Chinese General Practice ›› 2023, Vol. 26 ›› Issue (08): 989-996.DOI: 10.12114/j.issn.1007-9572.2022.0773

Special Issue: 肿瘤最新文章合集 衰弱最新文章合集 胰腺炎最新文章合集

• Monographic Research·Frailty in Cancer Patients • Previous Articles     Next Articles

Associated Factors of Frailty in Cancer Patients: a Meta-analysis

  

  1. School of Nursing, Nanjing Medical University, Nanjing 211166, China
  • Received:2022-09-05 Revised:2022-11-26 Published:2023-03-15 Online:2022-12-29
  • Contact: XU Qin

肿瘤患者衰弱影响因素的Meta分析

  

  1. 211166 江苏省南京市,南京医科大学护理学院
  • 通讯作者: 许勤
  • 作者简介:
    作者贡献: 郭银宁负责文章的撰写、数据收集与整理;郭银宁、缪雪怡进行统计学处理、结果分析与解释;蒋小曼、徐婷进行论文的修订;许勤负责文章的质量控制及审校,对文章整体负责、监督管理。
  • 基金资助:
    国家自然科学基金资助项目——健康生态学视阈下胃癌幸存者衰弱轨迹探究及干预方案设计(82073407)

Abstract:

Background

Frailty is common in cancer patients, which seriously affects their prognosis. However, the factors associated with frailty in cancer patients are not clear at present.

Objective

To identify the factors associated with frailty in cancer patients by a meta-analysis, to provide a scientific basis for the development and implementation of related interventions.

Methods

The databases of China National Knowledge Infrastructure (CNKI), CQVIP, WanFang Data, PubMed, Web of Science, Cochrane Library, CINAHL and Embase were comprehensively and systematically searched from inception to August 2022 for included cross-sectional studies, cohort studies or case-control studies reporting associated factors of frailty in cancer patients. Two researchers screened the literature and performed quality evaluation and data extraction. Stata 17.0 and RevMan 5.4 were used for meta-analysis.

Results

Eleven studies were included, among which nine were cross-sectional studies and the other two were cohort studies. Altogether, 2 898 cancer patients were studied, among whom 1 025 were frail, and 12 associated factors of frailty were reported. Meta-analysis showed that the prevalence of frailty in all cancer patients, lung cancer patients, digestive cancer patients, and other cancer patients was 34%〔95%CI (23%, 45%) 〕, 31%〔95%CI (25%, 36%) 〕, 42%〔95%CI (26%, 59%) 〕, and 12%〔95%CI (9%, 16%) 〕, respectively. The risk of frailty in cancer rose with advanced age〔OR=1.16, 95%CI (1.05, 1.27) 〕, combined with other diseases〔OR=1.46, 95%CI (1.28, 1.67) 〕, high BMI〔OR=1.13, 95%CI (1.05, 1.21) 〕, poor nutritional status〔OR=2.77, 95%CI (1.27, 6.06) 〕, high syndrome group scores〔OR=1.07, 95%CI (1.04, 1.09) 〕and depression〔OR=1.27, 95%CI (1.12, 1.44) 〕, but decreased with high education level〔OR=0.78, 95%CI (0.68, 0.90) 〕, albumin level≥35 g/L〔OR=0.33, 95%CI (0.12, 0.90) 〕and high level of instrumental activities of daily living (IADL) 〔OR=0.50, 95%CI (0.42, 0.59) 〕. Egger's test assessing the potential publication bias in 11 studies via funnel plot asymmetry showed that there was a certain publication bias (t=-4.12, P=0.003) .

Conclusion

This meta-analysis revealed that age, education level, comorbidity, BMI, albumin, nutritional status, syndrome group, depression and IADL were the associated factors of frailty in cancer patients. It is necessary for health professionals to pay more attention to cancer patients with advanced age, low education level, combined with other diseases, high BMI, albumin level <35 g/L, poor nutritional status, with syndrome group, depression or low-level activities of daily living, so as to prevent the occurrence of frailty.

Key words: Neoplasms, Frailty, Root cause analysis, Cross-sectional studies, Cohort studies, Case-control studies, Meta-analysis

摘要:

背景

衰弱在肿瘤患者中高发,严重影响患者的预后恢复。然而,目前关于肿瘤患者衰弱的影响因素尚不十分明确。

目的

通过Meta分析明确肿瘤患者衰弱的影响因素,为后期肿瘤患者衰弱干预方案的设计及实施提供科学依据。

方法

全面系统检索中国知网、维普网、万方数据知识服务平台、PubMed、Web of Science、Cochrane Library、CINAHL、Embase数据库中关于肿瘤患者衰弱影响因素的横断面研究、队列研究或病例对照研究,检索时间为建库至2022年8月。由2名研究者筛选文献,并进行质量评价、数据提取,采用Stata 17.0和RevMan 5.4软件进行Meta分析。

结果

共纳入11篇文献,其中9篇横断面研究,2篇队列研究,包括2 898例肿瘤患者,其中衰弱患者1 025例,涉及影响因素12个。Meta分析结果显示,肿瘤患者衰弱发生率为34%〔95%CI(23%,45%)〕,其中肺癌患者衰弱发生率为31%〔95%CI(25%,36%)〕,消化系统肿瘤患者衰弱发生率为42%〔95%CI(26%,59%)〕,其他类型肿瘤患者衰弱发生率为12%〔95%CI(9%,16%)〕。Meta分析结果显示,高龄〔OR=1.16,95%CI(1.05,1.27)〕、合并其他疾病〔OR=1.46,95%CI(1.28,1.67)〕、体质指数(BMI)高〔OR=1.13,95%CI(1.05,1.21)〕、营养状况差〔OR=2.77,95%CI(1.27,6.06)〕、症状群评分高〔OR=1.07,95%CI(1.04,1.09)〕、合并抑郁〔OR=1.27,95%CI(1.12,1.44)〕是肿瘤患者发生衰弱的危险因素(P<0.05),而文化程度高〔OR=0.78,95%CI(0.68,0.90)〕、白蛋白≥35 g/L〔OR=0.33,95%CI(0.12,0.90)〕以及工具性日常生活活动能力好〔OR=0.50,95%CI(0.42,0.59)〕是其保护因素(P<0.05)。采用Egger's检验对11篇文献衰弱发生率的发表偏倚进行检验并绘制漏斗图,经Egger's检验(t=-4.12,P=0.003),纳入文献存在一定的发表偏倚。

结论

现有Meta分析结果表明,年龄、文化程度、合并其他疾病、BMI、白蛋白、营养状况、症状群、抑郁、工具性日常生活活动能力是肿瘤患者发生衰弱的影响因素。临床需要关注高龄、文化程度低、合并其他疾病、BMI高、白蛋白<35 g/L,营养状况差、伴有症状群、合并抑郁以及日常生活活动能力低下的肿瘤患者,进而预防衰弱的发生。

关键词: 肿瘤, 衰弱, 影响因素分析, 横断面研究, 队列研究, 病例对照研究, Meta分析