Unfavorable impact of cancer cachexia on activity of daily living and need for inpatient care in elderly patients with advanced non-small-cell lung cancer in Japan: a prospective longitudinal observational study

BMC Cancer

Research Article

Katsuhiro Omae¹  Keita Mori¹  Masahiro Endo²  Takashi Aoyama³  Hitomi Shiozaki³  Akira Tanuma⁴  Takeshi Ishii⁴  Yoshiyuki Masuda⁴  Taro Okayama⁴  Takuya Ohashi⁵  Akira Ono⁶  Toshiaki Takahashi⁶  Tetsuhiko Taira⁶  Tateaki Naito⁶  Shota Omori⁶  Kazuhisa Nakashima⁶  Haruyasu Murakami⁶  Kazushige Wakuda⁶  Hirotsugu Kenmotsu⁶  Madoka Kimura⁷  Takuya Oyakawa⁸  Hisao Imai⁹  Nobuyuki Yamamoto^1,10 

[1] Clinical Research Center, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Sunto-gun, 411-8777, Shizuoka, Japan;Division of Diagnostic Radiology, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Sunto-gun, 411-8777, Shizuoka, Japan;Division of Nutrition, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Sunto-gun, 411-8777, Shizuoka, Japan;Division of Rehabilitation Medicine, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Sunto-gun, 411-8777, Shizuoka, Japan;Division of Rehabilitation Medicine, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Sunto-gun, 411-8777, Shizuoka, Japan;Division of Physical Medicine and Rehabilitation, Shizuoka General Hospital, 4-27-1 Kita Ando Aoi-ku, 420-8527, Shizuoka, Japan;Division of Thoracic Oncology, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Sunto-gun, 411-8777, Shizuoka, Japan;Division of Thoracic Oncology, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Sunto-gun, 411-8777, Shizuoka, Japan;Department of Clinical Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Tosei-ku, 537-8511, Osaka, Japan;Division of Thoracic Oncology, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Sunto-gun, 411-8777, Shizuoka, Japan;Division of Cardiology, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Sunto-gun, 411-8777, Shizuoka, Japan;Division of Thoracic Oncology, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Sunto-gun, 411-8777, Shizuoka, Japan;Division of Respiratory Medicine, Gunma Prefectural Cancer Center, 617-1 Takabayashi-nishi-machi, Ohta-shi, 373-8550, Gunma, Japan;Third Department of Internal Medicine, Wakayama Medical University, 811-1, Kimiidera, 641-8509, Wakayama, Japan;

关键词: Non-small-cell lung cancer;    Elderly;    Cancer cachexia;    Activity of daily living;    Length of hospital stay;    Medical cost;   

DOI  :  10.1186/s12885-017-3795-2

 received in 2017-04-10, accepted in 2017-11-17,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundCancer cachexia in elderly patients may substantially impact physical function and medical dependency. The aim of this study was to estimate the impact of cachexia on activity of daily living (ADL), length of hospital stay, and inpatient medical costs among elderly patients with advanced non-small-cell lung cancer (NSCLC) receiving chemotherapy.MethodsThirty patients aged ≥70 years with advanced NSCLC (stage III-IV) scheduled to receive first-line chemotherapy were prospectively enrolled between January 2013 and November 2014. ADL was assessed using the Barthel index. The disability-free survival time (DFS) was calculated as the time between the date of study entry and the date of onset of a disabling event, which was defined as a 10-point decrease in the Barthel index from that at baseline. The mean cumulative function of the length of hospital stay and inpatient medical costs (¥, Japanese yen) was calculated.ResultsThe study patients comprised 11 women and 19 men, with a median age of 74 (range, 70–82) years. Cachexia was diagnosed in 19 (63%) patients. Cachectic patients had a shorter DFS (7.5 vs. 17.1 months, p < 0.05). During the first year from study entry, cachectic patients had longer cumulative lengths of hospital stay (80.7 vs. 38.5 days/person, p < 0.05), more frequent unplanned hospital visits or hospitalizations (4.2 vs. 1.7 times/person, p < 0.05), and higher inpatient medical costs (¥3.5 vs. ¥2.1 million/person, p < 0.05) than non-cachectic patients.ConclusionsElderly NSCLC patients with cachexia showed higher risks for disability, prolonged hospitalizations, and higher inpatient medical costs while receiving chemotherapy than patients without cachexia. Our results might indicate that there is a potential need for an early intervention to minimize progression to or development of cachexia, improve functional prognosis, and reduce healthcare resource burden in this population.Trial registrationTrial registration number: UMIN000009768. Name of registry: UMIN (University hospital Medical Information Network). Date of registration: 14 January 2013. Date of enrolment of the first participant to the trial: 23 January 2013.

【 授权许可】

CC BY   
© The Author(s). 2017