Health-Related Behaviours of Cancer Survivors: A Nationwide Korean Study.

This cross-sectional study investigated health-related behaviours in Korean cancer survivors by time after cancer diagnosis. The data of 50,532 subjects (aged 40 to 79 years) who participated in the 2007-2019 Korean National Health and Nutrition Examination Surveys (KNHANES) were subjected to analysis. Health-related behaviours included obesity, current smoking, frequent drinking, influenza vaccination, health screening, and cancer screening. The odds for these behaviours were estimated by multivariate logistic regression models with adjustment for potential covariates. Approximately 5% of subjects were cancer survivors, and among these three-fifths were long-term (≥5 years) survivors. Cancer survivors had healthier behaviours than non-survivors for almost all behaviours. However, these trends were attenuated in long-term survivors. In conclusion, healthy behaviour should be emphasised for long-term cancer survivors. Key Words: Cancer survivors, Cross-sectional studies, Health-related behaviours.

Association between neck circumference and pulmonary function in Korean adults.

Neck circumference (NC) is associated with various diseases. However, its association with pulmonary diseases remains unclear. This study aimed to investigate the association between NC and pulmonary function in Korean adults. Data from the 2019 Korean National Health and Nutrition Examination Survey were used, including forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC). A total of 3818 adults aged 40 to 79 years were included in the analysis. Multivariable logistic regression models were used to examine factors associated with low pulmonary function (<80% of the predicted value) and calculate odds ratios (ORs) and 95% confidence intervals (CIs) for decreased lung function per 1-cm increase in NC. A negative correlation was observed between the NC and pulmonary function in both sexes. In multivariate logistic regression analyses, in contrast to men, women exhibited a notable relationship between increased NC and impaired pulmonary function, with a more pronounced effect observed in FVC (OR, 1.14; 95% CI, 1.05-1.24). Central obesity may play a role in pulmonary function decline. Understanding this relationship can inform preventive strategies and interventions to improve the respiratory health of individuals with central obesity.

Association Between Oral Health Status and Survival Time in Terminally Ill Cancer Patients.

INTRODUCTION: Patients with terminal cancer often experience various oral problems. Whether oral health status is associated with the survival of terminally ill cancer patients receiving palliative care remains unclear. METHODS: We analyzed the data of 59 Korean patients with terminal cancer receiving palliative care, including their oral health status, using a modified Korean version of the Oral Health Assessment Tool (OHAT). Patients were categorized into "Good," "Moderate," or "Poor" groups based on OHAT scores. The Kaplan-Meier method was used to compare the median survival time, and the prognosis between groups was estimated using Cox proportional hazard models. RESULTS: The most common oral symptoms observed were xerostomia (69.5%) and mucositis (17.0%). Significantly shorter survival times were observed in patients with hyperbilirubinemia, elevated creatinine levels, and no use of dentures. The "Poor" group had a shorter survival than the "Good" oral group (P = .010). A multivariate Cox proportional hazards analysis revealed that the "Poor" group was significantly associated with poor survival compared to the "Good" group (hazard ratio, 2.05; P = .047). CONCLUSION: Terminally ill cancer patients with poor oral health may have a higher risk of shorter survival. Palliative care professionals should pay attention to oral health. Further research is needed to determine the effects of oral care on survival.

Association between neck circumference and depressive mood among Korean adults.

The relationship between central obesity and depression remains of debate. From the 2019 Korea National Health and Nutrition Examination Survey, data of 3768 adults with available information on neck circumference and depressive mood were analyzed. Multivariate logistic analysis revealed that a small neck circumference was significantly associated with depressive mood among men, but not among women. Our findings indicate that assessing neck circumference among men would help detect depression early.

Renal Insufficiency According to Time after Cancer Diagnosis: Findings of a Nationwide Cross-Sectional Study.

Background: Little is known about the relationship between renal insufficiency and time after cancer diagnosis. Methods: The data of 71,302 individuals (aged 19 to 79 yr) that participated in the 2007-2019 Korean National Health and Nutrition Examination Surveys were subjected to analysis. Renal insufficiency was defined as an estimated glomerular filtration rate of < 60 ml/min/1.73 m2. Odds ratios of renal insufficiency were estimated using multivariate logistic regression models adjusted for potential covariates. Results: Of the 71,302 study subjects, 3.7% were cancer survivors and 2.2% were long-term (≥ 5 yr) survivors. Renal insufficiency was significantly more prevalent among short-term survivors, but not among long-term survivors, than among subjects without cancer. Conclusion: A cancer history of ≥ 5 yr is not an independent risk factor of renal insufficiency.

Validation of Modified Models of Objective Prognostic Score in Patients With Advanced Cancer.

Background: The objective prognostic score (OPS) needs to be modified to reflect practical palliative care circumstances. Objectives: We aimed to validate modified models of OPS with few or no laboratory tests for patients with advanced cancer. Design: An observational study was performed. Setting/Subjects: A secondary analysis of an international, multicenter cohort study of patients in East Asia was performed. The subjects were inpatients with advanced cancer in the palliative care unit. Measurements: We developed two modified OPS (mOPS) models to predict two-week survival: mOPS-A consisted of two symptoms, two objective signs, and three laboratory results, while mOPS-B consisted of three symptoms, two signs, and no laboratory data. We compared the accuracy of the prognostic models using sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). Calibration plots for two-week survival and net reclassification indices (NRIs) were compared for the two models. Survival differences between higher and lower score groups of each model were identified by the log-rank test. Results: We included a total of 1796 subjects having median survival of 19.0 days. We found that mOPS-A had higher specificity (0.805-0.836) and higher AUROCs (0.791-0.797). In contrast, mOPS-B showed higher sensitivity (0.721-0.725) and acceptable AUROCs (0.740-0.751) for prediction of two-week survival. Two mOPSs showed good concordance in calibration plots. Considering NRIs, replacing the original OPS with mOPSs improved overall reclassification (absolute NRI: 0.47-4.15%). Higher score groups of mOPS-A and mOPS-B showed poorer survival than those of lower score groups (p < 0.001). Conclusions: mOPSs used reduced laboratory data and had relatively good accuracy for predicting survival in advanced cancer patients receiving palliative care.

The effect of depression on cognitive decline among Korean retirees.

Background: Little information is available on the characteristics of cognitive ability among retirees. This study aimed to identify factors associated with cognitive impairment among Korean retirees. Materials and Methods: We used data from the Korean Longitudinal Study of Ageing survey. A total of 1755 retirees aged 45 years or older who had normal cognition were followed up for 12 years to identify cognitive impairment. Stepwise multivariate logistic models were used to assess odds ratios (ORs) and 95% confidence intervals (CIs) for cognitive decline. Results: Well-known risk factors, such as age (OR, 1.07; 95% CI, 1.06-1.09), female sex (OR, 1.49; 95% CI, 1.08-2.04), low education (OR, 2.45; 95% CI, 1.91-3.14), and depressive mood (OR, 1.51; 95% CI, 1.16-1.97), remained significantly associated with cognitive decline. Sex-stratified analysis revealed that depressive mood was significantly associated with cognitive decline in male retirees only (OR, 1.90; 95% CI, 1.31-2.75). Conclusion: Our finding indicates that screening male retirees for depressive mood is required to retard cognitive aging.

Clinicians' Prediction of Survival and Prognostic Confidence in Patients with Advanced Cancer in Three East Asian Countries.

Background: Little is known about accuracy and confidence of clinicians' prediction of survival (CPS) in East-Asian countries. Objective: We aimed to examine accuracy of CPS for 7-, 21-, and 42-day survival in palliative inpatients and its association with prognostic confidence. Design: An international prospective cohort study in Japan (JP), Korea (KR), and Taiwan (TW). Setting/Subjects: Subjects were inpatients with advanced cancer admitted to 37 palliative care units in three countries. Measurements: Discrimination of CPS was investigated through sensitivity, specificity, overall accuracy, and area under the receiver operating characteristics curves (AUROCs) according to 7-, 21-, and 42-day survival. The accuracies of CPS were compared with those of Performance Status-based Palliative Prognostic Index (PS-PPI). Clinicians were instructed to rate confidence level on a 0-10-point scale. Results: A total of 2571 patients were analyzed. The specificity was highest at 93.2-100.0% for the 7-day CPS, and sensitivity was highest at 71.5-86.8% for the 42-day CPS. The AUROCs of the seven-day CPS were 0.88, 0.94, and 0.89, while those of PS-PPI were 0.77, 0.69, and 0.69 for JP, KR, and TW, respectively. As for 42-day prediction, sensitivities of PS-PPI were higher than those of CPS. Clinicians' confidence was strongly associated with the accuracy of prediction in all three countries (all p-values <0.01). Conclusions: CPS accuracies were highest (0.88-0.94) for the seven-day survival prediction. CPS was more accurate than PS-PPI in all timeframe prediction except 42-day prediction in KR. Prognostic confidence was significantly associated with the accuracy of CPS.

The association between oxidative balance score and lung function: A nationwide cross-sectional survey.

Purpose: Given the impact of oxidative imbalance on the development of airway pathologies, this study was undertaken to investigate the association between oxidative balance (OB) scores and lung function in the adult Korean population. Methods: Data of 17,368 adults with available OB scores and pulmonary function test results were extracted from the 2013-2019 Korean National Health and Nutrition Examination Surveys. Multivariable logistic regression models were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for reduced forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) per 1-point decrease in OB score. Dose dependent association of reduced lung function with OB scores was also investigated. Results: Males, low-income subjects, individuals with comorbidities, and those with reduced pulmonary function had lower OB scores (representing oxidative balance). Overall, the association between oxidative imbalance and reduced lung function was remarkable in FVC than FEV1 (OR [95% CI], 1.06 [1.04-1.07] vs. 1.03 [1.02-1.04]; both p < 0.001). Linear relationships between the level of reduced lung function and OB scores were significantly noted (p for trend<0.001 in both FEV1 and FVC). Conclusion: Our findings suggest that oxidative imbalance is associated with reduced pulmonary function.

Subtypes of type 2 diabetes and their association with outcomes in Korean adults - A cluster analysis of community-based prospective cohort.

BACKGROUND: Little is known about the subtypes of type 2 diabetes (T2D) and their association with clinical outcomes in Asians. METHODS: We performed data-driven cluster analysis in patients with newly diagnosed drug-naive T2D (n = 756) from the Korean Genome and Epidemiology Study. Clusters were based on five variables (age at diagnosis, BMI, HbA1c, and HOMA2 ß-cell function, and insulin resistance). RESULTS: We identified four clusters of patients with T2D according to k-means clustering: cluster 1 (22.4 %, severe insulin-resistant diabetes [SIRD]), cluster 2 (32.7 %, mild age-related diabetes [MARD]), cluster 3 (32.7 %, mild obesity-related diabetes [MOD]), and cluster 4 (12.3 %, severe insulin-deficient diabetes [SIDD]). During 14 years of follow-up, individuals in the SIDD cluster had the highest risk of initiation of glucose-lowering therapy compared to individuals in the other three clusters. Individuals in the MARD and SIDD clusters showed the highest risk of chronic kidney disease and cardiovascular disease, and individuals in the MOD clusters showed the lowest risk after adjusting for other risk factors (P < 0.05). CONCLUSIONS: Patients with T2D can be categorized into four subgroups with different glycemic deterioration and risks of diabetes complications. Individualized management might be helpful for better clinical outcomes in Asian patients with different T2D subgroups.

Metabolic Dysfunction-Associated Fatty Liver Disease and Mortality: A Population-Based Cohort Study.

BACKGROUND: We investigated whether metabolic dysfunction-associated fatty liver disease (MAFLD) is associated with an elevated risk of all-cause and cardiovascular mortality using a large-scale health examination cohort. METHODS: A total of 394,835 subjects in the Kangbuk Samsung Health Study cohort were enrolled from 2002 to 2012. Participants were categorized by the presence of nonalcoholic fatty liver disease (NAFLD) and MAFLD as follows: normal subjects; patients with both NAFLD and MAFLD; patients with NAFLD only; and patients with MAFLD only. Cox proportional hazards models were used to analyze the risk of mortality. RESULTS: During a median 5.7 years of follow-up, 20.69% was patients with both NAFLD and MAFLD, 1.51% was patients with NAFLD only, and 4.29% was patients with MAFLD only. All-cause and cardiovascular death was higher in patients with MAFLD than those without MAFLD (P<0.001, respectively). In patients with MAFLD only, the hazard ratio (HR) of all-cause and cardiovascular death was 1.35 (95% confidence interval [CI], 1.13 to 1.60) and 1.90 (95% CI, 1.26 to 2.88) after adjusting for age, which lost its statistical significance by multivariable adjustments. Compared to patients with less than two components of metabolic dysfunction, patients with more than two components of metabolic dysfunction were a higher risk of cardiovascular death (HR, 2.05; 95% CI, 1.25 to 3.38) and only women with more than two components of metabolic dysfunction were a higher risk of all-cause death (HR, 1.44; 95% CI, 1.02 to 2.03). CONCLUSION: MAFLD criteria could identify a high-risk group for all-cause and cardiovascular death.

Performance of mid-upper arm circumference and other prognostic indices based on inflammation and nutrition in oncology outpatients: a tertiary cancer center study.

BACKGROUND: We aimed to compare the performance of established inflammation and nutrition-based prognostic indices with a relatively novel index 'mid-upper arm circumference (MUAC)' in outpatients with advanced cancer. METHODS: This study was a secondary analysis of a prospective cohort study that enrolled 200 outpatients with advanced cancer visiting a medical oncology clinic at a tertiary hospital. All patients were followed until death, and the Glasgow Prognostic Score (GPS), modified GPS (mGPS), Prognostic Nutritional Index (PNI), neutrophil/lymphocyte ratio (NLR), C-reactive protein/albumin ratio (CAR), and MUAC were compared by calculating the area under the receiver operating characteristic curves (AUROCs). RESULTS: The mean age of the patients was 64.4 years, 64.0% were male, and the median overall survival was 32.4 weeks [95% confidence interval (CI): 5.6-142.7]. Overall, all indices showed similarly high AUROCs for estimating 12-week (0.68 to 0.75) and 24-week survival (0.67 to 0.74). When confined to the GPS, mGPS, and MUAC, the AUROCs for 12-week survival were 0.75 (95% CI: 0.66-0.82), 0.74 (95% CI: 0.65-0.82), and 0.72 (95% CI: 0.64-0.79), respectively. For 24-week survival, the AUROCs were 0.70 (95% CI: 0.62-0.76), 0.67 (95% CI: 0.60-0.74), and 0.72 (95% CI: 0.64-0.79), respectively. MUAC had the highest specificity for estimating 12-week survival (86.0%), while GPS showed the highest sensitivity for estimating 12-week survival (81.1%). CONCLUSIONS: Inflammation and nutrition-based prognostic indices showed similar acceptable accuracies in estimating the 12- and 24-week survival of oncology outpatients. Notably, a simple and non-invasive index MUAC, showed comparable performance with established indices including GPS and mGPS.

Comparison of Objective Prognostic Score and Palliative Prognostic Score performance in inpatients with advanced cancer in Japan and Korea.

OBJECTIVE: Accurate prognostication is important for patients and their families to prepare for the end of life. Objective Prognostic Score (OPS) is an easy-to-use tool that does not require the clinicians' prediction of survival (CPS), whereas Palliative Prognostic Score (PaP) needs CPS. Thus, inexperienced clinicians may hesitate to use PaP. We aimed to evaluate the accuracy of OPS compared with PaP in inpatients in palliative care units (PCUs) in three East Asian countries. METHOD: This study was a secondary analysis of a cross-cultural, multicenter cohort study. We enrolled inpatients with far-advanced cancer in PCUs in Japan, Korea, and Taiwan from 2017 to 2018. We calculated the area under the receiver operating characteristics (AUROC) curve to compare the accuracy of OPS and PaP. RESULTS: A total of 1,628 inpatients in 33 PCUs in Japan and Korea were analyzed. OPS and PaP were calculated in 71.7% of the Japanese patients and 80.0% of the Korean patients. In Taiwan, PaP was calculated for 81.6% of the patients. The AUROC for 3-week survival was 0.74 for OPS in Japan, 0.68 for OPS in Korea, 0.80 for PaP in Japan, and 0.73 for PaP in Korea. The AUROC for 30-day survival was 0.70 for OPS in Japan, 0.71 for OPS in Korea, 0.79 for PaP in Japan, and 0.74 for PaP in Korea. SIGNIFICANCE OF RESULTS: Both OPS and PaP showed good performance in Japan and Korea. Compared with PaP, OPS could be more useful for inexperienced physicians who hesitate to estimate CPS.