营养指导在胃癌术后患者中的应用

目的：了解胃癌患者术后进食情况及营养指导的作用。方法：选取2015年3月至年2016年5月期间我院普外科确诊为胃癌并行手术者133例,随机分为对照组和研究组,对对照组患者进行常规健康教育,对研究组患者在术后开始进食时由专业营养师进行饮食营养教育,观察两组患者进食半月后的进食内容、进食餐次、进食量、体重变化情况及进食中的不适症状。结果：研究组进食能量高于对照组[（1095．91±385）kCal vs （932．00±315．43）kCal,P ＝0．008],研究组体重下降低于对照组[（1．68±2．70）kg vs （3．95±3．26）kg]。结论：对胃癌术后患者进行专业饮食营养指导对改善患者进食量和减少体重下降是有效的。     

Dietary changes among cancer survivors

Given the limited scientific knowledge about dietary factors that affect cancer recurrence, dietary guidelines for cancer survivors are similar to general recommendations on healthy eating. This study explored the patterns of and motivation for, dietary changes among cancer patients. We conducted in-person interviews with 143 cancer survivors who were chosen from a mail survey on complementary and alternative medicine among cancer patients. We applied qualitative analysis using the software package NUD*IST to sort and code the transcribed interviews. The majority of dietary changes reported by 69 cancer patients agreed with current nutritional recommendations, such as decreasing meat and fat intake and increasing the consumption of vegetables and fruits. However, many diet changers also reported the intake of herbal and vitamin supplements, many with unproven effects. The major themes for changing diet were hopes that nutrition would increase well-being, maintain health and prevent cancer recurrence and beliefs that foods that cause or prevent cancer should be avoided and increased, respectively. Many cancer patients use non-scientific reasons when deciding on dietary changes and supplement use. Increasing communication with health care providers may prevent the use of extreme diets, unproven and possibly harmful supplements and reduce exaggerated hopes related to the benefits of a particular dietary regimen.     

Patient information preferences among breast and prostate cancer patients

Preferences for information about their disease and treatment were collected from 392 patients who had been treated for either breast or prostate cancer an average of 2 years previously. Type of information that they had received, their ratings of its value to them and their preferred format for further information were examined. The most common and most preferred form of information was through doctor interview, followed by educational booklets. Prostate cancer patients preferred videotapes; breast cancer patients tended to prefer individualized approaches including a tour of the department. Effects of age, educational levels, occupational backgrounds and self‐reports for anxiety and depression at the time of the survey and at time of diagnosis were analysed. Prostate cancer patients who were most severely depressed showed a preference for not receiving any information at all, perhaps reflecting a tendency towards withdrawal.     

新型冠状病毒肺炎疫情下肿瘤患者居家防护和饮食指导

新型冠状病毒肺炎疫情下,肿瘤患者免疫力低下,属于易感人群。营养不良是肿瘤患者最常见的营养问题,肿瘤患者作为特殊的人群值得被关注。本文从患者居家防护与饮食指导方面进行阐述,以期在特殊时期为肿瘤患者提供指导。     

The effect of dietary intake changes on nutritional status in acute leukaemia patients after first induction chemotherapy

This study aimed to evaluate how changes in dietary intake among acute lymphoblastic and acute myeloid leukaemia (ALL and AML) patients affect nutritional status after the first induction chemotherapy. Dietary intake was assessed using 24‐h recall and a 136‐item food frequency questionnaire. Nutritional status was assessed by Patients Subjective Global Assessment questionnaire before starting induction therapy and again after 1 month. All newly diagnosed acute leukaemia patients aged 15 years old and older who attended three referral hospitals for initiation of their induction chemotherapy were included in the sample selection provided that they gave informed consent. A total of 30 AML and 33 ALL patients participated in the study. Dietary intake and nutritional status worsened after the chemotherapy treatment. Dietary intake in terms of macronutrients, micronutrients, food variety and diet diversity score changed significantly after the induction chemotherapy. No significant relationship was found between the changes in dietary indices and nutritional status. Chemotherapy‐related side effects as an additional factor to cancer itself could affect dietary intake of leukaemia patients. The effectiveness of an early assessment of nutritional status and dietary intake should be further investigated in order to deter further deterioration.     

食管癌高发区农村居民饮食状况调查及防治分析

目的:调查分析食管癌高发区农村居民饮食状况,为食管癌的预防供参考依据。方法:用自制问卷对盐亭县3个乡镇20岁以上农村居民的饮食状况进行走访入户调查。结果:调查有效问卷共937人,男性491人（52.4%）,女性446人（47.6%）,平均年龄（52.8±17.6）岁。饮用自来水、深井水及其他类型清洁水源的农村居民分别为674人（71.9%）、106人（11.3%）、37人（3.9%）,饮用浅井水、河水的居民分别为54人（5.8%）、2人（0.2%）。近一年对水果、豆制品食用频率大的居民分别为356人（38.0%）、294人（31.4%）,近十年食用频率逐渐变大的居民分别为246人（26.3%）、175人（18.7%）。近一年对泡菜、酸菜、腌菜、烧烤、烫热食物食用频率小的居民分别为450人（48.0%）、437人（46.6%）、621人（66.3%）、541人（57.7%）、443人（47.3%）,近10年食用频率逐渐变小的居民分别为277人（29.6%）、315人（33.6%）、328人（35.0%）、314人（33.5%）、304人（32.4%）。14.5%的居民喜食较硬米饭,17.2%的居民喜食较咸的菜,46.5%的居民喜食温度较高的食物,32.4%的居民进食速度较快。调查的491名男性中有205人（41.8%）经常吸烟,有190人（38.7%）经常饮酒。结论:食管癌高发地区的防治工作已有明显成效,但部分农村居民仍存在不良的饮食习惯,我们应进一步加强饮食习惯和一级预防的联系,降低食管癌发病率和死亡率。     

Patients' preferences for low rectal cancer surgery

Aim

To elicit surgery preferences of patients who have experience with either low anterior resection (LAR) or abdominoperineal resection (APR) and its outcomes, to support decision-making in future patients with resectable rectal cancer.

Methods

One hundred and twenty-two patients were interviewed. Surgery preference was assessed in two ways. In the treatment trade-off method, the certainty of a stoma was hypothetically weighed against the risk of incontinence. In the time trade-off method, remaining life expectancy was traded off to avoid a permanent stoma or faecal incontinence.

Results

To avoid APR, LAR patients accepted a much higher risk of incontinence than APR patients. In fact, 71% of the LAR patients chose LAR if they would certainly suffer monthly incontinence, and still 32% if they would certainly suffer daily incontinence. Nevertheless, APR patients would give up less remaining life years to be without a permanent stoma than LAR patients to be without monthly incontinence.

Conclusions

Most patients preferred LAR above APR, even if LAR involved a risk of faecal incontinence. This seems to justify that LAR, if surgically possible, is performed in the first instance. However, since APR patients could live well with a permanent stoma, we recommend clearly informing patients before surgery about the surgical options and their potential outcomes.     

Treatment preferences and involvement in treatment decision making of patients with endometrial cancer and clinicians

Background:

Vaginal brachytherapy (VBT) in high–intermediate-risk endometrial cancer (EC) provides a significant reduction in the risk of local cancer recurrence, but without survival benefit and with increased mucosal atrophy. Five-year local control is estimated to be similar for VBT and a watchful waiting policy (WWP), in which patients receive VBT combined with external radiation in case of a recurrence. Our aim was to assess treatment preferences of EC patients and clinicians regarding VBT and WWP, and to evaluate their preferred and perceived involvement in treatment decision making.

Methods:

Interviews were held with 95 treated EC patients. The treatment trade-off method was used to assess the minimally desired benefit from VBT in local control. Patients'' preferred and perceived involvement in decision making were assessed using a questionnaire. Seventy-seven clinicians completed a questionnaire assessing their minimally desired benefit and preferred involvement in decision making.

Results:

Minimally desired benefit of VBT was significantly lower for patients than for clinicians (median=0 vs 8%, P<0.001), for irradiated than for non-irradiated patients (median=0 vs 6.5%, P<0.001), and for radiation oncologists than for gynaecologists (median=4 vs 13%, P<0.001). Substantial variation existed within the groups of patients and clinicians. Participants preferred the patient and clinician to share in the decision about VBT. However, irradiated patients indicated low perceived involvement in actual treatment decision making.

Conclusions:

We found variations between and within patients and clinicians in minimally desired benefit from VBT. However, the recurrence risk at which patients preferred VBT was low. Our results showed that patients consider active participation in decision making essential.     

Adult dietary fat intake and ovarian cancer risk

The association of dietary fat intake with ovarian cancer risk has been inconsistent across populations. We examined dietary fat intake, overall and by type and ovarian cancer risk in two prospective cohort studies. We assessed long-term dietary fat intake among Nurses’ Health Study (NHS) and NHSII participants using food frequency questionnaires administered every 2–4 years beginning in 1984 and 1991, respectively. We examined cumulative energy-adjusted intake of total fat, specific types of fat (animal, vegetable, saturated, monounsaturated, polyunsaturated and trans fat) and cholesterol. We identified 700 ovarian cancer cases in NHS and 196 in NHSII with dietary information. Cox proportional hazards regression was used to estimate associations between intake and ovarian cancer risk. Dietary fat intake changed over time in both cohorts and was lower in NHS than NHSII. Higher cumulative average intakes of animal fat and cholesterol were significantly positively associated with risk of ovarian cancer in NHS (relative risk [RR] comparing extreme quartiles = 1.57, 95% CI: 1.20, 2.06 and 1.35, 95% CI: 1.08, 1.69, respectively), but not in NHSII. Other dietary fat sources were not clearly associated with risk in either population. We did not observe clear associations between dietary fat and ovarian cancer risk in two large prospective cohort studies.     

Mediterranean dietary pattern and cancer risk in the EPIC cohort

Background:

Although several studies have investigated the association of the Mediterranean diet with overall mortality or risk of specific cancers, data on overall cancer risk are sparse.

Methods:

We examined the association between adherence to Mediterranean dietary pattern and overall cancer risk using data from the European Prospective Investigation Into Cancer and nutrition, a multi-centre prospective cohort study including 142 605 men and 335 873. Adherence to Mediterranean diet was examined using a score (range: 0–9) considering the combined intake of fruits and nuts, vegetables, legumes, cereals, lipids, fish, dairy products, meat products, and alcohol. Association with cancer incidence was assessed through Cox regression modelling, controlling for potential confounders.

Results:

In all, 9669 incident cancers in men and 21 062 in women were identified. A lower overall cancer risk was found among individuals with greater adherence to Mediterranean diet (hazard ratio=0.96, 95% CI 0.95–0.98) for a two-point increment of the Mediterranean diet score. The apparent inverse association was stronger for smoking-related cancers than for cancers not known to be related to tobacco (P (heterogeneity)=0.008). In all, 4.7% of cancers among men and 2.4% in women would be avoided in this population if study subjects had a greater adherence to Mediterranean dietary pattern.

Conclusion:

Greater adherence to a Mediterranean dietary pattern could reduce overall cancer risk.     

Decision‐making preferences and information needs among Greek breast cancer patients

Objectives: We aimed at assessing Greek breast cancer patients' preferences for participation in treatment decision making and their information needs. Methods: In a cross‐sectional study, 329 breast cancer patients were administered at the Control Preferences Scale, a card‐sort measurement designed to elicit preferences for participation in decision making. Information needs were assessed with Cassileth's Information Styles Questionnaire. Results: The majority of patients (71.1%) preferred to play a passive role in treatment decision making, with most of them wanting to delegate responsibility of the decision completely to their doctor (45.3%). A collaborative role was preferred by 24%, whereas only 4.6% chose an active role. Most women expressed a general desire for as much information as possible about their illness (62.6%), but a substantial proportion (37.4%) did not want detailed information; instead, they wished to avoid awareness of bad news. Women who desired less informational details and preferred a passive role requested less frequently a mammography (p<0.001) and/or Pap test (p<0.0005) prediagnostically. Conclusions: This study's findings showed that the proportion of patients who wanted to play a passive role in decision making is the highest reported compared to similar studies from other countries, indicating the impact of the dominating paternalistic model of the doctor–patient relationship in the Greek medical encounter. The association of desired information details and decision‐making preferences with screening for cancer procedures prediagnostically highlights the significance of providing the patients with the appropriate information and the choices available for their treatment. Copyright © 2010 John Wiley & Sons, Ltd.     

Adjuvant dietary fat intake reduction in postmenopausal breast cancer patient management

Management of localized breast cancer now commonly involves a breast-sparing approach combined with systemic adjuvant therapy resulting in improved cosmetic results and patient survival. Reducing dietary fat intake represents a conceptually new approach to further improve outcome of patients with resected breast cancer. The rationale supporting evaluation of dietary fat reduction in the management of patients with localized breast cancer is based on: (1) epidemiologic observations (along with biochemical and hormonal correlates) of major differences in stage-by-stage survival of patients with localized breast cancer comparing outcome in countries with low fat (Japan) versus high fat (U.S.A.) dietary intakes; (2) relationships between dietary fat intake and factors prognostic of clinical outcome in patients with established breast cancer; (3) effects of weight gain (especially that associated with adjuvant chemotherapy) on breast cancer clinical outcome; (4)in vivo animal studies demonstrating adverse influence of increased dietary fat intake (especially linoleic acid) on growth and metastatic spread of mammary cancer; (5) direct adverse effects of increased linoleic acid on human breast cancer growthin vitro; (6) plausible mechanisms which could mediate the effects of dietary fat intake reduction on breast cancer growth and metastatic spread; (7) demonstration of adherence to dietary fat reduction regimens in ongoing clinical feasibility studies including those involving postmenopausal patients with resected breast cancer; and (8) favorable sample size requirements for definitive assessment of dietary fat intake reduction influence on breast cancer growth and metastases (using as endpoints relapse-free survival and overall survival) in postmenopausal breast cancer patients with localized disease.     

Cod liver oil,other dietary supplements and survival among cancer patients with solid tumours

The effect of various dietary supplements on chronic diseases and mortality has been widely studied, but few convincing results have emerged from studies in well‐nourished populations. In Norway, both cod liver oil and other dietary supplements are frequently used. In the Norwegian Women and Cancer cohort study, we explored if supplement use before diagnosis affected survival of cancer patients with solid tumours. We performed Cox proportional hazards analyses, adjusting for age at diagnosis, smoking and stage. Cod liver oil was the most frequently used dietary supplement, followed by multivitamins and minerals. Whole year daily use of cod liver oil was associated with lower risk of death in patients with solid tumours [RR = 0.77 (95% CI 0.61–0.97)] and in lung cancer patients [RR=0.56 (95% CI 0.34–0.92)]. Also daily and occasional use of other dietary supplements decreased the risk of death among lung cancer patients [RR = 0.70 (95% CI 0.49–0.99) and 0.55 (95% CI 0.31–0.97)]. More research is needed to clarify the association; meanwhile adjustment for dietary supplement use should be performed in survival analyses of lung cancer patients. © 2009 UICC     

Anti-inflammatory and nutritional improvement effects of dietary supplementation combined with fish oil in patients with epithelial cancer

The present study investigated the effects of dietary supplementation combined with fish oil containing relatively low levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on the inflammatory and nutritional status of patients with epithelial cancer. Fish oil capsules (498 mg EPA and 213 mg DHA) and dietary supplements (100 kcal and 5 g protein) were administered for 8 weeks to 20 patients with cancer and inflammation [C-reactive protein (CRP) ≥0.30 mg/dl]. Blood EPA levels increased significantly after 4 and 8 weeks, while no significant differences were observed in log-transformed (log) CRP levels, which were the major inflammatory indices in these patients. A declining trend was observed at 8 weeks after excluding 2 patients with suspected infection (P=0.06). A significant increase was observed from week 0 to week 8 for log interleukin-6 (IL-6) levels. After excluding the 2 patients with suspected infection, no significant difference was observed when comparing week 0 to week 8 for log IL-6. No deterioration in albumin or pre-albumin levels was observed. These results suggest that although suppression of acute inflammation associated with infection is difficult, intake of relatively low EPA and DHA supplements may be effective for mild chronic inflammation in patients with epithelial cancer without infection. Large-scale randomized clinical trials are required to make the final decision regarding efficacy. The study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR; 06/07/2018, UMIN000033309).     

Evaluation of dietary and life-style habits of patients with gastric cancer: a case-control study in Turkey

Objective: Gastric cancer is an important public health problem in the world and Turkey. In addition toHelicobacter pylori (H. pylori), smoking, alcohol consumption and family history, certain dietary factors havebeen associated with its occurrence. The impact of dietary habits and life-style factors on the risk of gastriccancer in Turkey were evaluated in this study. Design: A questionnaire was applied to 106 patients with gastricadenocarcinoma and 106 controls without cancer matched for age (range 28-85 years) and gender selected froma hospital based population. Adjusted odds ratios (ORs) and 95% confidence intervals (CI) were calculated withlogistic regression analysis. Results: The incidence of H. pylori was 81.3% in patients. Frequent consumption ofsalty dishes, very salty foods like pickles, soup mixes, sausages, foods at hot temperature (ORs = 3.686, 7.784,5.264, 3.148 and 3.273 respectively) and adding salt without tasting (OR = 4.198) were associated with increasedgastric risk. Also heavy smoking and high amount of alcohol consumption (p = 0.000) were risk factors. Frequentconsumption of green vegetables, onion, garlic and dried fruits (ORs = 0.569, 0.092, 0.795 and 0.041) was nonsignificantlyassociated with decreased risk. Conclusion: Improved dietary habits, reducing salt consumptionand eradication of H. pylori infection may provide protection against gastric cancer in Turkey.     

Chemotherapy use and patient treatment preferences in advanced colorectal cancer

BACKGROUND:

The objective of this study was to determine how patient preferences guide the course of palliative chemotherapy for advanced colorectal cancer.

METHODS:

Eligible patients with metastatic colorectal cancer (mCRC) were enrolled nationwide in a prospective, population‐based cohort study. Data were obtained through medical record abstraction and patient surveys. Logistic regression analysis was used to evaluate patient characteristics associated with visiting medical oncology and receiving chemotherapy and patient characteristics, beliefs, and preferences associated with receiving >1 line of chemotherapy and receiving combination chemotherapy.

RESULTS:

Among 702 patients with mCRC, 91% consulted a medical oncologist; and among those, 82% received chemotherapy. Patients ages 65 to 75 years and aged ≥75 years were less likely to visit an oncologist, as were patients who were too sick to complete their own survey. In adjusted analyses, patients aged ≥75 years who had moderate or severe comorbidity were less likely to receive chemotherapy, as were patients who were too sick to complete their own survey. Patients received chemotherapy even if they believed that chemotherapy would not extend their life (90%) or that chemotherapy would not likely help with cancer‐related problems (89%), or patients preferred treatment focusing on comfort even if it meant not living as long (90%). Older patients were less likely to receive combination first‐line therapy. Patient preferences and beliefs were not associated with receipt of >1 line of chemotherapy or combination chemotherapy.

CONCLUSIONS:

The majority of patients received chemotherapy even if they expressed negative or marginal preferences or beliefs regarding chemotherapy. Patient preferences and beliefs were not associated with the intensity or number of chemotherapy regimens. Cancer 2013. © 2012 American Cancer Society.