Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.
Hull York Medical School, University of York, York, UK.
Eur J Clin Nutr. 2024 Jun;78(6):486-493. doi: 10.1038/s41430-024-01433-9. Epub 2024 Apr 5.
Older adults with cancer are a growing population requiring tailored care to achieve optimum treatment outcomes. Their care is complicated by under-recognised and under-treated wasting disorders: malnutrition, sarcopenia, and cachexia. We aimed to investigate the prevalence, overlap, and patients' views and experiences of malnutrition, sarcopenia, and cachexia, in older adults with cancer.
Mixed-methods study with cross-sectional study and qualitative interviews. Interviews were thematically analysed through a phenomenological lens, with feedback loop analysis investigating relationships between themes and findings synthesised using modified critical interpretative synthesis.
n = 30 were screened for malnutrition, sarcopenia, and cachexia, n = 8 completed semi-structured interviews. Eighteen (60.0%) were malnourished, 16 (53.3%) sarcopenic, and 17 (56.7%) cachexic. One or more condition was seen in 80%, and all three in 30%. In univariate analysis, Rockwood clinical frailty score (OR 2.94 [95% CI: 1.26-6.89, p = 0.013]) was associated with sarcopenia, reported percentage meal consumption (OR 2.28 [95% CI: 1.24-4.19, p = 0.008]), and visible wasting (OR 8.43 [95% CI: 1.9-37.3] p = 0.005) with malnutrition, and percentage monthly weight loss (OR 8.71 [95% CI: 1.87-40.60] p = 0.006) with cachexia. Screening tools identified established conditions rather than 'risk'. Nutritional and functional problems were often overlooked, overshadowed, and misunderstood by both patients and (in patients' perceptions) by clinicians; misattributed to ageing, cancer, or comorbidities. Patients viewed these conditions as both personal impossibilities, yet accepted inevitabilities.
Perceptions, identification, and management of these conditions needs to improve, and their importance recognised by clinicians and patients so those truly 'at risk' are identified whilst conditions are more remediable to interventions.
患有癌症的老年人是一个不断增长的群体，需要量身定制的护理，以实现最佳的治疗效果。他们的护理因未被充分认识和治疗的消耗性疾病而变得复杂：营养不良、肌肉减少症和恶病质。我们旨在研究癌症老年患者中营养不良、肌肉减少症和恶病质的患病率、重叠率以及患者的看法和体验。
采用横断面研究和定性访谈相结合的混合方法研究。通过现象学视角对访谈进行主题分析，并通过反馈循环分析调查主题和研究结果之间的关系，使用修改后的批判性解释合成方法对综合结果进行分析。
对 30 名患者进行了营养不良、肌肉减少症和恶病质的筛查，8 名患者完成了半结构式访谈。18 名（60.0%）患者存在营养不良，16 名（53.3%）患者存在肌肉减少症，17 名（56.7%）患者存在恶病质。一种或多种情况见于 80%的患者，三种情况均见于 30%的患者。在单变量分析中，Rockwood 临床虚弱评分（OR 2.94[95%CI：1.26-6.89，p=0.013]）与肌肉减少症相关，报告的每餐进食百分比（OR 2.28[95%CI：1.24-4.19，p=0.008]）和可见的消瘦（OR 8.43[95%CI：1.9-37.3，p=0.005]）与营养不良相关，每月体重减轻百分比（OR 8.71[95%CI：1.87-40.60，p=0.006]）与恶病质相关。筛查工具识别的是已确立的疾病状态，而不是“风险”。患者和（在患者的认知中）临床医生往往忽视、掩盖和误解了营养和功能问题；这些问题被归因于衰老、癌症或合并症。患者认为这些情况既是个人的不可能，也是不可避免的。
需要改善对这些疾病的认知、识别和管理，使临床医生和患者认识到这些疾病的重要性，以便在这些疾病更具可纠正性时，能够识别出真正“有风险”的患者。
