Frailty in Middle-aged and Older Adult Postoperative Patients with Gynecological Malignancies Structural Equation Modeling

Overview

Journal Front Public Health

Specialty Public Health

Date 2024 Oct 11

PMID 39391154

Authors

Shuo Man

Xiaofang Wu

Haowen Huang

Jinjin Yu

Ling Xia

Affiliations

Soon will be listed here.

Abstract

Background: Frailty and self-management are important determinants of quality of life in cancer patients. However, their synergistic effects and potential mechanisms on quality of life in middle-aged and older adult postoperative gynecologic malignancy patients have not been adequately studied.

Objective: This cross-sectional study aimed to explore the relationship between frailty, self-management, and quality of life in middle-aged and older adult postoperative gynecologic malignancy patients.

Methods: A cross-sectional study was conducted from January 2024 to April 2024 in three gynecological wards of a tertiary hospital in Wuxi. The study recruited 177 patients aged 45 years or older who underwent surgery for gynecologic malignancies (cervical, ovarian, and endometrial cancer). Data were collected using demographic and clinical characteristics, the Edmonton Frailty Scale, the Self-Management Competence Scale, and the EORTC Core Quality of Life Questionnaire. Structural equation modeling was used to explore the interactions between frailty, self-management, and quality of life.

Results: The prevalence of frailty in middle-aged and older adult postoperative gynecologic malignancy patients was 39.5%, with a mean total self-management score of 125.81 ± 13.21 and a mean total quality of life score of 69.26 ± 10.88. The fit indices of the model indicated a good fit, and that frailty had multiple effects on quality of life; specifically, frailty could affect the quality of life directly or through self-management, i.e., self-management partially mediated frailty and quality of life.

Conclusion: Self-management is a mediating variable between frailty and quality of life, suggesting that clinical workers can intervene in self-management skills to improve patient's quality of life and physical and mental health.

References

Mitnitski A, Rockwood K . The rate of aging: the rate of deficit accumulation does not change over the adult life span. Biogerontology. 2015; 17(1):199-204. DOI: 10.1007/s10522-015-9583-y. View

Kumar A . Answering the call: Are we ready for action on frailty in gynecologic oncology?. Gynecol Oncol. 2022; 166(3):377-378. DOI: 10.1016/j.ygyno.2022.08.010. View

Cesari M, Calvani R, Marzetti E . Frailty in Older Persons. Clin Geriatr Med. 2017; 33(3):293-303. DOI: 10.1016/j.cger.2017.02.002. View

Sanchez-Garcia S, Gallegos-Carrillo K, Espinel-Bermudez M, Doubova S, Sanchez-Arenas R, Garcia-Pena C . Comparison of quality of life among community-dwelling older adults with the frailty phenotype. Qual Life Res. 2017; 26(10):2693-2703. DOI: 10.1007/s11136-017-1630-5. View

Liu P, Zhang Y, Li Y, Li S, Li Y, Chen Y . Association of frailty with quality of life in older hypertensive adults: a cross-sectional study. Qual Life Res. 2021; 30(8):2245-2253. DOI: 10.1007/s11136-021-02816-2. View

Di Donato V, Caruso G, Bogani G, Giannini A, DOria O, Perniola G . Preoperative frailty assessment in patients undergoing gynecologic oncology surgery: A systematic review. Gynecol Oncol. 2021; 161(1):11-19. DOI: 10.1016/j.ygyno.2020.12.030. View

Xiong C, Jiang C, Zhang H, Chen J, Zhao M, Xiong C . Self-management and illness perception among cervical cancer patients: A cross-sectional study. Int J Nurs Pract. 2023; 29(3):e13134. DOI: 10.1111/ijn.13134. View

Maisey N, Norman A, Watson M, Allen M, Hill M, Cunningham D . Baseline quality of life predicts survival in patients with advanced colorectal cancer. Eur J Cancer. 2002; 38(10):1351-7. DOI: 10.1016/s0959-8049(02)00098-9. View

Turner G, Clegg A . Best practice guidelines for the management of frailty: a British Geriatrics Society, Age UK and Royal College of General Practitioners report. Age Ageing. 2014; 43(6):744-7. DOI: 10.1093/ageing/afu138. View

10.

Tortorella L, Vizzielli G, Fusco D, Cho W, Bernabei R, Scambia G . Ovarian Cancer Management in the Oldest Old: Improving Outcomes and Tailoring Treatments. Aging Dis. 2017; 8(5):677-684. PMC: 5614329. DOI: 10.14336/AD.2017.0607. View

11.

Tanimura C, Oba K, Noguchi Y, Itamochi T . A Concept Analysis of Self-Management of Physical Frailty. Yonago Acta Med. 2024; 67(2):80-92. PMC: 11128080. DOI: 10.33160/yam.2024.05.007. View

12.

Fan J, Yu C, Guo Y, Bian Z, Sun Z, Yang L . Frailty index and all-cause and cause-specific mortality in Chinese adults: a prospective cohort study. Lancet Public Health. 2020; 5(12):e650-e660. PMC: 7708389. DOI: 10.1016/S2468-2667(20)30113-4. View

13.

Zhou Y, Huo Q, Du S, Shi X, Shi Q, Cui S . Social Support and Self-Efficacy as Mediating Factors Affecting the Association Between Depression and Medication Adherence in Older Patients with Coronary Heart Disease: A Multiple Mediator Model with a Cross-Sectional Study. Patient Prefer Adherence. 2022; 16:285-295. PMC: 8824789. DOI: 10.2147/PPA.S337634. View

14.

Han C, Rosko A, Spakowicz D, Hammer M, Von Ah D . Associations of frailty with symptoms, and HRQOL in older cancer survivors after cancer treatments: a systematic review and meta-analyses. Qual Life Res. 2023; 33(3):583-598. DOI: 10.1007/s11136-023-03537-4. View

15.

Reiser E, Potsch N, Seebacher V, Reinthaller A, Wimazal F, Fleischmann E . Impact of frailty on the management of patients with gynecological cancer aged 80 years and older. Arch Gynecol Obstet. 2020; 303(2):557-563. PMC: 7858206. DOI: 10.1007/s00404-020-05807-9. View

16.

Nunes de Arruda F, Oonk M, Mourits M, de Graeff P, Jalving M, de Bock G . Determinants of health-related quality of life in elderly ovarian cancer patients: The role of frailty and dependence. Gynecol Oncol. 2019; 153(3):610-615. DOI: 10.1016/j.ygyno.2019.03.249. View

17.

Foster C, Fenlon D . Recovery and self-management support following primary cancer treatment. Br J Cancer. 2011; 105 Suppl 1:S21-8. PMC: 3251956. DOI: 10.1038/bjc.2011.419. View

18.

Aung M, Cheng H . Self-management Behaviors and Associated Factors in Adult Cancer Survivors: An Integrative Review. Cancer Nurs. 2023; . DOI: 10.1097/NCC.0000000000001289. View

19.

Shirali E, Yarandi F, Ghaemi M, Montazeri A . Quality of Life in Patients with Gynecological Cancers: A Web-Based Study. Asian Pac J Cancer Prev. 2020; 21(7):1969-1975. PMC: 7573423. DOI: 10.31557/APJCP.2020.21.7.1969. View

20.

Fanfani F, Fagotti A, Salerno M, Margariti P, Gagliardi M, Gallotta V . Elderly and very elderly advanced ovarian cancer patients: does the age influence the surgical management?. Eur J Surg Oncol. 2012; 38(12):1204-10. DOI: 10.1016/j.ejso.2012.08.003. View