Saudi Cultural Missions Theses & Dissertations
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Item Restricted PREDICTORS OF HEALTH-RELATED QUALITY OF LIFE AFTER LUNG CANCER SURGERY(University of Birmingham, 2024) Algaeed, Saffana Khalid; Naidu, Babu; Thickett, DavidGlobally, lung cancer is the leading cause of death. Surgical removal of a primary non-small cell lung cancer (NSCLC) tumour offers a significant chance of cure for those suffering. Additionally, it is anticipated that the introduction of screening programs for lung cancer will result in an increase in survival rates. Therefore, health-related quality of life (HRQOL) following surgery has become an important consideration for these patients. However, a considerable number of lung cancer patients who have undergone surgery have not experienced improvement in their breathing afterwards, a condition that can persist for several months following surgery. Computed Tomography (CT) scans of lung cancer patients often demonstrate concurrent emphysema with low attenuation areas (LAAs), the significance of which is unclear. Moreover, sarcopenia is observed in about half of lung cancer patients and is linked to impaired health outcomes and lower survival rates. Identifying the predictors of postoperative HRQOL decline is vital; however, little information is available regarding the relationship between baseline HRQOL, quantitative computed tomography (QCT) of emphysema, or CT-based body composition with postoperative dyspnoea and global health. This thesis aims to examine the predictors of HRQOL of dyspnoea and global health six months following lung cancer surgery. This is a prospective observational study. The European Organisation for Research and Treatment of Cancer (EORTC QLQ-C30) questionnaire and lung cancer module LC13 were introduced at baseline pre-surgery, eight weeks, and six months after lung surgery. Using the CT scans, lung density measurements using %LAA at thresholds of -950 Hounsfield Units (HU) and -910 HU for the assessment of emphysema were quantified and the cross-sectional area of thoracic and abdominal muscles, specifically pectoralis (PM), erector spinae (ESM), psoas (PSM), and skeletal muscles (SM), were analysed using an open-access software. Univariate and multivariate linear, ordinal and multinational regression analyses were performed to find out the predictive value of preoperative HRQOL and CT scan density measurements. Comparative analyses, as well as intra-class correlation coefficients and Bland Altman plots, have also been employed. A total of 1064 patients were recruited over 10 years, and 906 consented patients were included in the study. A significant increase in dyspnoea scores was observed beyond the minimal clinical difference, with values at baseline, eight weeks, and six months were 20.5 ± 22.6, 39.6 ± 24.5, and 33.2 ± 24.7, respectively. In an eight-week period, global health scores dropped from 73.2 ± 20.5 to 63.3 ± 20.5, with only a minimal improvement observed at six months (66.6 ± 22.2). In the multivariate regression analyses, we have demonstrated that baseline dyspnoea is a strong predictor for patients’ postoperative HRQOL after lung cancer surgery (OR = 3.07 – 12.3, p = 0.00). Additionally, baseline global health significantly predicts postoperative HRQOL (coefficient = 0.45 – 0.5, p = 0.00). The data demonstrate that %LAA-950 is a significant predictor of postoperative dyspnoea and global health (OR = 1.2-1.3, p = 0.00), while %LAA-910 is not consistently a strong predictor after adjusting for clinical and perioperative factors. AI-based and semi-automated software showed strong consistency in measuring %LAA-950 and whole lung volume, 15th percentile, and mean lung density. However, there was a lower degree of agreement between the two programs in lobar measurements. Finally, no statistically significant differences were observed in the changes in HRQOL following lung surgery among the small number of patients with sarcopenia6 0Item Restricted Investigation of Malnutrition, Sarcopenia and Frailty in Middle-Aged and Older People aged 50 years and above using UK Biobank(University of Manchester, 2024-04-18) Almohaisen, Nada; Burden, Sorrel; Gittins, Matt; Todd, ChrisBackground Malnutrition, frailty, and sarcopenia are widespread health conditions in older adults across different settings. These conditions are associated with negative impacts on physical and cognitive function, falls, disability, hospitalisation, increased risk of infections, and fractures. Despite similarities in diagnostic criteria and health outcomes, the relationship between these conditions is still poorly understood. Furthermore, these conditions are frequently underdiagnosis, leading to delayed treatment and management, resulting in deteriorating health status and increased healthcare costs. Thus, it is crucial to understand the relationship between these conditions for early detection and intervention to improve the overall well-being of adults who are ageing. Aims This project aimed to investigate the relationship between malnutrition, frailty, and sarcopenia in the middle-aged and older populations in the UK, using the UK Biobank database. It comprises of three quantitative studies. The first study evaluated the feasibility of mapping the three conditions in the database, determining their prevalence and overlap. The second study estimated their incidence and examined the relationship between them. Lastly, the third study explored the dietary habits of participants with these conditions. The project is important for improving the understanding of the overlap between the three conditions and the dietary habits of people who are malnourished, frail or sarcopenic. Methods This quantitative project analysed secondary data from the UK Biobank. Study 1 was a cross-sectional study of participants aged 50 and over at the baseline assessment visit to estimate the prevalence and overlap of malnutrition, frailty and sarcopenia. Study 2, a prospective cohort design, used data from Study 1 and the reassessment phase to estimate the incidence and overlap of new cases of these conditions. Lastly, Study 3 used a cross-sectional design to explore the dietary habits of participants with these three conditions using the results of Study 1 and data from the baseline assessment. Results Study 1 included 384,609 participants, the number of participants and estimated prevalence of those at risk of malnutrition was 63,489(16.5%), for frailty 17,589 (4.6%) and for sarcopenia 13,833 (3.6%), in participants aged 50 years and over. The overlap between these conditions showed that 51,156 (13.3%) were at risk of malnutrition and prefrailty, and all participants with sarcopenia had a minimum of two of the conditions. The presence of all three conditions was observed in only 2,325 individuals (0.6%). The cohort study included 18,545 participants, aged 50 and above who were condition free at baseline. The incidence of those “at risk of malnutrition” was 44.4 per 1,000 person-years among 13,863 participants. For “frailty”, the incidence was 3 per 1,000 person-years among 10,461 participants, while for “sarcopenia” it was 11 per 1,000 person-years among 16,293 participants. The overlap between these conditions was observed in 44 (0.4%) participants, with most participants “at risk of malnutrition” (n 1,629) also having prefrailty 1,502 (4.3%) among 10,479 participants. Study 3 found that participants with all three conditions had a higher intake of meat and vegetables than the control group, with odds ratios (OR) of 1.13 (95% CI 1.04 to 1.23) and 1.4 (95% CI 1.07 to 1.89), respectively. However, they had a lower intake of cheese, fibre, and fish, with OR 0.49 (95% CI 0.45 to 0.53), 0.44 (95% CI 0.39 to 0.49), and 0.87 (95% CI 0.79 to 0.96), respectively. In addition, individuals with all three conditions consumed less drinking milk infrequently compared to the control group (OR 0.59, 95% CI 0.52 to 0.66). Conclusion The study found a considerable prevalence and incidence of malnutrition risk, frailty, and sarcopenia in middle-aged and older adults. Notably, malnutrition risk decreases with ageing at a population level, whereas frailty increases as did sarcopenia. There was a strong coexistence between malnutrition risk and prefrailty, as well as between sarcopenia, prefrailty, and frailty. Moreover, participants with these three conditions were found to be following standard dietary guidelines aimed at the general population instead of consuming high-energy foods, underscoring the need for tailored dietary advice for some middle-aged and older. Future research should explore multimodal interventions to prevent and manage the coexistence of these conditions, focusing on their interrelating nature and potential synergistic effects.22 0