Modeling causal associations between frailty components and mortality in older patients with cancer: A structural equation approach.

e23021 Background: The independent prognostic value of both oncological and geriatric parameters is well-established in older cancer patients. Yet little is known about the causal pathways between them and how they may interact to affect mortality. Using structural equation modeling (SEM), we aimed to assess the direct and indirect impact of geriatric impairments and oncological parameters on mortality in older patients with cancer. Methods: Patients ≥70 years recruited in the ELCAPA cohort for geriatric assessment (GA), between 2007 and 2016, were included. The six following geriatric domains were assessed: function and mobility, nutrition, cognition, mood, comorbidities and polypharmacy, and social support. SEM analysis tested prespecified relationships between geriatric and oncological characteristics (i.e. stage, cancer site and anti-cancer treatment) and their influence on 6- and 12-months mortality following GA. Model fit was assessed through Root Mean Squared Error of Approximation (RMSEA) and Tucker-Lewis Index (TLI). Results: This analysis included 1434 patients (mean age, 80 years (±5.6); female, 48%; 48% metastasis; main localizations: colorectal (19%), upper digestive tract (17%), and breast (17%)). The 6- and 12-months mortality were 56% and 68%, respectively. Significant direct paths to increased mortality were identified for functional impairment (standardized coefficient (SC): 0.37; p < 0.001 and 0.32; p < 0.001), poor nutritional status (SC: 0.11; p = 0.005 and 0.14; p = 0.001) and poor social support (SC = 0.07; p = 0.08 and 0.09; p = 0.02), along with tumor site, metastatic status and anti-cancer treatment. SEM additionally revealed the indirect effects on mortality of comorbidities, cognitive impairment and depression mediated through functional and nutritional status. Model fit was excellent (RMSEA = 0.036, TLI = 0.941). Conclusions: SEM analysis showed the direct effects of functional and nutritional impairments on mortality and also revealed their central mediating role in the indirect impact of comorbidities, depression and cognitive impairment on mortality. Clinical trial information: NCT02884375.

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Cancer-specific mortality and competing causes of death in older adults: A prospective, multicenter cohort study (ELCAPA-19).

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.11547 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 11547-11547 ◽

Cited By ~ 1

Author(s):

Deborah Assouan ◽

Elena Paillaud ◽

Philippe Caillet ◽

Emmanuelle Kempf ◽

Helene Vincent ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Cancer Mortality ◽

Older Patients ◽

Rating Scale ◽

Mortality Rates ◽

Test Time ◽

Cancer Death ◽

Multicenter Cohort Study ◽

Patients With Cancer

11547 Background: Among older adults with cancer, comorbidities compete with cancer as the cause of death. The objectives were to quantify the proportion and rate of cancer-specific death in older patients with cancer, and to analyze the associations between geriatric factors and cancer death. Methods: Between January 2007 and December 2014, older patients with cancer were prospectively included by the ELCAPA cohort study’s eight investigating centers. Competing risk methods were used to estimate 6-month and 3-year cancer mortality rates and to probe associations between geriatric factors and cancer death. Results: A total of 1678 patients were included (mean ± standard deviation age: 81.3 ± 5.8; women: 49%). The most common cancers were colorectal (19%), breast (17%) and urinary (15%) cancers and 49% had metastasis. After a median follow-up period of 34 months, a total of 948 deaths were observed. Of the 282 deaths in non-metastatic patients, 203 (72%; 95% confidence interval (CI): [66%-77%]) were attributable to cancer. This proportion was 92% (89–94; N = 448/498) for metastatic patients. The 6-month and 3-year cancer mortality rates was respectively 12% (9–15) and 34% (29-38) for non-metastatic tumors and 45% (41–49) and 83% (80–87) for metastatic stage tumors. At 6 months, the geriatric factors independently associated with cancer death were a dependency in activities of daily living (ADL) score ≤ 5 (adjusted subhazard ratio: 2.11 (95%CI: [1.68–2.64]), mobility impairment (Timed Get Up and Go (TGUG) test time > 20 s (1.40 [1.05–1.87]) or inability to perform the TGUG (2.41 [1.67–3.48])) and comorbidities (total Cumulative Index Rating Scale-Geriatric score ≥13) (1.59 [1.23–2.06]). At 3 years, the independently associated factors were ADL ≤ 5 (1.60, [1.34–1.91]), TGUG > 20 s (1.28, [1.04–1.59]) or inability to perform TGUG (2.02 [1.47–2.79]), and cognitive impairment (1.23 [1.01–1.50]). Conclusions: Most older adults with cancer die from this disease and not from other comorbidities. However, geriatric parameters (dependency, impaired mobility, comorbidities, and cognitive impairment) are independently associated with cancer death. These geriatric impairments should be taken into account when assessing the cancer patient’s prognosis in clinical practice. Clinical trial information: NCT02884375.

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Social and Psychological Factors Associated With Adolescent Physical Activity

Journal of Physical Activity and Health ◽

10.1123/jpah.2015-0224 ◽

2016 ◽

Vol 13 (9) ◽

pp. 957-963 ◽

Cited By ~ 10

Author(s):

Jeanette M. Garcia ◽

John R. Sirard ◽

Ross Larsen ◽

Meg Bruening ◽

Melanie Wall ◽

...

Keyword(s):

Physical Activity ◽

Social Support ◽

Psychological Factors ◽

Structural Equation ◽

Perceived Social Support ◽

Cross Sectional Study ◽

Sem Analysis ◽

Self Report ◽

Equation Modeling ◽

Cross Sectional

Objective:The purpose of this study was to examine, using structural equation modeling, the associations between nominated friend physical activity (PA), friend social support with individual PA-related psychological factors, and adolescent PA.Methods:Data were obtained from EAT 2010 (Eating and Activity Among Teens), a large cross-sectional study conducted in 20 middle and high schools. The sample consisted of 1951 adolescents (mean age: 14.25 ± 1.96, 54% female, 68% ethnic minorities). PA, parent and friend social support (perceived social support for PA from parents and friends), and psychological measures (PA enjoyment, PA self-efficacy, and PA barriers) were assessed by self-report questionnaires. The SEM analysis consisted of 1 observed variable: friend PA, and 2 latent constructs: psychological factors, perceived social support.Results:The model was a good fit, indicating that there were significant direct effects of both friend PA (P < .01) and psychological factors (P < .0001) on adolescent PA. In addition, psychological factors mediated the association between friend PA and adolescent PA.Conclusion:The results of this model suggest that psychological factors and friend PA are associated with adolescent PA, and that psychological factors may play an important role. Future studies should further examine the association of both friend PA and psychological variables with adolescent PA.

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Coping Strategies and Postpartum Depressive Symptoms: a Structural Equation Modelling Approach

European Psychiatry ◽

10.1016/j.eurpsy.2015.06.001 ◽

2015 ◽

Vol 30 (6) ◽

pp. 701-708 ◽

Cited By ~ 15

Author(s):

A. Gutiérrez-Zotes ◽

J. Labad ◽

R. Martín-Santos ◽

L. García-Esteve ◽

E. Gelabert ◽

...

Keyword(s):

Social Support ◽

Depressive Symptoms ◽

Coping Strategies ◽

Life Events ◽

Life Stress ◽

Structural Equation ◽

Sem Analysis ◽

Passive Coping ◽

Postpartum Depressive Symptoms ◽

And Coping

AbstractBackgroundVariables such as the mother's personality, social support, coping strategies and stressful events have been described as risk factors for postpartum depression. Structural Equation Modelling (SEM) analysis was used to examine whether neuroticism, perceived social support, perceived life events, and coping strategies are associated with postpartum depressive symptoms at the 8th and 32nd weeks.MethodsA total of 1626 pregnant women participated in a longitudinal study. Different evaluations were performed 8 and 32 weeks after delivery. Several measures were used: the Edinburgh Postnatal Depression Scale (EPDS), the Diagnostic Interview for Genetic Studies (DIGS), the Eysenck Personality Questionnaire (EPQ-RS), the St. Paul Ramsey life events scale and the Duke-UNC Functional Social Support Questionnaire. The brief COPE scale was used to measure coping strategies. SEM analysis was conducted for all women and in those women with a clinical diagnosis of postpartum depression.ResultsPassive coping strategies were associated with postpartum depressive symptoms at both visits (8th and 32nd weeks). Neuroticism was associated with more passive coping strategies and less active coping strategies. Neuroticism and life stress were positively correlated, and social support was negatively correlated with life stress and neuroticism.ConclusionsEarly identification of potential risk for symptomatology of depression postpartum should include assessment of neuroticism, life events, social support and coping strategies.

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Supportive and motivating environments in school: Main factors to make well-being and learning a reality

Norsk Epidemiologi ◽

10.5324/nje.v20i1.1293 ◽

2011 ◽

Vol 20 (1) ◽

Author(s):

Anne G. Danielsen

Keyword(s):

Social Support ◽

Life Satisfaction ◽

Autonomy Support ◽

Structural Equation ◽

Well Being ◽

Sem Analysis ◽

World Health ◽

Equation Modeling ◽

Font Size ◽

Perceived Life Satisfaction

The author examined the relationships between (i) school-related social support from parents, teachers, and classmates, respectively, and students’ perceived life satisfaction; and (ii) school-related social support from teachers and classmates and self-reported academic initiative. The analyses were based on data from nationally representative samples of 13- and 15-year-old students from the Norwegian part of the sixth and seventh World Health Organization (WHO) international survey of Health Behavior in School-aged Children (HBSC). The Structural Equation Modeling (SEM) analyzing approach was employed. The findings indicate that school-related social support is positively related to students’ perceived life satisfaction and self-reported academic initiative. In two-level SEM analysis, a latent factor comprising pedagogical caring and autonomy support was substantially related to self-reported academic initiative at the class level.

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Chemotherapy-related cognitive impairment in older patients with cancer

Journal of Geriatric Oncology ◽

10.1016/j.jgo.2016.04.008 ◽

2016 ◽

Vol 7 (4) ◽

pp. 270-280 ◽

Cited By ~ 50

Author(s):

Kah Poh Loh ◽

Michelle C. Janelsins ◽

Supriya G. Mohile ◽

Holly M. Holmes ◽

Tina Hsu ◽

...

Keyword(s):

Cognitive Impairment ◽

Older Patients ◽

Patients With Cancer

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Risk factors for falls in older patients with cancer

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2017-001388 ◽

2017 ◽

Vol 8 (1) ◽

pp. 34-37 ◽

Cited By ~ 13

Author(s):

Xiaotao Zhang ◽

Ming Sun ◽

Suyu Liu ◽

Cheuk Hong Leung ◽

Linda Pang ◽

...

Keyword(s):

Risk Factors ◽

Social Support ◽

Older Adults ◽

Logistic Regression ◽

Major Depression ◽

Functional Impairment ◽

Older Patients ◽

Patients With Cancer ◽

Number Of Patients ◽

Risk Factors For Falls

ObjectivesA rising number of patients with cancer are older adults (65 years of age and older), and this proportion will increase to 70% by the year 2020. Falls are a common condition in older adults. We sought to assess the prevalence and risk factors for falls in older patients with cancer.MethodsThis is a single-site, retrospective cohort study. Patients who were receiving cancer care underwent a comprehensive geriatric assessments, including cognitive, functional, nutritional, physical, falls in the prior 6 months and comorbidity assessment. Vitamin D and bone densitometry were performed.AnalysisDescriptive statistics and multivariable logistic regression.ResultsA total of 304 patients aged 65 or above were enrolled in this study. The mean age was 78.4±6.9 years. They had haematological, gastrointestinal, urological, breast, lung and gynaecological cancers. A total of 215 patients with available information about falls within the past 6 months were included for final analysis. Seventy-seven (35.8%) patients had at least one fall in the preceding 6 months. Functional impairment (p=0.048), frailty (p<0.001), dementia (p=0.021), major depression (p=0.010) and low social support (p=0.045) were significantly associated with the fall status in the univariate analysis. Multivariate logistic regression analysis identified frailty and functional impairment to be independent risk factors for falls.ConclusionsFalls are common in older patients with cancer and lead to adverse clinical outcomes. Major depression, functional impairment, frailty, dementia and low social support were risk factors for falls. Heightened awareness and targeted interventions can prevent falls in older patients with cancer.

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Parental and Peer Support Matters: A Broad Umbrella of the Role of Perceived Social Support in the Association between Children’s Perceived Motor Competence and Physical Activity

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18126646 ◽

2021 ◽

Vol 18 (12) ◽

pp. 6646

Author(s):

Cristina Menescardi ◽

Isaac Estevan

Keyword(s):

Physical Activity ◽

Social Support ◽

Motor Development ◽

Structural Equation ◽

Model Fit ◽

Equation Modeling ◽

Motor Competence ◽

Indirect Path ◽

The Relationship

(1) Background: This study aimed to examine the role of social support in the relationship between perceived motor competence (MC) and physical activity (PA), according to the conceptual model of Motor Development. (2) Methods: Participants were 518 students (46.5% girls), 8–12 years old. By using a structural equation modeling approach, path analysis was used to test the actual-perceived MC relationship and the mediating influence of social support on the perceived MC–PA relationship. Analyses were done with age and sex as covariates. (3) Results: The results showed a good model fit (CFI = 0.98; RMSEA = 0.07; SRMR = 0.02), where actual MC was positively associated with perceived MC (ß = 0.26, p < 0.001), which in turn was positively related to social support (ß = 0.34, p < 0.001). The model showed the direct social support-PA path (ß = 0.42, p < 0.001) and the indirect path from perceived MC through social support to PA (ß = 0.14, p < 0.001). (4) Conclusions: This study confirms that social support mediates the perceived MC–PA relationship. As such, it is not only important to build and develop children’s actual and perceived MC, but also to promote social support for PA engagement.

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PT10.3: Nutritional Status Assessment in Older Patients with Cancer: A National Cross-Sectional Survey (Nutriagecancer)

Clinical Nutrition ◽

10.1016/s0261-5614(19)32596-8 ◽

2019 ◽

Vol 38 ◽

pp. S54-S55

Author(s):

E. Paillaud ◽

C. Martinez-Tapia ◽

R. Boulahssass ◽

A.-L. Couderc ◽

R. Guess ◽

...

Keyword(s):

Nutritional Status ◽

Older Patients ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Patients With Cancer ◽

Status Assessment

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The association between social support and chemotherapy-related toxicity in older patients with cancer

Journal of Geriatric Oncology ◽

10.1016/j.jgo.2019.08.015 ◽

2020 ◽

Vol 11 (2) ◽

pp. 274-279 ◽

Cited By ~ 1

Author(s):

Armin Shahrokni ◽

Can-Lan Sun ◽

William P. Tew ◽

Supriya Gupta Mohile ◽

Huiyan Ma ◽

...

Keyword(s):

Social Support ◽

Older Patients ◽

Patients With Cancer

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Nutritional Status and Its Contributing Factors among Older Adults with Cancer Receiving Chemotherapy

Clinical Nursing Research ◽

10.1177/1054773820947953 ◽

2020 ◽

Vol 29 (8) ◽

pp. 650-658

Author(s):

Eman Shokry Abd Allah ◽

Hanan Mohammed Mohammed Gad ◽

Hassanat Ramadan Abdel-Aziz

Keyword(s):

Older Adults ◽

Nutritional Status ◽

Older Patients ◽

Nutritional Assessment ◽

Mini Nutritional Assessment ◽

University Hospitals ◽

Contributing Factors ◽

Patients With Cancer ◽

Study Results ◽

Relationship Of

The study aimed to assess nutritional status and its contributing factors among older adults with cancer receiving chemotherapy so, a descriptive study design was used. The study was conducted at Zagazig University Hospitals, Egypt. The study’s sample was selected purposively which composed of 194 older adults. Nutritional status was measured by the Arabic version of the Mini-Nutritional Assessment (MNA). Contributing factors were identified by examining the relationship of nutritional status with demographic and clinical variables. Study results revealed that 33% of the older patients were malnourished and 51.5% were at risk for malnutrition. Statistically significant relations were found between nutritional status and advanced age, illiteracy, insufficient monthly income, comorbidities, cancer stage four at diagnosis, and receiving ≥4 chemotherapy cycles. High prevalence of malnutrition and many contributing factors were identified among older patients with cancer receiving chemotherapy. So, continuous malnutrition screening along chemotherapy courses with special concern for contributing factors assessed in this study is recommended.

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