Nutritional Impairment and Quality of Life Trajectories Among Older Adults With Advanced Cancer

Nutritional impairment is common among older adults with advanced cancer. The association between baseline nutritional impairment and the trajectory of quality of life (QOL) and psychological health among patients receiving palliative cancer treatment is not known.

We performed a secondary analysis of a nationwide clinical trial (NCT02107443; PI: Mohile, UG1CA189961). Adults aged $\ge$  70 years with $\ge$  1 impaired geriatric domain were enrolled (2014-2017). Nutritional impairment was defined as Mini Nutritional Assessment-Short Form score of $\le$  11. The Functional Assessment of Cancer Therapy-General (FACT-G, range 0-108) assessed QOL and the Geriatric Depression Scale-15 (GDS-15, range 0-15) assessed psychological health. We modeled group-based trajectories for FACT-G and GDS-15 via a discrete mixture model that identifies distinct subgroups with similar trajectories or patterns. After identifying distinct groups, we used multinomial logistic regression to assess the association of nutritional impairment with FACT-G and GDS-15 trajectory group membership.

Among 479 patients, mean age was 77 (range 70-93) and 56% had nutritional impairment. We identified four QOL trajectories and four psychological health trajectories. Nutritional impairment was associated with group membership in Lowest (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.0-8.9), Middle-Low (OR 3.8, 95% CI 2.1-6.9), and Middle-High QOL (OR 2.4, 95% CI 1.4-4.2), compared to Highest QOL. For depression, nutritional impairment was associated with membership in Worsening Mild Depression group (OR 3.7, 95% CI 1.8-7.5), compared to No Depression group.

Baseline nutritional impairment was independently associated with membership in every worse QOL trajectory group and with membership in the "Worsening Mild Depression" group. This is the first study, to our knowledge, to examine the association between baseline nutritional impairment and QOL and psychological health trajectory among patients with cancer. Integrating early nutritional assessment with paired supportive care is important for older adults with advanced cancer.