Abstract
Purpose
Frailty is defined as a state of decreased physiologic reserves arising from cumulative deficits in multiple homeostatic systems, which is important in the field of clinical oncology. We aimed to explore the relationship between preoperative frailty and adverse outcomes, and systematically analyze the factors influencing frailty based on the health ecology model among elderly gastric cancer patients.
Methods
A observational study was conducted to select 406 elderly patients who would undergo gastric cancer surgery at a tertiary hospital. The logistic regression model was used to examine the relationship between preoperative frailty and adverse outcomes, including total complications, prolonged length of stay (PLOS), and 90-day hospital readmission. Based on the health ecology model, the factors which may influence frailty were collected from four levels. Univariate and multivariate analysis were utilized to determine the factors influencing preoperative frailty.
Results
Preoperative frailty was associated with total complications (odds ratio [OR] 2.776, 95% confidence interval [CI] 1.588–4.852), PLOS (OR 2.338, 95%CI 1.342–4.073), and 90-day hospital readmission (OR 2.640, 95% CI 1.275–5.469). Besides, nutritional risk (OR 4.759, 95% CI 2.409–9.403), anemia (OR 3.160, 95% CI 1.751–5.701), number of comorbidity ≥ 2 (OR 2.318, 95% CI 1.253–4.291), low physical activity level (OR 3.069, 95% CI 1.164–8.092), apathetic attachment (OR 2.656, 95% CI 1.457–4.839), personal monthly income ≤ 1000 yuan (OR 2.033, 95% CI 1.137–3.635) and anxiety (OR 2.574, 95% CI 1.311–5.053) were independent risk factors for frailty. High physical activity level (OR 0.413, 95% CI 0.208–0.820) and improved objective support (OR 0.818, 95% CI 0.683–0.978) were independent protective factors for frailty.
Conclusions
Preoperative frailty was associated with multiple adverse outcomes and could be affected by factors of different dimensions from the health ecology perspective, including nutrition, anemia, comorbidity, physical activity, attachment style, objective support, anxiety, and income, which can guide the formation of a comprehensive prehabilitation for frailty among elderly gastric cancer patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
All data generated or analyzed during this study are included in this article and its supplementary material files. Further enquiries can be directed to the corresponding author.
References
Ahmed N, Mandel R, Fain MJ (2007) Frailty: an emerging geriatric syndrome. Am J Med 120(9):748–53. https://doi.org/10.1016/j.amjmed.2006.10.018
Annunziata MA, Muzzatti B, Bidoli E et al (2020) Hospital anxiety and depression scale (HADS) accuracy in cancer patients. Support Care Cancer 28(8):3921–3926. https://doi.org/10.1007/s00520-019-05244-8
Artaza-Artabe I, Sáez-López P, Sánchez-Hernández N et al (2016) The relationship between nutrition and frailty: Effects of protein intake, nutritional supplementation, vitamin D and exercise on muscle metabolism in the elderly. A systematic review. Maturitas 93:89–99. https://doi.org/10.1016/j.maturitas.2016.04.009
Bolliger M, Kroehnert JA, Molineus F et al (2018) Experiences with the standardized classification of surgical complications (Clavien-Dindo) in general surgery patients. Eur Surg 50(6):256–261. https://doi.org/10.1007/s10353-018-0551-z
Cadore EL, Sáez de Asteasu ML, Izquierdo M (2019) Multicomponent exercise and the hallmarks of frailty: considerations on cognitive impairment and acute hospitalization. Exp Gerontol 122:10–14. https://doi.org/10.1016/j.exger.2019.04.007
Chen J, Xie J, Sun YY et al (2019) Analysis of anxiety, depression, and life quality in senile debility patients. J Clin Med Pract 23(4):73–77. https://doi.org/10.7619/jcmp.201904022
Cheng LY, Zhang Y, Zhang ZX et al (2020) Research advances on family function assessment tools for the elderly. Chin Nurs Res 34(4):680–682. https://doi.org/10.12102/j.issn.1009-6493.2020.04.024
Chow WB, Rosenthal RA, Merkow RP et al (2012) Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American college of surgeons national surgical quality improvement program and the American geriatrics society. J Am Coll Surg 215:453–66. https://doi.org/10.1016/j.jamcollsurg.2012.06.017
Coburn N, Cosby R, Klein L et al (2017) Staging and surgical approaches in gastric cancer: a clinical practice guideline. Curr Oncol 24(5):324–331. https://doi.org/10.3747/co.24.3736
Cybularz M, Wydra S, Berndt K et al (2021) Frailty is associated with chronic inflammation and pro-inflammatory monocyte subpopulations. Exp Gerontol 149:111317. https://doi.org/10.1016/j.exger.2021.111317
Deftereos I, Djordjevic A, Carter VM et al (2021) Malnutrition screening tools in gastrointestinal cancer: a systematic review of concurrent validity. Surg Oncol 38:101627. https://doi.org/10.1016/j.suronc.2021.101627
Ding L, Lu J, Zhu H et al (2021) Effects of preoperative frailty on outcomes following surgery among patients with digestive system tumors: a systematic review and meta-analysis. Eur J Surg Oncol 23:S0748-7983. https://doi.org/10.1016/j.ejso.2021.07.019
Divani A, Heidari ME, Ghavampour N et al (2022) Effect of cancer treatment on sleep quality in cancer patients: a systematic review and meta-analysis of Pittsburgh Sleep Quality Index. Support Care Cancer 30(6):4687–4697. https://doi.org/10.1007/s00520-021-06767-9
Gwyther H, Bobrowicz-Campos E, Luis Alves Apóstolo J et al (2018) A realist review to understand the efficacy and outcomes of interventions designed to minimise, reverse or prevent the progression of frailty. Health Psychol Rev 12(4):382–404. https://doi.org/10.1080/17437199.2018.1488601
Hao QK, Li J, Dong BR et al (2017) Chinese experts consensus on assessment and intervention for elderly patients with frailty. Chin J Geriatr 36(3):251–256. https://doi.org/10.3760/cma.j.issn.0254-9026.2017.03.007
He B, Ma Y, Wan C et al (2019) Prevalence and risk factors for frailty among community-dwelling older people in China: a systematic review and meta-analysis. J Nutr Health Aging 23(5):442–450. https://doi.org/10.1007/s12603-019-1179-9
Hernandez LM, Rosenstock L, Gebbie K (2003) Who will keep the public healthy: educating public health professionals for the 21st century. National Academies Press, Washington
Hirahara N, Tajima Y, Fujii Y et al (2021) Prediction of postoperative complications and survival after laparoscopic gastrectomy using preoperative geriatric nutritional risk index in elderly gastric cancer patients. Surg Endosc 35(3):1202–1209. https://doi.org/10.1007/s00464-020-07487-7
Jiahui Y (2018) Study on hypothetical interventions of frailty among Chinese elderly: analysis based on the G-formula model. Xiamen University, Xiamen
Juárez-Cedillo T, Basurto-Acevedo L, Vega-García S et al (2014) Prevalence of anemia and its impact on the state of frailty in elderly people living in the community: SADEM study. Ann Hematol 93(12):2057–2062. https://doi.org/10.1007/s00277-014-2155-4
Kehler DS, Theou O (2019) The impact of physical activity and sedentary behaviors on frailty levels. Mech Ageing Dev 180:29–41. https://doi.org/10.1016/j.mad.2019.03.004
Kendhapedi KK, Devasenapathy N (2019) Prevalence and factors associated with frailty among community-dwelling older people in rural Thanjavur district of South India: a cross-sectional study. BMJ Open 9(10):e032904. https://doi.org/10.1136/bmjopen-2019-032904
Kim S, Kim GS (2019) Ecological factors affecting obesity among middle school students in South Korea. J Sch Health 89(3):181–190. https://doi.org/10.1111/josh.12727
Kim YJ, Lee SA (2021) The relationship of lifestyle factors with the prevalence of major depressive disorder by ecological factors. Psychiatry Investig 18(4):340–347. https://doi.org/10.30773/pi.2020.0309
Li RL, Wang L, Dai FM et al (2015) Research progress on association between attachment theory and the elderly with chronic pain. Chin J Nurs 50(5):537–540. https://doi.org/10.3761/j.issn.0254-1769.2015.05.005
Ligthart-Melis GC, Luiking YC, Kakourou A et al (2020) Frailty, sarcopenia, and malnutrition frequently (co-)occur in hospitalized older adults: a systematic review and meta-analysis. J Am Med Dir Assoc 21(9):1216–1228. https://doi.org/10.1016/j.jamda.2020.03.006
Macfarlane DJ, Lee CC, Ho EY et al (2007) Reliability and validity of the Chinese version of IPAQ (short, last 7 days). J Sci Med Sport 10(1):45–51. https://doi.org/10.1016/j.jsams.2006.05.003
Maltby J, Hunt SA, Ohinata A et al (2020) Frailty and social isolation: comparing the relationship between frailty and unidimensional and multifactorial models of social isolation. J Aging Health 32(10):1297–1308. https://doi.org/10.1177/0898264320923245
Martin FC, O’Halloran AM (2020) Tools for assessing frailty in older people: general concepts. Adv Exp Med Biol 1216:9–19. https://doi.org/10.1007/978-3-030-33330-0_2
McRae P, Bew P, Smith S et al (2020) An observational study of physical, cognitive and social activities in rehabilitation inpatients. Australas J Ageing 39(3):217–224. https://doi.org/10.1111/ajag.12785
Mlynarska A, Mlynarski R, Golba KS (2018) Anxiety, age, education and activities of daily living as predictive factors of the occurrence of frailty syndrome in patients with heart rhythm disorders. Aging Ment Health 22(9):1179–1183. https://doi.org/10.1080/13607863.2017.1348468
Pires Corona L, Drumond Andrade FC, de Oliveira Duarte YA et al (2015) The relationship between anemia, hemoglobin concentration and frailty in Brazilian older adults. J Nutr Health Aging 19(9):935–940. https://doi.org/10.1007/s12603-015-0502-3
Shen T, Zhao YQ (2018) Diagnostic and efficacy criteria for hematological diseases, 4th edn. Science Press, Beijing
Smits FJ, Verweij ME, Daamen LA et al (2022) Impact of complications after pancreatoduodenectomy on mortality, organ failure, hospital stay, and readmission: analysis of a nationwide audit. Ann Surg 275(1):e222–e228. https://doi.org/10.1097/SLA.0000000000003835
Song M, Rabkin CS, Ito H et al (2022) Circulating immune- and inflammation-related biomarkers and early-stage noncardia gastric cancer risk. Eur J Cancer Prev 31(3):270–273. https://doi.org/10.1097/CEJ.0000000000000706
Sun J, Sun R, Jiang Y et al (2020) The relationship between psychological health and social support: evidence from physicians in China. PLoS One 15(1):e0228152. https://doi.org/10.1371/journal.pone.0228152
Sung H, Ferlay J, Siegel RL et al (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71:209–249. https://doi.org/10.3322/caac.21660
Tanaka T, Suda K, Inaba K et al (2019) Impact of frailty on postoperative outcomes for laparoscopic gastrectomy in patients older than 80 years. Ann Surg Oncol 26:4016–4026. https://doi.org/10.1245/s10434-019-07640-0
Tonggui L, Kazuo K (2006) Measuring adult attachment: Chinese adaptation of the ECR scale. Acta Psychol Sin 38(3):399–406
Wada Y, Nishi M, Yoshikawa K et al (2022) Preoperative nutrition and exercise intervention in frailty patients with gastric cancer undergoing gastrectomy. Int J Clin Oncol. https://doi.org/10.1007/s10147-022-02202-z
Acknowledgements
We thank the support from the National Natural Science Foundation of China, the Social Development Fund of Jiangsu Province, and Jiangsu Higher Education Institution for this study.
Funding
This work was supported by the National Natural Science Foundation of China (Grant No.82073407); the Social Development Fund of Jiangsu Province (Grant No.BE2021722); the National Natural Science Foundation of China (Grant No.72004099); the Jiangsu Higher Education Institution (Grant 2018, No.87).
Author information
Authors and Affiliations
Contributions
Study concept and design: LD, XM, XX, JH, QX; Acquisition of data: LD, XM, XJ; LC, JL; Analysis and interpretation of data: LD, XM, XJ, LC, JL, HZ, YG, SZ; Drafting of the manuscript: LD, XM, HZ, YG, SZ, XX, JH, QX; Critical revision of the manuscript for important intellectual content: XX, JH, QX.
Corresponding authors
Ethics declarations
Conflict of interest
The authors report no conflicts of interest in this work.
Ethical approval
The study was approved by the Ethics Committee of the hospital (Number: 2020-SR-516).
Consent to participate
Written informed consent from participants was required in accordance with local/national guidelines.
Consent for publication
Written consent for publication of data was obtained from all participants prior to study enrollment.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Ding, L., Miao, X., Jiang, X. et al. Adverse outcomes and health-ecological influencing factors of preoperative frailty among elderly patients with gastric cancer. J Cancer Res Clin Oncol 149, 7043–7051 (2023). https://doi.org/10.1007/s00432-023-04651-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00432-023-04651-z