Relationship Between Nutritional Status and Quality of Life in Patients with Lung Cancer

Figures & data

Table 1 Patients’ Socio-Demographic Characteristics – Whole Group of Patients with Lung Cancer

Parameters		All (n=310)
Age [years]	Mean±SD	63.8±9.4
Sex	Female	133 (42.9%)
	Male	177 (57.1%)
Residence	Urban	215 (69.4%)
	Rural	95 (30.6%)
Source of income	Professional activity	86 (27.7%)
	Social welfare, disability pension, retirement, family support	224 (72.3%)
Relationship status	In a relationship	174 (56.1%)
	Single	136 (43.9%)
Education	Primary	34 (11.0%)
	Vocational	137 (44.2%)
	High school	103 (33.2%)
	College/university	36 (11.6%)

Table 2 Participants’ Clinical Characteristics – Whole Group of Patients with Lung Cancer

Parameter			All (n=310)
Year of diagnosis	4 and more		24 (7.7%)
	3		16 (5.2%)
	2		233 (75.2%)
	1		37 (11.9%)
Cancer type	Small-cell carcinoma		76 (24.5%)
	Non-small-cell carcinoma		234 (75.5%)
T parameter	T1		51 (16.5%)
	T2		99 (31.9%)
	T3		37 (11.9%)
	T4		118 (38.1%)
	Tx		2 (0.6%)
	No data		3 (1.0%)
N parameter	N0		96 (30.97%)
	N1		60 (19.35%)
	N2		97 (31.29%)
	N3		30 (9.68%)
	Nx		24 (7.74%)
	No data		3 (0.97%)
M parameter	M0		177 (57.10%)
	M1a		84 (27.10%)
	M1b, M1c		8 (2.58%)
	Mx		38 (12.26%)
	No data		3 (0.97%)
Metastases to: bone brain liver adrenal glands multiple organs no metastasis	Yes		24 (7.74%) 24 (7.74%) 43 (13.87%) 35 (11.29%) 28 (9.03%) 181 (58.39%)
Number of hospitalizations	mean±SD		1.35±1.99
Type of treatment Surgical treatment Chemotherapy Radiotherapy Symptomatic treatment Unconventional treatment	Yes		152 (49.03%) 118 (38.06%) 105 (33.87%) 209 (67.42%) 8 (2.58%) (more than one answer was possible)
Symptoms
Chronic coughing Dyspnea Chest pain Hemoptysis Recurrent infections Cardiac arrhythmia Hoarseness	Yes		254 (81.94%) 213 (68.71%) 213 (68.71%) 88 (28.39%) 83 (26.77%) 40 (12.90%) 68 (21.94%)
Performance status	0		50 (16.13%)
	1		129 (41.61%)
	2		105 (33.87%)
	3 or 4		26 (8.39%)
FEV1 [L]	mean±SD		2.47±3.52
FVC [L]	mean±SD		3.51±4.91
FEV1/FVC [%]	mean±SD		67.99±14.03
BMI	Kg/m^2		22.3 (20.1-24.4)
MNA Malnourished At risk of malnutrition Normal nutritional status	58 137 115		18.71% 44.19% 37.10%

Table 3 EORTC-QLQ Scores in Patients with Lung Cancer Depending on Nutritional Status

QLQ	MNA			p
	Malnutrition (N=58)	Risk of Malnutrition (N=137)	Normal Nutritional Status (N=115)
	(mean ± SD)
Overall quality of life	28.16±17.92	35.64±17.29	55.14±23.48	p<0.001*
Physical functioning	47.13±21.3	64.77±17.79	79.3±14.14	p<0.001*
Role functioning	36.21±25.96	49.64±26.23	76.38±25.55	p<0.001*
Emotional functioning	43.97±25.3	43.43±22.79	65.65±32.05	p<0.001*
Cognitive functioning	56.61±23.14	64.84±20.78	84.2±19.1	p<0.001*
Social functioning	50.86±28.51	47.81±29.48	72.9±32.03	p<0.001*
Fatigue	65.9±22.01	56.45±23.76	31.88±23.53	p<0.001*
Nausea and vomiting	35.63±27.12	21.53±21.21	8.26±14.87	p<0.001*
Pain	58.91±22.99	46.96±22.25	27.39±22.21	p<0.001*
Dyspnea	62.64±24.25	50.36±24.63	35.36±23.06	p<0.001*
Insomnia	63.79±21.88	57.66±27.27	31.59±33.58	p=0.001*
Appetite loss	58.05±26.17	41.61±27.65	22.9±26.99	p=0.001*
Constipation	39.66±32.12	17.27±24.62	15.36±23.48	p=0.001*
Diarrhea	13.22±22.46	13.38±25.07	4.35±16.24	p=0.001*
Financial difficulties	56.32±30.72	50.85±28.89	27.25±32.62	p=0.001*
Shortness of breath	53.45±22.36	46.07±21.07	25.02±18.66	p=0.001*
Coughing	64.94±22.88	55.72±23.26	41.81±22.09	p=0.001*
Hemoptysis	27.01±30.24	14.11±20.1	11.59±17.68	p=0.003*
Sore mouth or tongue	27.01±28.92	13.87±18.81	5.51±14.6	p=0.001*
Difficulty swallowing	35.63±29.19	16.79±19.85	6.67±14.78	p=0.001*
Tingling in hands or feet	24.71±30.31	20.68±21.06	9.57±16.38	p=0.001*
Hair loss	35.63±35.79	19.46±27.61	9.57±22.41	p=0.001*
Chest pain	45.4±32.26	34.31±25.55	17.97±22.2	p=0.001*
Arm or shoulder pain	23.56±31.22	16.06±22.9	10.14±21.25	p=0.003*
Pain in other body parts	40.8±36.43	30.9±26.39	12.75±22.33	p<0.001*
No improvement with pain medication	61.06±17.44	58.26±16.68	45.97±17.05	p=0.001*

Notes: ANOVA + post hoc analysis (Tukey HSD). *Statistically significant (p<0.05).

Table 4 Regression Analysis for the Impact of Nutritional Status on EORTC-QLQ Domains

Questionnaire	Subscale	Univariate				Multivariate
		b	95% CI		p	b	95% CI		p
QLQ-C30 — functional scales	Overall quality of life	2.21	1.777	2.643	<0.001*	1.365	0.882	1.849	<0.001*
	Physical functioning	2.463	2.098	2.827	<0.001*	1.682	1.301	2.063	<0.001*
	Role functioning	3.114	2.547	3.682	<0.001*	1.744	1.163	2.326	<0.001*
	Emotional functioning	2.131	1.539	2.724	<0.001*	1.473	0.852	2.094	<0.001*
	Cognitive functioning	2.392	1.953	2.831	<0.001*	1.843	1.346	2.34	<0.001*
	Social functioning	2.142	1.47	2.814	<0.001*	0.915	0.23	1.6	0.009 *
QLQ-C30 — symptom scales	Fatigue	−2.894	−3.393	−2.394	<0.001*	−1.982	−2.527	−1.437	<0.001*
	Nausea and vomiting	−2.126	−2.565	−1.688	<0.001*	−1.652	−2.153	−1.151	<0.001*
	Pain	−2.483	−2.967	−1.999	<0.001*	−1.827	−2.356	−1.297	<0.001*
	Dyspnea	−2.221	−2.735	−1.706	<0.001*	−1.477	−2.056	−0.898	<0.001*
	Insomnia	−2.725	−3.359	−2.091	<0.001*	−1.929	−2.631	−1.227	<0.001*
	Appetite loss	−2.957	−3.528	−2.385	<0.001*	−2.47	−3.189	−1.751	<0.001*
	Constipation	−1.626	−2.198	−1.053	<0.001*	−1.263	−1.975	−0.552	0.001 *
	Diarrhea	−0.911	−1.385	−0.436	<0.001*	−0.655	−1.261	−0.048	0.036 *
	Financial difficulties	−2.586	−3.252	−1.92	<0.001*	−1.074	−1.8	−0.348	0.004 *
QLQ-LC13	Shortness of breath	−2.421	−2.862	−1.981	<0.001*	−1.672	−2.184	−1.161	<0.001*
	Coughing	−1.878	−2.372	−1.385	<0.001*	−1.832	−2.423	−1.241	<0.001*
	Hemoptysis	−1.112	−1.585	−0.639	<0.001*	−0.913	−1.363	−0.463	<0.001*
	Sore mouth or tongue	−1.725	−2.149	−1.302	<0.001*	−0.947	−1.459	−0.434	<0.001*
	Difficulty swallowing	−2.204	−2.639	−1.768	<0.001*	−1.679	−2.216	−1.143	<0.001*
	Tingling in hands or feet	−1.506	−1.97	−1.043	<0.001*	−0.86	−1.396	−0.325	0.002 *
	Hair loss	−1.943	−2.545	−1.342	<0.001*	−1.059	−1.71	−0.409	0.002 *
	Chest pain	−2.131	−2.693	−1.569	<0.001*	−1.329	−1.968	−0.69	<0.001*
	Arm or shoulder pain	−1.033	−1.561	−0.506	<0.001*	−0.597	−1.224	0.029	0.063
	Pain in other body parts	−2.416	−2.999	−1.832	<0.001*	−2.13	−2.886	−1.374	<0.001*
	No improvement with pain medication	−1.114	−1.558	−0.67	<0.001*	−1.143	−1.678	−0.609	<0.001*

Notes: *Statistically significant (p<0.05), b – linear regression coefficient, impact of nutritional status on domains and areas of quality of life.