规范化的营养管理对头颈癌放疗患者营养状况的影响

目的探讨规范化的营养管理对头颈癌放疗患者营养状况的影响。方法收集2016年1月至2017年10月间四川省肿瘤医院放疗科68例头颈癌放疗患者的临床资料,按照随机数字表法分为对照组与观察组各34例,对照组给予常规营养管理,观察组提供规范化的营养管理,对比两组患者治疗期间体重、白蛋白、总淋巴细胞计数、血红蛋白以及血清前白蛋白等相关指标的变化。结果观察组放疗前、放疗4周、放疗结束后体重分别为（62.9±3.5）kg、（60.9±2.5）kg、（60.2±1.4）kg,差异具有统计学意义（F组间=9.79,P<0.001;F时间=23.71,P<0.001;F交互=16.69,P<0.001）;对照组体重分别为（62.4±3.6）kg、（58.9±2.4）kg、（56.2±1.2）kg,差异具有统计学意义（F组间=47.73,P<0.001;F时间=114.38,P<0.001;F交互=88.75,P<0.001）,观察组体重丢失幅度明显低于对照组,差异有统计学意义（P<0.05）;治疗前观察组与对照组白蛋白、血清前白蛋白含量、总淋巴细胞计数、血红蛋白含量分别为（44.2±3.4）g/L、（280.1±58.5）mg/L、（1.86±0.66）×109/L、（129.8±14.1）g/L、（43.6±3.6）g/L、（273.7±49.4）mg/L、（1.89±0.84）×109/L、（140.0±12.6）g/L,放疗4周后、放疗结束时两组各指标均有所下降,观察组各血液指标下降幅度同样低于对照组,差异有统计学意义（P<0.05）;观察组治疗期间放射性口腔炎、放射性皮炎等不良反应发生率分别为5.88%、2.94%,明显低于对照组17.65%、14.71%,差异有统计学意义（P<0.05）。结论规范化的营养管理在头颈癌放疗患者营养干预中效果显著,能有效改善营养状况并降低并发症发生率。     

恶性肿瘤住院患者营养状况和生活质量调查及分析

目的：调查恶性肿瘤住院患者的营养状况,并对其生活质量进行分析。方法：本研究是一项多中心、横断面研究,纳入 2014 年 4 月至 2019 年 1 月在全国多家三甲医院接受治疗的恶性肿瘤患者为研究对象。应用营养风险筛查 2002 量表（Nutrition Risk Screening 2002,NRS 2002）与患者主观整体营养状态评估量表（Patient-Generated Subjective Global Assessment,PG-SGA）进行营养风险筛查与评估,利用生物电阻抗技术进行人体成分检测,利用欧洲癌症研究治疗组织生命质量评估问卷（European Organization for Research and Treatment of Cancer Quality of Life Questionnaire 30-Item Core Instrument,EORTC QLQ-C30）V3.0 调查问卷进行生活质量评价。依据 PG-SGA 评分将患者分为营养良好 / 可疑营养不良（0 ~ 3 分）、轻度 / 中度营养不良（4 ~ 8 分）与重度营养不良（≥ 9 分）3 组,对比分析 3 组患者的去脂体重、相位角等人体成分指标及躯体功能、疼痛等生活质量各项指标。结果：本研究最终共纳入 589 例恶性肿瘤患者。营养不良的发生率高达 85.91%,而未得到营养干预的比例达 80.56%。老年（92.60%）、女性（91.62%）及有合并症的患者（92.01%）营养不良的发生率较高（P < 0.05）。随着 PG-SGA 等级的升高,患者的肌肉质量、四肢骨骼肌质量指数与相位角等人体成分指标呈逐渐降低的趋势（P < 0.05）。营养不良患者（PG-SGA 评分≥ 4 分）的躯体功能、角色功能等生活质量评价指标较低（P < 0.05）,而疲倦、疼痛等生活质量评价指标较高（P < 0.05）。同时 PG-SGA 与肌肉质量（r = -0.184,P < 0.05）、四肢骨骼肌质量指数（r = -0.208,P < 0.05）、相位角（r = -0.390,P < 0.05）等人体成分指标及角色功能（r = -0.386,P < 0.05）、认知功能（r = -0.326,P < 0.05）等生活质量评价指标呈负相关,与恶心呕吐（r = 0.675,P < 0.05）及食欲丧失（r = 0.489,P < 0.05）等生活质量评价指标呈正相关。结论：恶性肿瘤住院患者营养不良的发生率较高,而营养干预相对匮乏。肿瘤患者营养不良的发生率受年龄、性别、疾病类型以及治疗方式等的影响。同时,营养不良严重影响患者的人体成分与生活质量,且不利于患者的预后与康复。     

癌性贫血对肺癌患者生活质量及预后的影响

目的:统计肺癌患者治疗前后癌性贫血发生率,分析其危险因素,探讨癌性贫血对肺癌患者生活质量(QOL)和预后的影响.方法:回顾性分析我院240例肺癌患者的临床资料,统计其治疗前后癌性贫血的发生率,分析其与性别,年龄、临床分期、PS评分、血清白蛋白水平和化疗的关系.应用QOL量表EORTCQLQ-C30中文版评价癌性贫血对肺癌患者QOL的影响,并探讨其对肺癌患者生存的影响.结果:240例肺癌患者,总体癌性贫血发生率为52.5%,治疗后癌性贫血发生率明显高于治疗前(15.8%,P=0.000).化疗者癌性贫血发生率明显高于未化疗者(57.7% vs 36.2%,P=0.004),化疗后明显高于化疗前(57.7% vs 19.2%,P=0.000).单因素和Logistic多因素回归分析均证实,年龄、临床分期、血清白蛋白水平及化疗是影响癌性贫血的危险因素(P均＜0.05).性别和病理类型与癌性贫血无关.癌性贫血明显影响肺癌患者的QOL;发生癌性贫血的患者生存期明显短于未发生癌性贫血者(9个月vs14个月,P=0.000).Cox多因素回归分析证实,癌性贫血、临床分期、PS评分是影响肺癌患者预后的独立因素.结论:肺癌患者有较高的癌性贫血发生率,癌性贫血与年龄、临床分期、血清白蛋白水平及化疗密切相关,年龄越大、分期越晚,癌性贫血发生率越高越重.癌性贫血不但影响肺癌患者的QOL,还影响其预后.     

营养干预对宫颈癌患者同步放化疗耐受性及生活质量的影响

目的:探讨营养干预对宫颈癌患者同步放化疗耐受性及生活质量(QOL)的影响。方法:将86例宫颈癌患者随机分为营养干预组和对照组,观察两组患者的放疗中断率、化疗完成次数及放疗剂量达40Gy时生活质量评分情况。结果:营养干预组的放疗中断率为2.3%（1/43）,对照组为18.6%（8/43）,P=0.03;营养干预组完成化疗周期数为4.0±0.98,对照组为3.3±1.28,P=0.005;放射剂量达40Gy时两组患者QOL评分的差异有统计学意义（P＜0.01）。结论:营养干预能有效提高宫颈癌患者同步放化疗的耐受性,提高其生活质量。     

规范化癌痛护理干预对肿瘤患者癌痛控制及生活质量的影响

目的探讨规范化癌痛护理干预对肿瘤患者癌痛控制及生活质量的影响。方法选取2014年2月至2016年2月间陕西省肿瘤医院收治的80例癌痛患者,采用随机数表法分为观察组与对照组,每组40例。在常规癌痛药物治疗的基础上,观察组患者采用规范化癌痛护理干预,对照组患者采用常规护理干预。3个月后,观察比较两组患者干预前后的癌痛程度和生活质量改善情况。结果两组患者治疗后疼痛数字分级法(NRS)评分均较治疗前下降,且观察组下降幅度显著大于对照组,差异均有统计学意义(均P<0.01)。观察组患者护理干预后,躯体功能、角色功能、情绪功能、认知功能、社会功能、总健康状况和总生活质量均高于对照组患者,差异均有统计学意义(均P<0.05)。观察组患者护理干预后,各症状评分均低于对照组患者,差异均有统计学意义(均P<0.05)。结论规范化癌痛护理干预可有效缓解癌痛患者躯体疼痛,提高患者生活质量,临床应用价值高。     

索拉非尼对中晚期肝细胞癌患者近期生活质量的影响北大核心CSCD

目的研究索拉非尼治疗三月后对中晚期肝细胞癌患者生活质量的影响。方法运用EORTC QLQ-C30量表评定36例口服索拉非尼治疗患者的生活质量,分析比较患者治疗前与治疗后3月生活质量的变化。结果 患者在躯体功能、疲倦、恶心呕吐、疼痛、便秘、腹泻及经济方面的评分,差异有统计学差异(P<0.05),总体生活质量无明显变化。结论索拉非尼作为分子靶向治疗新药,不仅可延长肝细胞癌患者的生存期,且近期生活质量无明显下降,耐受性较好。     

药物干预对中重度晚期癌痛患者生活质量影响的临床研究

目的：调查与分析药物干预对58例中重度晚期癌痛患者疗效及生活质量的影响。方法选择58例中重度晚期癌性疼痛患者,合理规范使用三阶梯镇痛药物,利用简明疼痛调查量表（BPI）及癌症患者生活质量量表（QOL-C30）对患者治疗前、治疗后1周及治疗后1个月情况进行调查和分析。结果患者药物治疗后 NRS（numeral rating scale）评分较治疗前低（P ＜0．05）,治疗后1周及治疗后1个月的疼痛缓解总有效率分别为86．1％及91．3％。药物的主要不良反应有便秘、恶心、呕吐、排尿困难、嗜睡、瘙痒等,QOL-C30量表六项功能指标及总体健康、总体生活质量评价治疗前后均存在显著性差异（均P ＜0．05）,其中角色功能、认知功能、总体健康及总体生活质量评价治疗后两阶段（1周及1个月）相比较存在显著性差异（均 P ＜0．05）。结论药物干预对中重度晚期癌痛患者有效,药物不良反应如消化道反应恶心、呕吐、便秘等不容忽视,生活质量中身体功能、情绪功能及社会功能应得到长期关注,并采取相应措施干预,不断改善和提高患者整体生活质量。     

系统性护理干预对中重度癌痛患者及家属生活质量的影响

目的探讨系统性护理干预对中重度癌痛患者及家属生活质量的影响。方法选取2013年9月至2015年7月间河北工程大学附属医院收治的94例肺癌晚期伴中重度癌痛患者,采用随机数表法分为观察组与对照组,每组47例。观察组患者给予系统性护理干预,对照组患者给予常规护理,干预一个月后,比较两组患者的癌痛缓解程度、依从性和治疗满意程度,采用焦虑自评量表(SAS)和抑郁自评量表(SDS)对患者焦虑和抑郁程度进行评价,并比较两组患者和家属的生活质量与心理状态。结果经过系统性护理干预后,观察组患者的依从性、癌痛缓解有效率及对治疗的总满意率,均显著高于对照组患者,两组组间比较,差异有统计学意义(P<0.05);两组患者疼痛视觉模拟评分表(VAS)、SAS和SDS评分均明显下降,且观察组各指标下降更明显,组间比较,差异有统计学意义(P<0.05);组内治疗前后比较,两组患者的食欲、睡眠、精神状态、日常活动、抑郁、焦虑、恐惧、消极和自信程度均有显著改善,差异有统计学意义(P<0.05);组间治疗后比较,除食欲外的上述指标均表现为观察组好于对照组,组间比较,差异有统计学意义(P<0.05);家属生活质量与心理状态治疗后比较,全部指标均表现为观察组好于对照组,差异有统计学意义(P<0.05)。结论系统性护理干预能改善中重度癌痛患者的依从性,缓解癌痛,提高患者的治疗满意度,并提高患者和家属的生活质量。     

蛋白质摄入量对头颈部肿瘤放化疗期间人体成分及生活质量的影响

目的 探讨蛋白质摄入量对头颈部肿瘤患者放化疗期间营养状况、人体成分及生活质量的影响。方法83例头颈部肿瘤患者均采用患者主观整体评估方法对放疗前后的营养状态进行评估以及营养干预（饮食指导、ONS、PN）,按实际蛋白质摄入量0.8g/(kg·d)为界分为A组[≥0.8g/(kg·d)]和B组[＜0.8g/(kg.d)],采用生物电阻抗法观察两组患者放疗前后的人体成分变化及肿瘤患者生命质量测定表（EORCT QLQ-C30）观察两组患者放疗前后生活质量的变化。结果 两组患者放疗前营养不良发生率无统计学差异（P≥0.5）,放疗结束后A组营养不良发生率、握力前后变化值明显低于B组,差异有统计学差异,P＜0.05;体成分变化方面,A组在体重变化、体重变化百分比、BMI变化、体脂变化百分比、去脂体重变化、肌肉质量变化、去脂体重指数变化方面均明显低于B组,差异有统计学意义,P＜0.05;两组患者放疗前生活质量评分没有统计学差异,放疗结束后A组在疲劳、失眠、食欲丧失、疼痛、总体生活质量变化方面均优于B组,差异有统计学意义,P＜0.05。结论 应对头颈部肿瘤患者放疗期间进行全程的营养干预,重视头颈部肿瘤患者放化疗期间蛋白质、能量的摄入,可改善患者的营养状态及体力,对体成分变化、提高患者的生活质量有益处。     

Quality of Life in Patients of Head and Neck Cancer During Covid 19

The Indian Institute of head and neck oncology, a charitable Cancer Centre under the Indore Cancer foundation, continued to offer treatment during the Covid pandemic. 44 head and neck cancer patients who underwent surgery with adjuvant radiotherapy and 43 head and neck cancer patients who underwent only radiotherapy as the primary line of treatment from March 2020 to May 2021, were selected for the purpose of this study. Patients who underwent treatment for head and neck cancer either by radiotherapy or by surgery followed by post-operative radiotherapy were analysed to evaluate quality of life. Feedback was obtained using a QOL questionnaire. The results were analysed against numerical scores. Pain, appearance, speech, swallowing, chewing taste sensation etc. were analysed. Fear and psychological discomfort remained the overriding aspect.     

Quality of life and outcomes research in head and neck cancer: A review of the state of the discipline and likely future directions

Quality of life (QOL) is by definition a multi-dimensional global construct that has become an increasingly important outcome measure in cancer treatment. The impact of a head and neck cancer (HNC) diagnosis on the person and the consequences of its treatment cross multiple functional domains that have a clear and direct influence on one’s post-treatment well-being and associated QOL. The evaluation of QOL and performance outcome in cancer is critical to optimal patient care, comprehensive evaluation of treatment alternatives, and the development of informed rehabilitation and patient education services. Despite the difficulties of going from concept to quantification of patient perceptions, the number of instruments available to measure QOL psychometrically has increased rapidly. Assessments can now be made in a variety of distinctive ways using both specific and generic measures. There is no gold-standard questionnaire and the choice is based on psychometric properties, research objectives and study design. QOL assessment has evolved over the years into an organised scientific discipline, such that useful insights can be obtained by a review of the current literature. However, more work needs to be done to improve the applicability and clinical utility of QOL assessment. Most importantly, QOL studies should be reported in such a way as to provide clinically meaningful data to physicians and surgeons, in order to link research to clinical practice. Further attention should be paid to the development of newer theoretical models, minimalist approaches, development of more sensitive and specific instruments and the effective use of modern technology to achieve this objective.     

Evidence-based review: Quality of life following head and neck intensity-modulated radiotherapy

Inverse planned Intensity modulated radiotherapy (IMRT) can minimize the dose to normal structures and therefore can reduce long-term radiotherapy-related morbidity and may improve patients’ long-term quality of life. Despite overwhelming evidence that IMRT can reduce late functional deficits in patients with head and neck cancer, treated with radiotherapy, a review of the published literature produced conflicting results with regard to quality of life outcomes. Following a critical appraisal of the literature, reasons for the discrepant outcomes are proposed.     

Impact of radiation-induced xerostomia on quality of life after primary radiotherapy among patients with head and neck cancer

PURPOSE: To investigate the impact of xerostomia on overall quality of life (QoL) outcome and related dimensions among head and neck cancer patients treated with primary radiotherapy. METHODS AND MATERIALS: A total of 288 patients with Stage I-IV disease without distant metastases were included. Late xerostomia according to the Radiation Therapy Oncology Group (RTOG-xerostomia) and QoL (European Organization for Research and Treatment of Cancer QLC-C30) were assessed at baseline and every 6th month from 6 months to 24 months after radiotherapy. RESULTS: A significant association was found between RTOG-xerostomia and overall QoL outcome (effect size [ES] 0.07, p < 0.001). A significant relationship with global QoL, all functioning scales, and fatigue and insomnia was observed. A significant interaction term was present between RTOG-xerostomia and gender and between RTOG-xerostomia and age. In terms of gender, RTOG-xerostomia had a larger impact on overall QoL outcome in women (ES 0.13 for women vs. 0.07 for men). Furthermore, in women ES on individual scales were larger, and a marked worsening was observed with increasing RTOG-xerostomia. No different ES according to age was seen (ES 0.10 for 18-65 years vs. 0.08 for >65 years). An analysis of the impact of RTOG-xerostomia on overall QoL outcome over time showed an increase from 0.09 at 6 months to 0.22 at 24 months. With elapsing time, a worsening was found for these individual scales with increasing RTOG-xerostomia. CONCLUSIONS: The results of this prospective study are the first to show a significant impact of radiation-induced xerostomia on QoL. Although the incidence of Grade > or =2 RTOG-xerostomia decreases with time, its impact on QoL increases. This finding emphasizes the importance of prevention of xerostomia.     

Long-term quality of life after treatment for locally advanced oropharyngeal carcinoma: Surgery and postoperative radiotherapy versus concurrent chemoradiation

The aim of this study was to evaluate the long-term quality of life (QoL) in survivors with oropharyngeal carcinoma (OC) treated with surgery and postoperative radiotherapy (PORT) versus concurrent chemoradiation (CRT) using the European Organization for Research and Treatment of Cancer QoL Questionnaires. The study group consisted of 57 patients. The scores for physical (P = 0.043) and social (P = 0.036) functioning were significantly more favorable in the chemoradiation group. Surgical patients showed statistically higher problems with fatigue (P = 0.047), pain (P = 0.027), swallowing (P = 0.042), social eating (P = 0.038) and social contact (P = 0.002). CRT group reported significantly greater problems with teeth (P = 0.049), open mouth (P = 0.036), dry mouth (P = 0.022) and sticky saliva (P = 0.044). The global QoL score was higher in CRT group (P = 0.027). These results support an organ preservation approach with CRT in patients with advanced OC. However, considering the absence of randomized trial comparing outcomes after surgical versus nonsurgical approaches, severe xerostomia following CRT, the higher postoperative morbidity in the setting of salvage surgery, future prospective clinical trials on greater samples of patients are needed to confirm our conclusions.     

Nutritional counseling with or without systematic use of oral nutritional supplements in head and neck cancer patients undergoing radiotherapy

Background

To evaluate the benefit of oral nutritional supplements (ONS) in addition to nutritional counseling in head and neck cancer (HNC) patients undergoing radiotherapy (RT).

The course of health-related quality of life in head and neck cancer patients treated with chemoradiation: A prospective cohort study

Background and purpose

To evaluate the course of health-related quality of life (HRQOL) from diagnosis to 2 years follow-up in patients with head and neck cancer (HNSCC) treated with chemoradiation (CRT).

Materials and methods

164 patients completed the EORTC QLQ-C30 and QLQ-H&N35 questionnaires 1 week before and 6 weeks and 6, 12, 18, and 24 months after CRT. Patients were compared to a reference group. A linear mixed-model analysis was used to assess changes in HRQOL over time, and whether this was associated with age, gender, comorbidity, and tumor sublocation.

Results

Significant differences for the majority of HRQOL scales were observed between patient and reference group at baseline, and follow-up. The course of HRQOL was different for survivors compared to non-survivors. In survivors, improvement over time was observed (in global quality of life, physical, role, and social function, fatigue, pain, swallowing, speech, social eating, and social contacts), while in non-survivors the pattern over time was either no changes in HRQOL or a deterioration (in physical function, social eating and contacts). In both survivors and non-survivors, emotional functioning improved after treatment, but deteriorated in the longer term. Patients with comorbidity reported worse physical function, and patients with oral/oropharyngeal cancer (compared to hypopharyngeal/laryngeal cancer) reported more oral pain and sexual problems, but fewer speech problems.

Conclusions

The course of HRQOL of HNSCC patients during the first 2 years after CRT is different for survivors compared to non-survivors and is associated with comorbidity and tumor subsite.     

头颈部放射性口腔黏膜炎患者营养状况与生活质量相关性研究

目的 探讨头颈部肿瘤放射性口腔黏膜炎的患者营养状况与生活质量的相关性。 方法 采用一般资料问卷、癌症患者生活质量量表（QLQ-C30）、患者主管整体评定量表（PG-SGA）、美国国家癌症研究所常见毒性反应标准（NCI-CTCAE）量表对80例头颈部放射性口腔黏膜炎患者进行调查。结果 80例符合入选标准的患者,其中男51例,女29例。年龄19~80（58.21±11.84）岁。PG-SGA评价结果：A级患者为12例,B级患者为35例,C级患者为 33例。躯体功能、角色功能、认知功能、社会功能、总体健康状况及疲倦、疼痛、便秘、腹泻等症状与营养状况存在明显相关性（P＜0.05）,情绪功能、恶心呕吐、气促、失眠、食欲丧失、经济困难与营养状况无明显相关性（P>0.05）。 结论 头颈部放射性口腔黏膜炎患者存在着不同程度的营养不良,其营养状况与生活质量呈正相关关系（P＜0.01）。因此,改善头颈部放射性口腔黏膜炎患者的营养状况可大幅度提高患者的生活质量,改善临床治疗结局,为今后制定护理干预措施提供参考依据。     

Evaluation of the information given to patients undergoing head and neck cancer surgery using the EORTC QLQ-INFO25 questionnaire: A prospective multicentric study

AimProviding head and neck cancer patients with adequate information is essential to their confidence and satisfaction regarding medical care. The aims of this study were to evaluate patient perceptions of the information received, the predictive factors of such perceptions and their potential correlation with patient quality of life (QoL).MethodsWe conducted a prospective multicentric study using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-INFO25 and QLQ-C30 questionnaires before and after surgery.ResultsThis study enrolled 200 patients, 149 men and 51 women, mean age 63.5 ± 10.3 years. Before and after treatment, global QLQ-INFO25 scores were 39.3 and 42.5, respectively, whereas satisfaction with the information received scores were 69.9 and 58.1, respectively. Regarding EORTC QLQ-INFO25 scores, between the pre- and post-treatment periods, we observed a significant increase in three scales/items (information about other services, information about different places of care and information about things you can do to help yourself) and a significant decrease in two scales/items (satisfaction with the information received and overall the information has been helpful). Before and after treatment, global QoL scores were 62.7 and 61.0, respectively. Overall, we found low correlations between QLQ-INFO25 and QLQ-C30 scores. Patient age and education level, centre of care, tumour site and treatment characteristics had a significant impact on QLQ-INFO25 scores.ConclusionPerceived information was satisfactory in the perioperative period for head and neck cancer patients. Several demographic and clinical factors were identified as significant predictors of QLQ-INFO25 scores.