Socio-demographic and economic characteristics of the Respondents
From the total of 347 cancer patients, 320 were voluntarily participated, making the response rate 92.2%. The mean (± SD) age of the study participant was 45.2 (±12.4). The majority (56.3%) of patients were in the age range of 36-55 years. Regarding the educational status of cancer patients, 209 (65.4%) attended elementary school and above. About half of the patients (53.4 %) were married and 69.7% live in urban areas. More than half (57.8%) of individuals had a monthly income of greater than1500 Ethiopian birr. (Table 1)
Table 1: Socio-demographic and economic characteristics of study participants (n=320) at Tikur Anbessa Specialized Hospital, Sep to Oct 2018
Socio-demographic variables
|
|
Numbers
|
Percent (%)
|
Age
|
18-35
|
75
|
23.4
|
|
36-55
|
180
|
56.3
|
|
56-65
|
65
|
20.3
|
|
Mean (±SD) age in years
|
45.2 (±12.4)
|
|
Residence
|
Urban
|
223
|
69.7
|
|
Rural
|
76
|
23.8
|
|
Semi urban
|
21
|
6.6
|
Current Marital Status
|
Married
|
171
|
53.4
|
|
Single
|
96
|
30
|
|
Divorced
|
19
|
5.9
|
|
Widowed
|
34
|
10.6
|
Educational Status
|
Illiterate
|
62
|
19.4
|
|
Read and write only
|
49
|
15.3
|
|
Elementary education
|
68
|
21.3
|
|
Secondary education
|
62
|
19.4
|
|
Diploma and higher
|
79
|
24.7
|
Occupational Status
|
No work/housewife
|
69
|
21.6
|
|
Daily laborer
|
13
|
4.1
|
|
Merchant
|
55
|
17.2
|
|
Private worker
|
73
|
22.8
|
|
Government employee
|
55
|
17.2
|
|
Others*
|
55
|
17.2
|
Monthly income (ETB)
|
< 500
|
23
|
9.6
|
|
501-1000
|
54
|
22.6
|
|
1001-1500
|
24
|
10
|
|
1501-2000
|
31
|
13
|
|
>2000
|
107
|
33.4
|
Source of drinking water
|
Piped water
|
276
|
86.3
|
|
Borehole
|
14
|
4.4
|
|
Wells
|
29
|
9.1
|
Drinking water treatment
|
Yes
|
98
|
30.6
|
|
No
|
222
|
69.4
|
|
|
Health and Cancer-related characteristics of the Respondents
The most common types of cancer identified in this study classified by the organic system were reproductive system 87(27.2 %) and lower gastrointestinal tract (LGIT) 78 (24.4 %). The majorities were on stage II 123 (38.4%). The common types of treatments were 181(56.6 %) chemotherapy and radiation therapy 69 (21.6%) as a curative treatment. Most patients had a Performance status ≥2 (64.1%) and Performance status <2 115(35.9%). Two hundred fifty-eight (80.6%) of patients had decreased food intake within the past month. Regarding weight loss 223(69.8%) of cancer patients loss >5% of their weight within the last 6 months. Two hundred seventy-six (86.3%) of the patients needed critical nutrition intervention. According to PG-SGA score result, 202(63.1%) and 88(27.5%) of the participants were moderately and severely malnourished respectively. BMI of the participants also showed that 206(64.4%) and 89(27.8%) were normal and underweight respectively. (Table 2)
Table 2: Health and Cancer- related characteristics of cancer patients (n=320) at Tikur Anbessa Specialized Hospital, Sep to Oct 2018
Characteristics
|
|
Number
|
Percent (%)
|
Alcohol
|
Yes
|
75
|
23.4
|
|
No
|
245
|
76.6
|
Smoking status /Ex-smokers
|
Yes
|
83
|
25.9
|
|
No
|
237
|
74.1
|
Type of cancer
|
UGIT cancer
|
54
|
16.9
|
|
LGIT cancer
|
78
|
24.4
|
|
RS cancer
|
87
|
27.2
|
|
Lung cancer
|
22
|
6.9
|
|
Breast cancer
|
25
|
7.8
|
|
Others***
|
54
|
16.9
|
Cancer stage
|
Stage I
|
38
|
11.9
|
|
Stage II
|
125
|
39.1
|
|
Stage II
|
89
|
27.8
|
|
Stage IV
|
68
|
21.3
|
Type of treatment
|
Chemotherapy and Radiation
|
32
|
10.0
|
|
Chemotherapy and Surgery
|
11
|
3.4
|
|
Chemotherapy and Hormonal
|
7
|
2.2
|
|
Chemotherapy
|
181
|
56.6
|
|
Radiation and Surgery
|
10
|
3.1
|
|
Radiation and Hormonal
|
6
|
1.9
|
|
Radiation
|
69
|
21.6
|
|
Anti-pain
|
4
|
1.3
|
Other co-morbidities
|
Yes
|
38
|
11.9
|
|
No
|
282
|
88.1
|
Performance status
|
<2
|
115
|
35.9
|
|
≥2
|
205
|
64.1
|
Food intake
|
Unchanged
|
49
|
15.3
|
|
Increased than usual
|
13
|
4.1
|
|
Decreased than usual
|
258
|
80.6
|
Weight loss percentage
|
0-1.9%
|
50
|
15.6
|
|
2-5.0%
|
47
|
14.7
|
|
5.1-9.9%
|
55
|
17.2
|
|
10-19.9%
|
116
|
36.3
|
|
>20%
|
52
|
16.3
|
BMI
|
Under weight
|
89
|
27.8
|
|
Normal weight
|
206
|
64.4
|
|
Over weight
|
25
|
7.8
|
|
Mean (±SD) BMI
|
20.26(±3.13)
|
|
PG-SGA score
|
Well nourished
|
30
|
9.4
|
|
Moderately malnourished
|
202
|
63.1
|
|
Severely malnourished
|
88
|
27.5
|
Total numeric score
|
>9
|
276
|
86.3
|
|
4-8
|
2
|
.6
|
|
2-3
|
9
|
2.8
|
|
0-1
|
33
|
10.3
|
Factors associated with malnutrition (underweight) of cancer patients
In the bivariate analysis sex, educational status, alcohol consumption, performance status, cancer type and stage of cancer were associated with nutritional status (underweight) of cancer patients. The variables mentioned above were entered into a multivariate binary logistic regression model to control the effect of confounders. In the multivariable logistic regression analysis; performance statues ≥2 and cancer stage II, III & IV were associated with the nutritional status of cancer patients. Patients who had a performance status of ≥2 were 7.9 times malnourished than PS <2 [AOR = 7.9, 95 % CI (3.05, 20.48)]. Patients with cancer stage II , III & IV were 3.47, 3.81 and 6.11 times more likely to be malnourished than stage I cancer patients [AOR = 3.47, 95 % CI (1.17,12.31)] , [AOR = 3.81 % CI (1.17,12.31)] and [AOR = 6.11, 95 % CI (1.48,25.14)] respectively. But the association of educational status was lost its significance with the nutritional status of cancer patients (underweight) after an adjustment was done for the other variables (table 3).
Table 3. Bivariate and multivariate regression analysis results of factors associated with undernutrition (as determined by PG-SGA score) of cancer patients (n=320) at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, Sep to Oct 2018
Variable
|
Nutritional status (PG-SGA)
|
|
COR, 95% CI
|
AOR, 95%CI
|
|
Undernourished
N (%)
|
Normal
N (%)
|
|
|
Sex
|
|
|
|
|
Female
|
155(53.4%)
|
12 (40%)
|
1.83(0.85,3.91)*
|
|
Male
|
135 (46.6%)
|
18 (60%)
|
1
|
|
Educational Status
|
|
|
|
|
Illiterate
|
59(95.2%)
|
3(4.8%)
|
3.18(0.84,11.94)*
|
|
Read and
write only
|
44(89.8%)
|
5(10.2%)
|
1.15(0.39,3.36)
|
|
Primary
education
|
64(94.1%)
|
4(5.9%)
|
2.59(078.8.54)*
|
|
Secondary
education
|
55(88.7%)
|
7(11.3%)
|
1.28(0.46,3.49)
|
|
College and
higher
|
68(86.1%)
|
30(9.4%)
|
1
|
|
Alcohol
|
|
|
|
|
Yes
|
71(94.7%)
|
4(5.3%)
|
2.19(0.74, 6.49)*
|
|
No
|
219(89.4%)
|
26(10.6%)
|
1
|
|
Performance status
|
|
|
|
|
<2
|
90(78.3%)
|
25(21.7%)
|
1
|
1
|
≥2
|
199(97.1%)
|
5(2.9%)
|
9.21(3.65,23.23)**
|
7.9(3.05,20.48)**
|
Cancer type
|
|
|
|
|
UGIT cancer
|
53(98.1%)
|
1(1.9%)
|
9.211(1.11,76.48)**
|
|
LGIT cancer
|
74(94.9%)
|
4(5.1%)
|
3.21(0.91,11.29)*
|
|
RS cancer
|
76(87.4%)
|
11(12.6%)
|
1.2(0.45,3.2)
|
|
Lung cancer
|
20(90.9%)
|
2(9.1%)
|
1.73(0.33,8.93)
|
|
Breast cancer
|
21(84%)
|
4(16%)
|
0.91(0.24,3.37)
|
|
Others*
|
46(85.2%)
|
8(14.8%)
|
1
|
|
Cancer stage
|
|
|
|
|
Stage I
|
22(66.7%)
|
11(33.3%)
|
1
|
1
|
Stage II
|
116(90.6%)
|
12(9.4%)
|
4.83(1.89,12.3)**
|
3.47(1.25,9.58)**
|
Stage III
|
82(92.1%)
|
7(7.9%)
|
5.85(2.03, 87)**
|
3.81(1.17,12.31)**
|
Stage IV
|
69(98.6%)
|
1(1.4%)
|
34.5(4.21,282)**
|
6.11(1.48,25.14)**
|
AOR: adjusted odds ratio; COR: crude odds ratio; CI: confidence interval; ** significant p-value <0.01; 1= reference
Factors associated with the malnutrition (underweight) of cancer patients (as determined by BMI)
In the bivariate analysis sex, age, marital status, educational status, occupation, monthly income, drinking water treatment, alcohol consumption, performance status, cancer type and stage of cancer were associated with nutritional status (underweight) of cancer patients. The variables mentioned above were entered into a multivariate logistic regression model to control the effect of confounders. In the multivariable logistic regression analysis; only performance statues ≥2, was associated with the nutritional status of cancer patients. But the association of variable such as; sex, age, marital status, educational status, occupation, drinking water treatment, alcohol consumption, UGIT cancer and cancer stage IV was lost their significance with the nutritional status of cancer patients (underweight) after an adjustment was done for the other variables. Patients who had Performance Status ≥ 2 were 2.01 times likely to be at risk of malnutrition than PS <2 and [AOR = 4.01, 95 % CI (1.16, 3.49)] (table 4).
Table 4. Bivariate and multivariate regression analysis results of factors associated with malnutrition (as determined by BMI) of cancer patients (n=320) at Tikur Anbessa Specialized Hospital, Addis Ababa Ethiopia, Sep to Oct 2018
Variable
|
Nutritional status (BMI)
|
COR 95% CI
|
AOR 95%CI
|
|
Undernourished
n (%)
|
Normal
n (%)
|
|
|
Sex
|
|
|
|
|
Female
|
57(34.1%)
|
110(65.9%)
|
1.95(1.18,3.2)**
|
|
Male
|
32(20.9%)
|
121(79.1%)
|
1
|
|
Age
|
|
|
|
|
18-35
|
34(45.3%)
|
41(54.7%)
|
1
|
|
36-55
|
44(24.4%)
|
36(75.6%)
|
0.39(0.22,0.68)*
|
|
56-65
|
11(16.9%)
|
54(83.1%)
|
0.24(0.11,0.5)**
|
|
Marital status
|
|
|
|
|
Married
|
37(21.6%)
|
134(78.4%)
|
1
|
|
Single
|
37(38.5%)
|
59(61.5%)
|
2.27(1.31,3.9)**
|
|
Divorced
|
5(26.3%)
|
14(73.7%)
|
1.29(0.43,3.82)*
|
|
Widowed
|
10(29.4%)
|
24(70.6%)
|
1.5(0.66,3.43)*
|
|
Educational Status
|
|
|
|
|
Illiterate
|
19(30.6%)
|
43(69.4%)
|
0.64(0.32,1.31)*
|
|
Read and write
Only
|
15(30.6%)
|
34(69.4%)
|
0.64(0.3,1.37)*
|
|
Primary
education
|
8(11.8%)
|
60(88.2%)
|
0.19(0.08,0.4)**
|
|
Secondary
education
|
15(24.2%)
|
47(75.8%)
|
0.46(0.22,0.9)**
|
|
College and
higher
|
32(40.5%)
|
47(59.5%)
|
1
|
|
Occupation
|
|
|
|
|
No work/
Housewife
|
24(34.8%)
|
45(65.2%)
|
1
|
|
Daily laborer
|
5(38.5%)
|
8(61.5%)
|
1.09(0.52,2.32)
|
|
Merchant
|
10(18.2%)
|
45(81.8%)
|
1.28(0.36,4.49)
|
|
Private workers
|
19(26%)
|
54(74.4%)
|
0.45(0.18,1.1)*
|
|
Government
Employee
|
13(23.6%)
|
42(76.4%)
|
0.72(0.33,1.56)
|
|
Others
|
18(32.7%)
|
37(67.3%)
|
0.63(0.27,1.47)*
|
|
Monthly income (ETB)
|
|
|
|
|
<500
|
9(39.1%)
|
14(60.9%)
|
2(0.77,5.16)*
|
|
501-1000
|
14(25.9%)
|
40(24.1%)
|
1.09(0.51,2.31)
|
|
1001-1500
|
5(20.8%)
|
19(79.2%)
|
0.8(0.27,2.41)
|
|
1501-2000
|
4(12.9%)
|
27(87.1%)
|
0.46(0.46,1.44)*
|
|
>2000
|
26(24.3%)
|
81(75.7%)
|
1
|
|
Do you treat drinking water?
|
|
|
|
|
Yes
|
22(22.4%)
|
76(77.6%)
|
0.67(0.38,1.16)*
|
|
No
|
67(30.2%)
|
155(69.8%)
|
1
|
|
Cancer type
|
|
|
|
|
UGIT cancer
|
18(37.5%)
|
30(62.5%)
|
2.58(1.07,6.2)**
|
|
LGIT cancer
|
23(29.5%)
|
59(72.5%)
|
1.84(0.79,4.26)*
|
|
RS cancer
|
22(23.9%)
|
70(76.1%)
|
1.31(0.56,3.07)
|
|
Lung cancer
|
5(22.5%)
|
17(77.3%)
|
1.29(0.38,4.34)
|
|
Breast cancer
|
10(45.5%)
|
12(54.5%)
|
3.45(1.21,9.8)**
|
|
Others*
|
10(18.5%)
|
44(81.5%)
|
1
|
|
Cancer stage
|
|
|
|
|
Stage I
|
6(8.2%)
|
27(81.8%)
|
1
|
|
Stage II
|
26(20.3%)
|
102(79.7)
|
0.26(0.09,0.5)**
|
|
Stage III
|
25(28.1%)
|
64(71.9%)
|
0.3(0.16,0.5)**
|
|
Stage IV
|
32(45%)
|
38(54.3%)
|
0.46(0.2,0.8)**
|
|
PS
|
|
|
|
|
<2
|
23(20%)
|
92(80.0%)
|
1
|
1
|
≥2
|
66(32.2%)
|
139(67.8%)
|
1.89(1.1,3.26)
|
2.01(1.16,3.49) **
|
AOR: adjusted odds ratio; COR: crude odds ratio; CI: confidence interval; ** significant p-value <0.01; 1= reference