Nutritional Aspect of Cancer Care in Medical Oncology Patients

PurposeAwareness of advances in the nutritional aspects of cancer care and translation of this information into clinical practice are important for oncology practitioners to effectively couple oncologic and nutritional approaches throughout the cancer journey. The goal of this consensus statement by a panel of medical oncologists was to provide practical and implementable guidance addressing nutritional aspects of cancer care from the perspective of the medical oncologist.MethodsA panel of medical oncologists agreed on a series of statements supported by scientific evidence and expert clinical opinion.FindingsParticipating experts emphasized that both poor nutritional intake and metabolic alterations underlie cancer-related malnutrition. The use of liquid and high energy-dense oral nutritional supplements may enable better patient compliance, whereas higher efficacy is more likely with the use of pharmaconutrient-enriched oral nutritional supplements in terms of improved weight, lean body mass, functional status, and quality of life, as well as better tolerance to antineoplastic treatment. A multimodal approach is currently believed to be the best option to counteract the catabolism leading to cancer-related malnutrition; this treatment is scheduled in parallel with anticancer therapies and includes nutritional interventions, multitarget drug therapies, and exercise and rehabilitation programs. Participating experts emphasized the role of the oncologist as a reference professional figure in the coordination of nutritional care for patients with cancer within the context of complex and different clinical scenarios, particularly for permissive-adjunctive nutritional support.ImplicationsThis review article provides practical guidance addressing major nutritional aspects of cancer care from the medical oncologist's perspective. Thus, this document is expected to assist oncology practitioners in terms of awareness of advances in the nutritional aspects of cancer care and translation of this information into their clinical practice to effectively couple oncologic and nutritional approaches as part of the continuum of care for patients with cancer.     

食管癌围手术期病人的护理

目的:探讨食管癌围手术期病人的护理。方法:2005年1~6月我科收住食管癌手术病人180例,术前给予心理护理、营养支持、呼吸道准备等一系列护理措施。术后给予心理支持、呼吸道护理、止痛泵护理、饮食指导、早期活动及出院指导。结果:180例病人均治愈出院,顺利康复。结论:做好食管癌围手术期病人的护理,可减少术后并发症的发生,对促进病人顺利康复起着重要作用。     

Nutritional support and risk status among cancer patients in palliative home care services

Goal of work  The aim of this study was to investigate the nutritional risk status and use of nutritional support among cancer patients enrolled in palliative home care services. Differences in the use of nutritional support in relation to nutritional, social and clinical factors, as well as survival were also investigated. Patients and methods  Structured telephone interviews were conducted with cancer patients enrolled in all 21 palliative home care services in the Stockholm region. An interview guide was designed to investigate topics related to the patient’s nutritional situation. Main results  Interviews with 621 patients were analysed. Sixty-eight percent of the patients were scored as at nutritional risk according on a modified version of NRS-2002. Nutritional support was used by 55% of the patients, with oral nutritional supplements most common and 14% using artificial nutrition. Use of nutritional support was related to low BMI and severe weight loss and was more common in patients with shorter survival times. Conclusions  These findings demonstrate that nutritional support is used to treat already malnourished patients with shorter survival time, rather than to prevent malnutrition. A more structured approach to nutritional issues for patients in palliative phases, which considers life expectancy and psycho-social aspects of nutritional issues, could help identify potential candidates for nutritional support.     

Liver transplantation. Nursing in hospital-based home care

At home hospital treatment nursing by the "Hospital de Cruces" staff provides integrated treatment for liver transplant patients in their home environments, their own houses, with the assistance of full hospital care and resources. The number of patients attended to since the start of this program in February 1996 until November 2001 has reached 164 patients in 205 episodes. The continuity of at home nursing treatment in a liver transplant patient's home is an effective tool which shortens the duration of a patient's hospital stay and the period of a patient's integration into his/her habitual environment with its beneficial consequences in aspects so important as the quality of their lives.     

A practical approach to nutritional support for patients with advanced cancer

Palliative care can last from a few days to months and, in some cases, years. Consequently the nutritional needs of palliative care patients also vary, as does the extent to which nutrition intervention is pursued. Anorexia and cachexia are common side-effects of advanced cancer. They are characterized by physical depletion of the patients and an emotional drain on them, their families and carers. Pulling together the practical aspects of nutrition support and the emotional and social significance of food requires a skillful practitioner; an experienced dietitian can be a valued member of the palliative care team. This article examines the role of nutrition support in the palliative care setting, focusing upon practical advice including food modification, the use of oral supplements and enteral feeding.     

Cachexia

Cachexia is a frequent syndrome in patients suffering from advanced cancer; it is characterized by anorexia, weight loss, and malnutrition, which combined with other psychic and social consequences lead to a deterioration in a patient's quality of life. Various factors play a role in the development of cachexia; these depend on the patient, the type of tumor, and the treatments received. Its complexity warrant the intervention of an interdisciplinary team, in which nursing plays an essential role. Up to present time, the results of pharmaceutical treatment have been rather unfavorable; therefore, nutritional treatments based on advise for concrete problems and dietary supplements gain importance; enteral or parenteral nutrition are reserved for selected cases. Other important aspects are psychological support, control of associated symptoms and the prevention and treatment of any complication which may appear.     

Approach to communicating with patients about the use of nutritional supplements in cancer care

In recent years, complementary and alternative medicine has become popular among the general population in the Western world. Cancer patients have joined this global trend, often seeking supplements to conventional oncologic care, usually without their physicians' knowledge. Among the most common forms of complementary and alternative medicine used by cancer patients are natural products such as herbs and megavitamins. The extensive use of nutritional supplements by cancer patients raises multiple questions and challenges for the physician. Since there are limited scientific data on the efficacy and safety of many nutritional supplements, advising patients about when to use them during the course of illness is difficult. This is true for each stage of cancer care: prevention, acute active care (radiation, chemotherapy, surgery), and post-acute care (follow-up visits and prevention of recurrence). The authors describe a patient-centered approach to the use of nutritional supplements in cancer care.     

老年食管癌患者放疗后的终末期护理

目的 总结一例我院食管癌放疗后的老年患者的终末期护理,供临床护理借鉴。方法 根据病情与护理问题,采用综合性的护理措施,重点将从营养支持管理方案、人工气道管理方案、结构化的皮肤护理方案,以及患者临终前的安宁疗护以上四个方面汇报该患者终末期护理干预,通过持续不断的评估,评价护理干预效果。结果 通过对各项护理干预的不断优化与改进,最终患者营养状况较干预前明显好转,呼吸平稳,痰液能及时有效的被清除、全身皮肤完好无破损,不舒适感降低,并发症发生率降低,患者死亡时面容安详,家属能坦然面对患者的离去,并对医院表达感谢。结论 恶性肿瘤终末期患者的护理工作是PDCA持续改进的过程,通过不断优化与改进的综合性护理干预,能有效舒缓病痛,提高生活质量,使患者舒适、平和、有尊严的走完生命中的最后旅程。     

慢性阻塞性肺疾病患者机械通气早期营养支持的探讨

目的对接受机械通气治疗的慢性阻塞性肺疾病（COPD）患者给予早期营养支持干预，提高其营养指数，降低通气时间和住院天数。方法将2005年-2007年入住本院呼吸科的118例使用BIPAP呼吸机治疗的COPD患者随机分为两组，实验组施行早期肠内鼻饲营养支持，而对照行常规饮食护理。结果实验组治疗前后血气分析结果明显优于对照组；实验组平均住院天数、通气天数低于对照组，而一次脱机成功率高于对照组。结论早期肠内营养支持护理简便安全，有助于机械通气患者呼吸系统功能的恢复。     

重症急性胰腺炎38例临床护理

目的:探讨重症急性胰腺炎(SAP)的护理方法.方法:对38例SAP患者给予生命体征监测、静脉置管、用药护理、引流管护理、营养支持和健康指导等护理措施.结果:本组35例治愈,3例自动出院.结论:对SAP患者,在治疗的基础上配合精细的护理措施,严密观察病情,可促进患者康复,减少并发症的发生.     

循证护理在前列腺癌患者围术期护理中的应用

目的:探讨循证护理在前列腺癌患者围术期中的实施的效果.方法:将70例患者随机分为观察组与对照组各35例.对照组采用常规护理模式进行护理,包括饮食、休息、治疗配合、健康宣教、术后护理、心理护理等;观察组实施循证护理,先给予患者针对性的综合评估,了解其机体素质、疾病状况等,然后根据评估结果进行护理程序及细节的制订,并对可能发生的问题进行预见性护理程序的制订及预防性措施的实施.结果:与对照组比较,观察组住院时间更短,治疗依从性和护理满意度更高,并发症发生率更低,EORTC QLQ-C30评分更理想(P＜0.05).结论:对前列腺癌手术患者实施循证护理效果好,可显著改善其生存质量.     

Which cancer patients are referred to Hospital at Home for palliative care?

Previous research has shown that palliative home care use is influenced by variables such as age, socioeconomic status, presence of an informal carer, diagnosis, and care dependency. However, there is little information on its association with other health service use. This study compared 121 cancer patients referred to Hospital at Home (HAH) for palliative care with a sample of 206 cancer patients not referred who died within the same period. Electronic record linkage of NHS databases enabled investigation of patients' total input of care in their last year of life. Univariate analysis showed that patients referred to HAH were younger, lived in less deprived areas, were less likely to have been diagnosed within a month of death and to have causes other than cancer recorded on their death certificate. They were furthermore more likely to have had specialist oncology input, Macmillan nursing, Marie Curie nursing, acute hospital care, and district nursing before their last month of life. When care was received, patients referred to HAH received more hours of district nursing care. However, patients not referred to HAH began their acute hospital and district nursing input earlier (further from death) than those referred. Multivariate logistic regression analysis showed HAH referral to be negatively associated with breast and genitourinary cancers and number of noncancer causes recorded on the death certificate. Referral was significantly positively associated with specialist oncology input, Marie Curie nursing, and a late start (close to death) of acute hospital and district nursing care. It is hypothesised that referral to palliative home care is more likely among patients who have had prior contact with cancer services or are most clearly identified as cancer patients, and whose illness progression is manifested by a relatively short but intensive period of care prior to death.     

Dimensions of informal care in Greece: the family's contribution to the care of patients hospitalized in an oncology hospital

Aims and objectives. This study aims to explore the kind and frequency of care provided to hospitalized cancer patients by relatives and the reasons for providing this care. Background. Informal care is a common phenomenon across many countries. In Greece, informal caring activities occur in most hospitals. Patients’ relatives stay by their bedside for long hours and assist with care. This phenomenon is highly correlated with the nursing staff shortage. Method. This study was carried out in a Greek oncology hospital. The sample consisted of 150 informal caregivers. We used a 37‐item questionnaire called In‐Hospital Informal Care Questionnaire Acute Care. Results. The participants provide substantial help to their patients daily. On average, they stay by their bedside for 20·23 hours in a 24‐hour period. Additionally, 104 participants stated that they hire a privately paid patient's helper. The relatives stay by their patients’ bedside for various reasons such as: (1) severity of the condition; (2) providing psychological support; (3) family tradition; (4) because they do not believe their patients are safe in the hospital without their supervision; or (5) the nursing staff shortage. Conclusions. The participants offer informal care that reflects specific nursing duties. We could argue that Greek hospitals ‘use’ relatives as unpaid labour to compensate for the nursing shortage. It is disquieting that usually someone from the hospital staff suggests to the relatives to stay at the patient's bedside even after visiting hours or to hire a private paid patient's helper. This implies that the staff considers such contribution necessary. Relevance to clinical practice. The findings show that relatives perform daily tasks that nurses should be performing. They indicate that the hospital should introduce specific staffing policies for reducing families’ burden. Our findings could influence future staffing plans of nursing managers, policy makers or health authorities.     

Do DRG reimbursement rates reflect nursing costs?

The assumption underlying diagnosis related group (DRG) reimbursement is that the prospective, diagnosis-determined rates reflect actual costs incurred during a hospital stay. The nursing component represents a significant percentage of the costs associated with a patient's hospital stay. However, a study of actual nursing labor costs for 240 acute care patients in five DRG categories showed that some DRGs vary in daily nursing labor costs up to 500% over the course of a patient's stay. For some DRGs, the patient's DRG classification is not an adequate measure for determining, assigning, or allocating nursing costs within the institution. Hospitals that do not track actual nursing costs risk unanticipated cost overruns for some diagnoses that may have a significant effect on hospital finances.     

在加速康复外科指导下结直肠手术的术后护理研究

目的 探讨加速康复外科理念的术前准备方法对结直肠癌手术患者的应用效果及护理体会.方法 60例结直肠癌手术患者随机分成两组,使用加速康复外科理念的术后护理方法30例作为加速康复组,使用传统的术后护理方法30例作为传统对照组,比较两组患者耐受半流饮食时间、术后肠道通气时间、术后住院天数以及术后并发症发生情况.结果 加速康复外科理念的术后护理方法与传统的术后护理方法相比,耐受半流饮食和肠道恢复通气时间明显提前(P＜0.01),住院时间明显缩短(P＜0.01),术后并发症的发生率差异无统计学意义(P＞0.05).结论 加速康复外科术后护理方法较传统的术后护理方法提供了更好的医疗服务,而且加快了患者术后肠道恢复,缩短了住院时间,并不增加术后并发症的发生率.     

Choroidal melanoma.

Choroidal melanoma is a rare and deadly cancer. Nursing care for these patients involves ophthalmic clinical expertise as well as psychosocial and emotional support. Although past research has been helpful in determining the prognosis of these patients, it is impossible to predict with certainty which patients have tumors or nevi that will grow, will compromise their vision, or will kill them. Providing emotional support, establishing a good rapport with the patients and their support persons, and encouraging patients to schedule and adhere to their mutually agreed on follow-up appointments are nursing interventions that may save or prolong a patient's life.     

Nurse/patient dependency — is it iatrogenic?

It is often assumed that nursing care is given in response to the patient's degree of incapacity. This study indicates that rather than nursing care arising as a response to patients' dependency, nursing care is producing dependency. A considerable proportion of the measured dependency of 168 elderly patients arose from the type of nursing care they received--it was iatrogenic. Task allocation nursing was found to be positively unhealthy for elderly long-stay patients, whilst individualized care (nursing process) was associated with lower patient dependency, a shorter hospital stay and a better chance of surviving the hospital stay. The findings demonstrate the inadequacy of nurse staffing formulas which are based on patient dependency. It is suggested that despite the rising numbers of very old people in the population, the elimination of nurse-induced dependency could reduce the level of dependency in geriatric wards.     

Documentation and communication of nutritional care for elderly hospitalized patients: perspectives of nurses and undergraduate nurses in hospitals and nursing homes

Background

Nutritional care is a basic human right for all people. Nevertheless, undernourishment is known to be a frequent and serious health care problem among elderly hospitalized patients in Western Europe. Nutritional documentation contributes to ensuring proper nutritional treatment and care. Only a few studies have explored how nurses document nutritional care in hospitals, and between hospitals and nursing homes. Available research suggests that documentation practices are unsatisfactory. The aim of this study was to explore how nurses document nutritional treatment and care for elderly patients in hospitals and how nurses and undergraduate nurses communicate information about patients’ nutritional status when elderly patients are transferred between hospital and nursing homes.

Methods

A qualitative study was conducted using a phenomenological-hermeneutic approach. Data was collected in focus group interviews with 16 nurses in one large university hospital, and 11 nurses and 16 undergraduate nurses in five nursing homes associated with the university hospital. Participants from the university hospital represented a total of seven surgical and medical wards, all of which transferred patients to the associated nursing homes. The catchment area of the hospital and the nursing homes represented approximately 10% of the Norwegian population in heterogenic urban and rural municipalities. Data were coded and analysed thematically within the three contexts: self-understanding, critical common sense, and theoretical understanding.

Results

The results were summarized under three main themes 1) inadequate documentation of nutritional status on hospital admission, 2) inadequate and unsystematic documentation of nutritional information during hospital stay, 3) limited communication of nutritional information between hospital and nursing homes. The three main themes included seven sub-themes, which reflected the lack of nutritional screening and unsystematic documentation on admission and during hospital stay. Further the sub-themes elucidated poor exchange of information between hospital and nursing homes regarding the nutritional status of patients.

Conclusion

Overall, the documentation of nutritional treatment and care for elderly patients was inadequate in the hospital and between health care settings. Inappropriate documentation can create a negative nutritional spiral that leads to increased risk of severe health related complications for elderly patients. Moreover, it hinders nutritional follow-up across health care settings.

     

Management of COPD using the Roper-Logan-Tierney framework

This article reviews the health condition of a patient with chronic obstructive pulmonary disease (COPD). It discusses the use of the Roper-Logan-Tierney activities of daily living framework model, in conjunction with the nursing process to identify the patient's main priorities for nursing care. COPD is the fifth most common cause of morbidity and mortality in the UK. It is a chronic illness often caused by smoking. The disease is a life-long illness and can affect all aspects of the person's life. Furthermore, exacerbations are often poorly controlled resulting in more frequent admissions to hospital, placing more pressure on patients, nurses and healthcare services. Aspects of care related to breathing, eating and drinking, and maintaining a safe environment are explored. The nursing process, as a systemic tool, can help in identifying and understanding the individual needs of patients and aid in establishing patient-centred therapeutic care.     

癌症病人疼痛情况及其护理需求调查研究

目的 :调查癌性疼痛病人疼痛控制情况 ,了解疼痛时的护理需求。方法 :以问卷形式对 10 7例住院癌性疼痛病人进行受疼痛困扰情况、疼痛程度、止痛需求、使用止痛药物后疼痛缓解程度及护理需求进行调查。结果 :癌痛治疗方面的某些错误观念致使目前癌痛的控制情况并不理想 ,同时癌痛病人对护理的需求也是多方面的。结论 :疼痛严重影响着癌痛病人的生活质量 ;医护人员应积极做好病人及家属的宣传教育 ,并以周到的护理行为满足疼痛病人的护理需求