肿瘤患者营养教育

营养教育是营养干预的基本内容,是营养治疗的首选方法。肿瘤患者的营养教育遵循一般人群营养教育的基本 原则,但更具针对性,其内容比一般人群营养教育更加丰富,包括如下 10 个方面：回答患者、家属及照护者提出的问题, 告知营养诊断目的,完成饮食、营养与功能评价,查看实验室及仪器检查结果,传授营养知识、提出饮食、营养建议,介 绍肿瘤的病理生理知识,讨论个体化营养干预方案,告知营养干预可能遇到的问题及对策,预测营养干预效果,规划并实 施营养随访。研究证明,肿瘤患者营养教育是一项经济、实用而且有效的措施。营养教育不仅仅是传授饮食、营养知识, 更加重要的是学习如何改善营养,改变饮食行为,养成良好的饮食、营养习惯,从而改善营养与健康。因此,营养教育是 一个长期的过程,是一个养成的过程。肿瘤患者由于营养不良发生率更高、原因更加复杂、后果更为严重,因而更加需要 接受长期的营养教育,以缩短住院时间,减少并发症,改善临床结局,进而提高生活质量,延长生存时间。     

基于微信的健康教育模式对PICC带管肿瘤患者出院后知识掌握及自理能力的影响

目的探讨基于微信的健康教育模式对经外周静脉置入中心静脉导管(PICC)带管肿瘤患者出院后知识掌握及自理能力的影响。方法选取2018年1月至2019年1月间山东省立第三医院收治的174例PICC带管肿瘤患者,按护理方式不同分为研究组和对照组,每组87例。对照组患者采用常规护理,研究组患者采用基于微信的健康教育模式护理,比较两组患者知识掌握情况、自理能力、并发症发生情况和生存质量情况。结果研究组患者饮食知识、基本化疗知识、用药知识及患肢锻炼评分均高于对照组,差异均有统计学意义(均P<0.05)。研究组患者日常活动、日常观察、带管运动、处理异常情况和依从性评分均高于对照组,差异均有统计学意义(均P<0.05)。观察组患者并发症发生率为4.6%,低于对照组的23.0%,差异有统计学意义(P<0.05)。干预后,研究组患者生活质量各项评分均高于对照组,差异均有统计学意义(均P<0.05)。结论采用基于微信的健康教育模式在PICC带管肿瘤患者的护理中,效果较好,值得临床广泛应用。     

微视频在单孔胸腔镜肺癌手术患者健康教育中的应用研究

目的:探讨微视频在肺癌术后患者健康教育中的应用效果.方法:以100例接受单孔胸腔镜肺癌根治手术患者为研究对象,采用方便抽样法,按照入院时间分为对照组和实验组.对照组采用常规的PPT及纸质版的健康教育模式.观察组应用动画微视频的健康教育模式.比较两组的术后康复过程及不良事件发生情况.结果:观察组术后带管时间、非计划拔管率...     

External validation of a risk model for survival prediction in older patients with cancer undergoing elective abdominal surgery: a prospective cohort study

We previously developed a Chang Gung Memorial Hospital (CGMH) model to predict the 1-year postoperative mortality risk in patients with solid cancer undergoing cancer surgery. This study aimed to externally validate the CGMH score for survival outcome and surgical complication prediction in a prospective patient cohort. A total of 345 consecutive patients aged ≥65 years who underwent elective abdominal surgery for cancer treatment were prospectively enrolled. Patients were categorized into the low, intermediate, high, and very high-risk groups according to the CGMH score for comparison. The postoperative 1-year mortality rate was 12.5% in the entire cohort. The postoperative 1-year mortality rates were 0%, 2.2%, 14.0%, and 31.6% among patients in the low, intermediate, high, and very-high risk groups, respectively. The c-statistic of the CGMH model was 0.82 (95% confidence interval [CI], 0.76-0.88) for predicting the 1-year mortality risk. Hazard ratios for overall survival were 3.73 (95% CI, 2.11-6.57; P<0.001) and 10.1 (95% CI, 5.84-17.6; P<0.001) when comparing the high and very-high risk groups with the low/intermediate risk groups, respectively. Patients in the higher CGMH risk groups had higher risks of adverse surgical outcomes in terms of longer length of hospital stay, major surgical complications, postoperative intensive care unit stay, and in-hospital death. The CGMH model accurately predicted thesurvival probabilityand risk of adverse surgical outcomes in older patients with cancer undergoing elective abdominal surgery. Our study justifies the prospective use of the CGMH model for survival outcome and safety profile predictionfor cancer surgery in older patients.     

Is cancer survivorship associated with reduced work engagement? A NOCWO Study

Introduction  This study explores work engagement in employed tumor-free cancer survivors (CSs) compared to matched controls from the general population (NORM). Methods  The sample consisted of 446 CSs tumor-free after primary treatment [226 females with breast cancer and 220 males (166 testicular cancer and 54 prostate cancer)] diagnosed 2–6 years prior to the study. All had returned to work and had favourable prognosis. NORM sample consisted of 588 employed controls (319 females, 269 males). All CSs and NORM filled in a mailed questionnaire covering demography, morbidity, and work-related issues including work engagement which was self-rated by the Utrecht Work Engagement Scale (UWES). Results  No differences in work engagement were observed between the CSs and NORM measured by the UWES total scale score or by the Dedication and Absorption domain scores. The Vigor domains score was statistically lower among CSs (p = .03), but the effect size was only 0.19. The CSs reported significantly poorer work ability, poorer health status, greater numbers of disease symptoms, more anxiety, and reduced physical quality of life, and scored significantly higher on both neuroticism and extraversion. Conclusions/Implications for CSs  In spite of poorer health CSs who had returned to work after their treatment for breast, prostate, and testicular cancer showed similar work engagement as individuals without cancer. In such CSs employers have no reason to expect reduced work engagement. Future research should preferably have a prospective and comparative design.     

越秀区居民接受防癌知识教育4年效果的评价

目的：探讨社区开展防癌知识宣传教育的有效方式,提高居民对癌症预防知识的知晓率。方法：分别于１９９６年和２０００年在广州市越秀区调查４９５名和１１７０名居民对肿瘤的认识和知识来源,并进行了前后对比统计学分析。结果：居民对各种癌症病因认识的平均得分由１０．４９分提高到３８．８０分,提高了２８．３１分;对癌症早期症状的平均得分８．９１分提高到３５．１３分,提高了２６．２２分;居民对癌症知晓率从７．９％提     

Surgical morbidity and mortality after neoadjuvant chemotherapy in the CRITICS gastric cancer trial

Background

In order to determine the optimal combination of perioperative chemotherapy and chemoradiotherapy for Western patients with advanced resectable gastric cancer, the international multicentre CRITICS trial (ChemoRadiotherapy after Induction chemotherapy In Cancer of the Stomach) was initiated. In this trial, patients with resectable gastric cancer were randomised before start of treatment between adjuvant chemotherapy or adjuvant chemoradiotherapy following neoadjuvant chemotherapy plus gastric cancer resection. The purpose of this study was to report on surgical morbidity and mortality in this trial, and to identify factors associated with surgical morbidity.

Capecitabine improves cancer cachexia and normalizes IL-6 and PTHrP levels in mouse cancer cachexia models

Purpose

To clarify the potential of parathyroid hormone-related protein (PTHrP) and interleukin-6 (IL-6) as cachectic factors in a colon 26 model and the effects of capecitabine on cancer cachexia as determined by plasma levels of IL-6 and PTHrP and body weight loss.

Methods

From two colon 26 sublines-cancer cachectic clone20 and non-cachectic clone5 plasma levels of PTHrP protein and mRNA expression levels in tumor tissues were compared. An IL-6 neutralizing antibody, a PTHrP neutralizing antibody, and capecitabine were administered into mice bearing clone20 and their anticachectic effects evaluated.

Results

The plasma level of PTHrP protein in mice bearing clone20 was higher than that in mice bearing clone5. The expression level of PTHrP mRNA was 49-fold higher in tumor tissues of clone20 than of clone5, according to GeneChip^® analysis. PTHrP antibody as well as IL-6 antibody suppressed wasting of the body and gastrocnemius and adipose tissue weights. PTHrP antibody suppressed the induction of hypercalcemia but not hypoglycemia or elevation of IL-6, whereas IL-6 antibody suppressed the induction of hypoglycemia but not hypercalcemia or elevation of PTHrP. Capecitabine, a fluorinated pyrimidine anticancer agent, improved body wasting of mice bearing clone20 at a low dose with no reduction of tumor volume. Furthermore, capecitabine lowered the levels of PTHrP and IL-6 in plasma and suppressed hypoglycemia and hypercalcemia in this model. Capecitabine also showed anticachectic effects on cachexia in a cancer model induced by human cervical cancer cell line Y (also known as Yumoto).

Conclusions

PTHrP and IL-6 were found to be factors in the development of cachexia in a colon 26 cancer model, and capecitabine improved cancer cachexia by suppressing the plasma levels of IL-6 and PTHrP in colon 26 and Y cachectic models.     

Competences,education and support for new roles in cancer genetics services: outcomes from the cancer genetics pilot projects

In 2004 the Department of Health in collaboration with Macmillan Cancer Support set up service development projects to pilot the integration of genetics in mainstream medicine in the area of cancer genetics. In developing these services, new roles and responsibilities were devised that required supporting programmes of education and training. The NHS National Genetics Education and Development Centre has worked with the projects to draw together their experience in these aspects. New roles include the Cancer Family Nurse Specialist, in which a nurse working in a cancer setting was trained to identify and manage genetic or family history concerns, and the Genetic Risk Assessment Practitioner—a small team of practitioners working within a secondary care setting to deliver a standardised risk assessment pathway. Existing roles were also adapted for a different setting, in particular the use of genetic counsellors working in a community ethnic minority setting. These practitioners undertook a range of clinical activities that can be mapped directly to the ‘UK National Workforce Competences for Genetics in Clinical Practice for Non-genetics Healthcare Staff’ framework developed by Skills for Health and the NHS National Genetics Education and Development Centre (2007; draft competence framework). The main differences between the various roles were in the ordering of genetic tests and the provision of advice on invasive preventive options such as mastectomy. Those involved in service development also needed to develop competences in project management, business skills, audit and evaluation, working with users, general management (personnel, multi-agency work and marketing), educational supervision, IT, public and professional outreach, and research. Important resources to support the development of new roles and competences included pathways and guidelines, a formal statement of competences, a recognised syllabus, appropriate and timely courses, the availability of a mentor, supervision and opportunities to discuss cases, a formal assessment of learning and continuing support from specialist genetics services. This represents a current resource gap that will be of concern to cancer networks and a challenge to providers of educational resources and regional genetics services.     

微场景健康教育平台在乳腺癌化疗PICC置管患者出院后的应用效果

目的探讨微场景健康教育平台在乳腺癌化疗PICC置管患者出院后的临床应用效果。方法选取2015年7月至2020年6月间湖北省武穴市第一人民医院收治的67例女性乳腺癌患者,按照护理方式不同分为观察组34例和对照组33例。对照组患者采用常规护理项目及健康教育,观察组患者在对照组基础上增加微场景健康教育宣教,比较两组患者置管相关并发症发生情况、护理前后自我管理能力变化及护理满意度。结果观察组患者PICC置管并发症发生率为2.9%,低于对照组的18.2%,两组比较,差异有统计学意义(P<0.05)。干预前,两组患者自我管理能力各项评分比较,差异无统计学意义(P>0.05)。干预后,观察组患者自我管理能力各项评分均高于对照组,差异均有统计学意义(均P<0.05)。健康教育后,观察组患者护理满意度为94.1%,高于对照组的75.8%,两组比较,差异有统计学意义(X^2=4.45,P<0.05)。结论微场景健康教育平台能降低乳腺癌PICC置管患者出院后并发症发生率,提高自我管理能力,提高患者及家属满意度。     

Use of lung cancer risk models in planning research and service programs in CT screening for lung cancer

Computed tomography screening for lung cancer is now being tested in a number of international trials. The long-term success of the approach in the future National Screening Programme is dependent upon identifying populations at sufficient risk of lung cancer that the benefit–harm ratio of the intervention is likely to be high. There are a number of lung cancer risk prediction models currently available. We review these, and demonstrate, using the Liverpool Lung Project risk prediction model as a case study, the potential for use of a risk prediction model in the design of a randomized trial of lung cancer screening and in the planning of a service screening program.     

Using hierarchical spatial models for cancer control planning in Minnesota (United States)

Objective: Region-specific maps of cancer incidence, mortality, late detection rates, and screening rates can be very helpful in the planning, targeting, and coordination of cancer control activities. Unfortunately, past efforts in this area have been few, and have not used appropriate statistical models that account for the correlation of rates across both neighboring regions and different cancer types. In this article we develop such models, and apply them to the problem of cancer control in the counties of Minnesota during the period 1993–1997. Methods: We use hierarchical Bayesian spatial statistical methods, implemented using modern Markov chain Monte Carlo computing techniques and software. Results: Our approach results in spatially smoothed maps emphasizing either cancer prevention or cancer outcome for breast, colorectal, and lung cancer, as well as an overall map which combines results from these three individual cancers. Conclusions: Our methods enable us to produce a more statistically accurate picture of the geographic distribution of important cancer prevention and outcome variables in Minnesota, and appear useful for making decisions regarding targeting cancer control resources within the state.     

Successful video-assisted thoracoscopic lobectomy in a pregnant woman with lung cancer

A 38-year-old non-smoking female patient was evaluated at our hospital for an increasing mass in the right lower lung field at 24 weeks of gestation. Computed tomography revealed an approximately 7.5-cm diameter mass in the right lower lung lobe. After assessing the benefits to the patient and risks to the fetus, we performed a lobectomy with mediastinal lymph node dissection using video-assisted thoracoscopy. Three months postoperatively, the patient delivered a healthy male baby. The patient is alive 10 months following the lobectomy, and no evidence of recurrence and distant metastasis is noted. The 6-month-old infant is also doing well postpartum.     

Surgical resection deteriorates gemcitabine-induced leukopenia in pancreatic cancer

Background Gemcitabine hydrochloride (GEM) is one of the most effective chemotherapeutic agents for pancreatic cancer; however, factors affecting GEM-induced leukopenia have not been clarified yet. In the present study, we analyzed the relationship between patients backgrounds and GEM-induced leukopenia.Methods Thirty-eight patients with pancreatic cancer were analyzed for correlation between the dose of GEM and the blood leukocyte number. Moreover, we compared leukopenia in resected and non-resected patients.Results The incidence of grade 3 or 4 leukopenia was 25% in the non-resected patients, whereas equivalent leukopenia was observed in 57% of the resected patients (P = 0.048 by the ² test). The relative decrease in blood leukocytes induced by GEM administration was more severe in resected patients (41.3 ± 9.9%), as compared to non-resected patients (52.6 ± 16.0%; P = 0.023 by t-test).Conclusion In the present study, we found that the administration of GEM to patients after surgical resection caused more severe leukopenia, as compared to findings in non-resected patients. These data suggested that more frequent monitoring of the leukocyte count and prolonged intervals between GEM administrations are necessary for resected patients with pancreatic cancer.     

死亡教育在临终关怀科癌症患者中的应用

目的:通过对临终关怀科癌症患者及其家属的死亡知识认知度的调查并进行死亡教育,指导患者及家属正确讨论、面对死亡,克服对死亡的恐惧心理,以提高患者的生命质量,使患者的临终意愿得到尊从,达到真正的优死.方法:以2014年6月1日至2015年5月31日临终关怀科收治的癌症患者及直系家属或直接照顾者为研究对象.在入院时及进行死亡教育后一周、二周后自行填写死亡教育知识调查问卷,进行死亡教育前后的对照分析研究.结果:死亡教育后患者及其家属的死亡焦虑状况均有明显缓解;满意度从95.6％提升至98％.但患者生活质量改善无统计学差异,部分患者自我评价生活质量较前下降.结论:死亡教育在临终关怀工作中具有极其重要的作用及意义.     

Usefulness of the mesopancreas-first approach using isolating tape in conversion surgery for pancreatic cancer

BackgroundR0 resection is an important prognostic factor in patients with pancreatic cancer (PC). Advances in chemotherapy have improved the R0 resection rate for unresectable locally advanced (UR-LA) PC. There is a limit to determine on imaging whether R0 resection is possible due to chemotherapy effects. Therefore, we rely on intraoperative frozen section diagnosis (FSD). We devised a mesopancreas-first approach using isolating tape (iTape) to ensure the assessment of resectability before organ dissection.PatientsThe mesopancreas-first approach using iTape was performed in patients with UR-LA PC who were determined to be able to achieve R0 resection by pancreaticoduodenectomy after chemotherapy.MethodsIn this method, the mesopancreas is taped before organ dissection, and subsequent mesopancreas separation is performed by pulling the tape. The iTape is first placed through the retroperitoneal space between the mesopancreas and the inferior vena cava followed by extraction from the common hepatic artery, body of the pancreas, and splenic vein on the cranial side of the pancreas and from the superior mesenteric artery on the caudal side of the pancreas. As a result, the iTape is individually enmeshed in the mesopancreas. This way, only the mesopancreas can be dissected, while sparing other organs and tissues. If R0 resection is judged to be difficult by intraoperative FSD, the procedure is converted into bypass surgery.ConclusionThis method may be useful for pancreaticoduodenectomy in conversion cases and the resectability can be evaluated prior to organ dissection.     

Role of diagnostic laparoscopy in deciding primary treatment in advanced-stage ovarian cancer

ObjectiveWe evaluated the usefulness of preoperative diagnostic laparoscopy for treatment planning in patients with advanced-stage ovarian cancer.MethodsWe retrospectively analyzed 614 patients diagnosed with advanced-stage ovarian cancer between January 2010 and May 2018. Primary debulking surgery (PDS) or neoadjuvant chemotherapy (NAC) followed by interval debulking surgery were selected based on preoperative laparoscopic (Group 1, n=192) and computed tomography findings (Group 2, n=422). The primary outcomes in the PDS and NAC groups were suboptimal cytoreduction (residual disease >1 cm) rate and non-high-grade serous carcinoma (non-HGSC) rate, respectively.ResultsThe patients who underwent PDS in group 1 and group 2 were 49 (25.5%) and 279 (66.1%), respectively. The suboptimal cytoreduction rate after PDS was lower in Group 1 than in Group 2 (2.0% vs 11.1%, p=0.023). Moreover, Group 1 showed a tendency toward a lower proportion of non-HGSC patients who underwent NAC than that in Group 2 (9.1% vs. 15.4%, p=0.069). Further, Group 1 showed lower rates of postoperative morbidity than Group 2 (5.2% vs. 10.4%, p=0.033). However, Kaplan–Meier analysis showed no significant differences in survival outcomes between the 2 groups.ConclusionDiagnostic laparoscopy reduced the suboptimal cytoreduction rate in the PDS group and the implementation rate of NAC in non-HGSC patients. Moreover, it reduced postoperative morbidity without affecting survival in both groups. Thus, diagnostic laparoscopy is a valuable diagnostic tool for determining the primary treatment.     

Laparoscopic vs. robotic-assisted laparoscopy in endometrial cancer staging: large retrospective single-institution study

ObjectiveThe aim of this study is to analyze and draw the potential differences between the robotic-assisted surgery (RS) and the laparoscopy (LPS) in endometrial cancer staging.MethodsIn this single-institution retrospective study we enrolled 1,221 consecutive clinical stage I–III endometrial cancer patients undergone minimally invasive surgical staging. We compared patients treated by LPS and by RS, on the basis of perioperative and oncological outcomes (disease-free survival [DFS] and overall survival [OS]). A sub-analysis of the high-risk endometrial cancer population was performed in the 2 cohorts.ResultsThe 2 cohorts (766 treated by LPS and 455 by RS) were homogeneous in terms of perioperative and pathological data. We recorded differences in number of relapse/progression (11.7% in LPS vs. 7% in RS, p=0.008) and in number of deaths (9.8% in LPS vs. 4.8% in RS, p=0.002). Whereas, univariate and multivariate analyses according to DFS and OS confirmed that the surgical approach did not influence the DFS or the OS. In the multivariable analysis the association of the age and grading was significant for DFS and OS. In the sub-analysis of the 426 high risk EC patients (280 in LPS and 146 in RS) the univariate and the multivariate confirmed the influence of the age in DFS and OS, independently of the minimally invasive approach.ConclusionsIn our large retrospective analysis, we confirmed that the RS and LPS have similar efficacy and safety for endometrial cancer staging also for the high-risk endometrial cancer patients.     

Changes in volume,clinical practice and outcome after reorganisation of oesophago-gastric cancer care in England: A longitudinal observational study

Aim

The centralisation of oesophago-gastric (O-G) cancer services in England was recommended in 2001, partly because of evidence for a volume-outcome effect for patients having surgery. This study investigated the changes in surgical services for O-G cancer and postoperative mortality since centralisation.

A mathematical model of axillary lymph node involvement considering lymph node size in patients with breast cancer

BACKGROUND: Surgical sampling for assessing axillary status has not been considered as a well defined surgical procedure. We have reported that MRI is a good instrument for assessing lymph node size and identifying lymph node position. We also developed a mathematical model that takes into consideration the size of axillary lymph nodes, and retrospectively determined the number and size of the axillary lymph nodes that need to be sampled from level I-II to achieve a greater than 90% probability of metastasis detection after surgical sampling, with the future aim of using MR-axillography to assess lymph node size. METHODS: One thousand nine hundred and thirty four lymph nodes from 102 level I-II dissections performed on T1 and T2 breast cancer patients with nodal metastases were examined histologically and the greatest long-axis dimension on histologic slides was measured. RESULTS: This model permitted determination of the cutoff level necessary for an expected probability of detection of metastasis of over 90%. The cutoff level, regardless of tumor size, is a maximum of 6 nodes removed from level I-II in which the greatest long-axis measurement is greater than or equal to 6 mm. The cutoff level in patients with macrometastatic nodes is a maximum of 3 or 4 nodes in which the long-axis dimensions are greater than or equal to 9 or 7 mm, respectively, removed from level I-II. CONCLUSIONS: This model showed that surgical sampling on the basis of lymph node size might have good potential to detect lymph nodes metastases.