. However, there is less agreement on how frailty affects symptoms and health-related quality of life (HRQOL). This systematic review and meta-analysis aimed to evaluate the current literature on frailty, symptoms, and HRQOL, as well as the associations of frailty with these factors in older adult cancer survivors with chemotherapy.

METHODS

A review was conducted on peer-reviewed publications from 2008 to 2023, using seven electronic databases. Meta-analyses were performed using random effects models to determine pooled effect estimates for frailty prevalence, symptom severity, and HRQOL scores.

RESULTS

A total of 26 studies involving older cancer survivors were included in the analysis. Most of these studies were conducted in Western countries and focused on White survivors, particularly those with breast cancer. The mean pooled prevalence of frailty was 43.5%. Among frail survivors, the most common symptoms reported after cancer treatments were pain (36.4%), neuropathy (34.1%), and fatigue (21.3%). Frailty was associated with higher pooled mean symptom severity (B = 1.23, p = 0.046) and lower functional HRQOL (B = - 0.31, p = 0.051, with marginal significance) after cancer treatments.

CONCLUSION

Frail older cancer survivors are at high risk of adverse symptoms and poor HRQOL after cancer treatment. Further research on screening for frailty is needed to prevent older adults from developing worse symptoms burden and maintain HRQOL. It is also essential to understand the mechanisms of the associations between frailty, symptoms and HRQOL in this population.

Recent evidence and progress for developing precision nursing in symptomatology: A scoping review

AIM

To summarize the omics results of symptomatic research that can help nurses identify intervention targets and design precision interventions for pain, mental health, cognitive impairment, sleep disorder, fatigue, lymphedema, and quality of life, so as to provide a comprehensive summary of help and inspire to precision nursing.

METHODS

CINAHL, PubMed, Web of Science, and ScienceDirect databases were searched. Retrieval time was from January 2012 to December 2021. Symptomatology research applying omics that can be used to guide nurses in designing targeted interventions was included.

RESULTS

Forty-six studies were included in the final review. Symptomatology research that can be integrated with nursing science to develop precision nursing focused on pain, mental health, cognitive impairment, sleep disorder, fatigue, lymphedema, and quality of life. Most studies were related to cognitive impairment (n = 10; 21.74%), pain (n = 9; 19.57%), and mental health (n = 8; 17.39%). Moreover, the included studies involved various omics technologies, such as whole genome, epigenome, transcriptome, proteome, and metabolome.

CONCLUSION

The rapid development of various omic technologies promotes symptomatology research, which can help nurses fully understand the information of patients. Phenotypic characteristics and biomarkers shown in symptomatology research help nurses identify intervention targets and develop individualization interventions, so as to prevent and reduce symptoms and improve the quality of life.

IMPLICATION FOR NURSING AND HEALTH POLICY

This scoping review is the first synthesis of all peer-reviewed literature to summarize and provide important information and references from the omic results of symptomatology studies to develop precision nursing, highlighting the status and development of precision nursing. Nursing education policies should introduce the development and importance of precision nursing. Further research could consider investing more attention in precision nursing. Nursing researchers can carry out some studies applying omics technology to explore more biomarkers, helping guide the formulation of clinical intervention for symptoms.

Association between hemoglobin adducts of ethylene oxide levels and the risk of short sleep duration in the general population: an analysis based on the National Health and Nutrition Examination Survey

This study aimed to evaluate the association between blood ethylene oxide (HbEtO) levels and short sleep duration (SSD). Data of 3438 participants aged 20 years or older in this study were collected from the National Health and Nutrition Examination Survey (NHANES). The ethylene oxide (EtO) biomarker (HbEtO) was quantified in blood using a high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) method. SSD was defined as sleep time equal to or less than 6 h. The analyses utilized weighted logistic regression models and restricted cubic spline. There was a significant non-linear relationship between HbEtO levels and the risk of SSD (P for-nonlinearity = 0.035). After the full adjustment for confounders, compared with the lowest quantile, the odds ratios (ORs) with 95% confidence intervals (CIs) of SSD across the quantiles of ethylene oxide levels were 1.54(1.09-2.18), 1.15(0.87-1.53), and 1.80(1.11-2.92), respectively (P for trend < 0.05). In subgroup analysis, people who were female, who were non-Hispanic Black, who never engaged in physical activity, who consumed alcohol ≤ 14 g/day, who were normal weight or obese had a significantly higher risk of SSD when they had highest quartiles of HbEtO levels than those had lowest (p < 0.05). Our study indicated that HbEtO levels, an indicator for EtO exposure, were associated with SSD in general adult populations.

Depression and anxiety among individuals with medical conditions during the COVID-19 pandemic: Findings from a nationwide survey in Bangladesh

BACKGROUND

Coronavirus disease 2019 (COVID-19) disproportionately impacts individuals with medical conditions, including with respect to their mental health. The present study investigated depression and anxiety and their correlates among individuals with medical conditions in Bangladesh.

METHODS

Subjects were recruited to participate in an internet-based survey. Data were collected from November 2020 to January 2021 using convenience sampling by a semi-structured questionnaire through online platforms. Multiple regression analyses were performed to determine associations applying Bonferroni correction (p < 0.004). The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) measured depression and anxiety, respectively.

RESULTS

Nine-hundred-and-seventy-one participants (50.1% male; mean age = 42.29 ± 15.86 years; age range = 18-80 years) with medical conditions were included in final analyses. The most frequently reported conditions were diabetes, hypertension, obesity, heart disease, asthma, and anemia. Estimates of moderate to severe depression and anxiety were 38.9% and 35.2%, respectively. The mean depression and anxiety scores were significantly higher among participants who reported having hypertension, obesity, heart disease, asthma, anemia, cancer and chronic obstructive pulmonary disease (COPD). Using Bonferroni correction (p < 0.004), depression was associated with being female and a student, having poorer quality of life, poorer health status and greater numbers of co-morbidities, not engaging in physical exercise and tobacco smoking. Anxiety was associated with being female and a student, having lower socioeconomic status, poorer quality of life, poorer health status and greater numbers of co-morbidities, less sleep and tobacco smoking.

CONCLUSIONS

Depression and anxiety are prevalent among individuals with medical conditions and correlate with sociodemographic, quality-of-life and smoking measures. Interventions targeting vulnerable groups should be employed and investigated.

High neutrophil to lymphocytes ratio is associated with nutritional risk in hospitalised, unselected cancer patients: a cross-sectional study

Cancer patients possess metabolic and pathophysiological changes and an inflammatory environment that leads to malnutrition. This study aimed to (i) determine whether there is an association between neutrophil-to-lymphocyte ratio (NLR) and nutritional risk, and (ii) identify the cut-off value of NLR that best predicts malnutrition by screening for nutritional risk (NRS 2002). This cross-sectional study included 119 patients with unselected cancer undergoing chemotherapy and/or surgery. The NRS 2002 was applied within 24 h of hospitalisation to determine the nutritional risk. Systemic inflammation was assessed by blood collection, and data on C-reactive protein (CRP), neutrophils, and lymphocytes were collected for later calculation of NLR. A receiver operating characteristic (ROC) curve was used to identify the best cut-point for NLR value that predicted nutritional risk. Differences between the groups were tested using the Student's t-, Mann-Whitney U and Chi-Square tests. Logistic regression analyses were performed to assess the association between NLR and nutritional risk. The ROC curve showed the best cut-point for predicting nutritional risk was NLR > 5.0 (sensitivity, 60.9%; specificity, 76.4%). The NLR ≥ 5.0 group had a higher prevalence of nutritional risk than the NLR < 5.0 group (NLR ≥ 5.0: 73.6% vs. NLR < 5.0: 37.9%, p = 0.001). The NLR group ≥ 5.0 showed higher values of CRP and NLR than the NLR < 5.0 group. In addition, patients with NLR ≥ 5.0 also had higher NRS 2002 values when compared to the NLR < 5.0 group (NLR ≥ 5.0: 3.0 ± 1.1 vs. NLR < 5.0: 2.3 ± 1.2, p = 0.0004). Logistic regression revealed an association between NRS and NLR values. In hospitalised unselected cancer patients, systemic inflammation measured by NLR was associated with nutritional risk. Therefore, we highlight the importance of measuring the NLR in clinical practice, with the aim to detect nutritional risk.

High protein diet improves the overall survival in older adults with advanced gastrointestinal cancer

BACKGROUND

High protein diet (HDP) promotes improvement of lean body mass in elderly without cancer; but the impact of high protein intake on muscle strength and mortality in cancer patients remains to be elucidated. This study evaluates the association between HPD on handgrip strength (HGS) and survival in older adults outpatients with advanced gastrointestinal cancer.

METHODS

Ninety-one patients with advanced gastrointestinal cancer (>65% tumor stage III-IV) undergoing radiotherapy, chemotherapy or surgery were enrolled. Upon first oncological visit, tumor stage was assessed by a physician. Then, a nutritionist or a dietitian measured the body mass index (BMI), HGS by means of a dynamometer, and dietary food intake by using 24h food recall. Patients were stratified in HPD (i.e, ≥1.5 g/kg/d) or low protein diet (LPD: <1.5 g/kg/d). Kaplan-Meier curve was used to assess the survival since the cancer diagnosis.

RESULTS

HPD was reported by approximately 30% of patients. Protein intake was significantly higher in HPD vs LPD patients (2.2 ± 0.8 vs. 0.8 ± 0.4 g/kg/d, respectively; p < 0.0001). No significant association was found between HPD and HGS, even after adjustment for physical activity, alcohol intake, smoking, sex, age, tumor stage, oncologic treatment and BMI (OR: 0.97 [95%CI: 0.88-1.08], p = 0.64), or for energy intake kcal/kg/day, leucine g/d and lipids g/d (OR: 0.93 [95%CI: 0.85-1.03, p = 0.19]. In addition, HPD group showed higher overall survival than LPD group (HPD: 14.7 vs. LPD: 7.3 months, p = 0.04).

CONCLUSION

HPD is not associated with better muscle function as measured by HGS, but with overall survival in older adults outpatients with advanced gastrointestinal cancer. HPD may represent a strategy to mitigate the cancer-induced mortality and should be further explored.

Associations of Sleep Quality and Frailty among the Older Adults with Chronic Disease in China: The Mediation Effect of Psychological Distress

Frailty affects the elderly and leads to adverse health outcomes. Preliminary evaluations have suggested that sleep quality and psychological distress are predictors of frailty among older adults. However, the mechanisms by which sleep quality affect frailty had not been fully addressed in the previous research. This study aimed to explore the mediation effect of psychological distress on the association between sleep quality and frailty among the elderly with chronic diseases in rural China. A total of 2346 old adults were included in the analysis. Frailty status was measured by Fried Phenotype criteria. Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI), and psychological distress was examined by Kessler Psychological Distress Scale (K10). Ordinal logistic regressions were performed to assess the relationships between sleep quality and frailty. Mediation test was also conducted by bootstrap method. The prevalence rate of frailty among the elderly with chronic diseases was 21% in rural China. Compared with the elder of robust status, respondents identified as having frailty have lower SES, less vigorous physical activity, and worse self-reported health status. Poor sleep quality was a significant predictor of frailty with mediators (OR = 1.44, 95% CI = 1.19-1.76). Mediation analysis suggested that psychological distress mediated 41.81% of total effect between sleep quality and frailty. This study indicated that poor sleep quality was significantly related to frailty, and psychological was a mediator of this association. However, we could not investigate causal relationships between variables since this was one cross-sectional study. These findings suggested that an early detection of sleep problems and also psychological disorders should be taken to prevent frailty among the rural older adults in China.

High neutrophil to lymphocytes ratio is associated with sarcopenia risk in hospitalized cancer patients

BACKGROUND & AIMS

Systemic inflammation has been reported as a new predictor for cancer outcomes. This study aimed i) to identify the neutrophil to lymphocytes ratio (NLR) cut-off point that best predicts sarcopenia and ii) to verify the association between NLR and sarcopenia risk in hospitalized cancer patients.

METHODS

A cross-sectional study enrolled a total of 123 hospitalized cancer patients receiving chemotherapy and/or undergoing surgery. Systemic inflammation was assessed as revealed by circulating levels of C-reactive protein, neutrophils, platelet, and by calculating platelet-lymphocytes ratio (PLR) and NLR. Sarcopenia risk was assessed using the Strength, Assistance for walking, Rise from a chair, Climb stairs, and Falls (SARC-F; score≥4 identifies sarcopenia risk). ROC curve were used to identify the best NLR cut-off value which predicts sarcopenia risk. Differences between groups were tested using the T Student, Mann-Whitney, or Chi-Square tests. Logistic regression analyses were done to assess the association between NLR and sarcopenia risk.

RESULTS

ROC curve revealed that the best cut-off point to predict sarcopenia risk was NLR ≥6.5 (sensitivity of 45% and specificity of 81%). Those with NLR ≥6.5 presented higher C-reactive protein, neutrophils, platelet-lymphocytes ratio (PLR), and SARC-F than NLR <6.5 group. A negative correlation was found between NLR and gait speed (r = -0.48, p = 0.0001), handgrip strength (r = -0.29, p = 0.002), arm circumference (r = -0.29, p = 0.002) and calf circumference (r = -0.28, p = 0.003). Those with increased NLR values were associated with high sarcopenia risk in crude model, as well as if adjusted by smoking, alcohol intake, and sex (OR:1.19 [95%CI:1.03-1.37], p = 0.013) or by BMI (OR:1.20 [95%CI:1.05-1.38], p = 0.006).

CONCLUSION

In hospitalized cancer patients, systemic inflammation measured by NLR was associated with increased sarcopenia risk.

Serum uric acid concentration is not associated with handgrip strength, lean body mass or survival in gastrointestinal cancer patients

BACKGROUND AND AIMS

Serum uric acid (UA) concentrations are associated with physical capacity and muscle strength. In cancer patients, this relationship may influence the prognosis and survival. However, studies are controversial and require further research. Thus, this study aimed to evaluate if there is an association between the serum UA concentrations with handgrip strength (HGS), lean body mass (LBM) and survival probability in gastrointestinal tract cancer patients.

METHODS

A retrospective cross-sectional study enrolled patients of both genders and over 18 years old. All data was collected from medical records after an initial consultation with a dietitian. UA concentrations were dichotomized using the sample mean values, high ≥4.17 mg/dL and low <4.17 mg/dL.

RESULTS

From the 101 patients, 46 were women and 55 men. Those with high UA also included individuals with a history of smoking (p = 0.004), greater HGS (p = 0.008), greater LBM (p = 0.026) and a greater total caloric intake (p = 0.028). In the logistic regression analysis, no association was found between UA and HGS (OR: 1.03 95% CI: 0.96-1.10, p = 0.337) and LBM (OR: 1.03 95% CI: 0.96-1.11, p = 0.301) after adjusting for gender, whether or not the patient smokes, and total caloric intake. Further, survival probability did not change among the high and low UA concentrations.

CONCLUSION

In gastrointestinal tract cancer patients, serum UA concentrations were not linked to muscle strength, lean mass nor survival.