BMC Cancer (Nov 2017)

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

  • Tateaki Naito,
  • Taro Okayama,
  • Takashi Aoyama,
  • Takuya Ohashi,
  • Yoshiyuki Masuda,
  • Madoka Kimura,
  • Hitomi Shiozaki,
  • Haruyasu Murakami,
  • Hirotsugu Kenmotsu,
  • Tetsuhiko Taira,
  • Akira Ono,
  • Kazushige Wakuda,
  • Hisao Imai,
  • Takuya Oyakawa,
  • Takeshi Ishii,
  • Shota Omori,
  • Kazuhisa Nakashima,
  • Masahiro Endo,
  • Katsuhiro Omae,
  • Keita Mori,
  • Nobuyuki Yamamoto,
  • Akira Tanuma,
  • Toshiaki Takahashi

DOI
https://doi.org/10.1186/s12885-017-3795-2
Journal volume & issue
Vol. 17, no. 1
pp. 1 – 10

Abstract

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Abstract Background Cancer 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. Methods Thirty 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. Results The 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. Conclusions Elderly 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 registration Trial 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.

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