头颈部肿瘤患者放疗期间营养状态及营养干预效果的研究
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摘要
研究背景由于肿瘤本身及抗肿瘤治疗的影响,营养不良是肿瘤病人最常见的诊断。头颈部肿瘤病人是营养不良高发群体。营养不良存在众多负面影响,导致并发症发生率和死亡率增高。有研究显示,积极开展营养干预有助于减少病人体重丢失,改善营养状态,提高生活质量。因此,有必要描述我国头颈部肿瘤病人放疗期间的营养状态、生活质量改变,探索营养干预的模式和效果,为提高头颈部肿瘤病人的营养状态和生活质量提供参考资料。
研究目的1、描述头颈部肿瘤患者放疗期间营养状态、能量蛋白摄入情况、放射治疗毒副反应症状、生活质量的变化及影响因素。2、验证营养支持对头颈部肿瘤患者放疗期间营养状态、能量蛋白摄入情况及生活质量的影响。
研究方法研究采用目的抽样方法,选取84名于2007年3月～2007年8月在北京协和医院、中国医学科学院肿瘤医院行放疗的成年头颈部肿瘤病人作为第一部分研究对象。在放疗起始时取得病人知情同意,完成一般资料收集,进行身高、体重、SGA分级、放疗毒副反应、24小时膳食回顾以及EORTC QLQ-C30的测定。并分别在放疗2周、4周及结束时对病人的体重、SGA分级、放疗毒副反应、24小时膳食回顾以及EORTCQLQ-C30进行测定。第二部分为历史性对照研究,以第一部分研究样本作为对照组,选取45名于2007年9月～2007年12月在上述两家医院行放疗的成年头颈部肿瘤病人作为第二部分干预组研究对象,在放疗起始后,除进行同对照组一致的各项指标评测外,接受由放疗医生、营养医生及护士组成的营养干预小组的干预。步骤如下:在放疗起始,干预组病人接受标准营养健康教育,由护士根据SGA进行营养状态分级,将中度营养不良(B级)或重度营养不良(C级)的病人转诊营养医生门诊,由营养医生根据病人情况,进行个体化营养支持,支持手段包括营养咨询、饮食配方调整、经口补充营养制剂、管饲补营养制剂以及肠外营养支持,一周后随诊。在放疗2周、4周及结束时对病人的体重、SGA分级、放疗毒副反应、24小时膳食回顾以及EORTC QLQ-C30进行测定,评价后再根据SGA分级分流病人。
结果
1、头颈部肿瘤病人放疗期间放疗毒副反应在放疗2周后普遍存在,4周后程度最重并持续到放疗结束。
2、头颈部肿瘤病人放疗期间,88.1%病人出现体重下降,体重平均下降2.68kg,体重丢失大于等于5%的病人占50%;中重度营养不良病人从放疗起始时的35.8%增加到结束时的90%;体重指数明显下降;血清白蛋白明显下降;淋巴细胞绝对值明显减少;体重下降与放疗毒副反应呈正相关(r,0.369～0.209,P＜0.05)。
3、放疗期间病人能量和蛋白摄入低于机体需要量。放疗4周后,能量摄入仅达到所需能量的66.9%,人均缺少670-690kcal/日;蛋白摄入仅达所需蛋白的66.7%,人均缺少21g-22g/日。能量和蛋白摄入与放疗毒副反应呈负相关(r,-.340～-.234,P＜0.05)。
4、头颈部肿瘤病人放疗期间生活质量各维度评分存在显著差异。其中角色功能、社会功能、总体健康状况明显下降,疲倦感、疼痛、睡眠障碍、没有食欲等症状明显恶化。多元逐步回归分析显示病人SGA营养状态分级、放疗期间体重丢失、口腔炎以及年龄是影响生活质量的重要因素,可以解释生活质量54.8%的变异。
5、营养干预使患者放疗期间蛋白摄入有所增加,生活质量下降减少。但对放疗期间的体重丢失、能量蛋白摄入以及生活质量没有产生显著影响。
结论头颈部肿瘤病人放疗期间放疗毒副反应普遍存在,营养不良比例增高,能量蛋白摄入不足,生活质量下降。营养干预使蛋白摄入有少量增加,生活质量下降减少,但由于放疗毒副反应的存在以及营养支持途径不足,使得营养干预效果未产生统计学意义。
Background:Nutritional decline is often accepted as a part of the cancer course and its treatment.Malnutrition is the most common secondary diagnosis in patients with cancer.The prevalence of malnutrition in head and neck cancer patients were reported to be high. Malnutrition has a lot of significant negative impacts.In patients with cancer,malnutrition increases the risk of infections,treatment toxicity,health care cost and quality of life as well as survival.Over the past two decades greater attention has been focused on the strategies to manage the malnutrition.There are various interventional strategies used to support patients with a declining nutritional status.However,little studies have been done with the head and neck cancer patients in China.The researcher would describe the nutritional status of the head and neck cancer patients undergoing radiotherapy,and identify the effectiveness of nutritional interventions on the head and neck cancer patients.The result of the research will supply the baseline of supportive ways for the nutritional status as well as quality of life for cancer patients in China.
Objectives:To investigate the radiation reflections,nutritional status,weight loss,nutrient intake,quality of life at the onset and at the end of radiation theropy(RT).The relationships among radiation reflection,the nutrition status,nutrient intake as well as quality of life were identified also.To explore whether the nutritional interventions in this study will be able to enhance nutrient intake and whether the latter influence the patients' quality of life.
Methods:A descriptive study were used to describe the nutritional status,nutrient intake, radiation reflections,quality of life of the head and neck cancer patients undergoing radiotherapy.The purposive sampling method was used to select patients referred to radiation therapy departments of PUMC hospital,as well as the cancer special hospital from Mar 2007 to Sep 2007.The information about demographic data,disease status,SGA, anthropometric measures,albumin,24h diet recall,EORCT QLQ c-30 were gathered at onset of RT,as well as 2~(nd) week,4~(th) week and the end of RT.The sample in 2~(nd) part of research were all head and neck cancer patients referred to radiation therapy in the same two hospitals from Sep 2007 to Dec 2007.The information gathered was same as which in the observing group,and patients in this group received nutritional interventions.The interventional program included following steps,patients received standard nutritional education at onset of RT.Then patients in SGA-B or SGA-C levels,were transferred to nutritional doctor.It was the nutritional doctor who supplied nutritional supports according to patients' food habits and nutritional changes.The major supportive methods include diet counseling,nutritional supplyments by oral,and EN or PN.The measurement same as observational group were repeated at 2~(nd) week,4~(th) week and the end of RT.Whenever patients was in SGA-B or SGA-C,would be transferred to nutritional doctors.
Result:Radiation reflections existed commonly in the head and neck cancer patients from the 2~(nd) week in RT,which became more serious in the 4~(th) week in RT.The average of weight loss in the head and neck cancer patients was 2.68kg.There was 50%patients reduced their weight more than 5%.BMI,ALB reduced significantly.The percentage of patients with malnutrition in the end of RT increased to be 90%.The energy as well as protein intake were always lower than needed.There were positive correlations between radiation reflections and energy and protein intake.The scores of each dimensions in QLQ C-30 reduced at the end of RT.The influencing factors included SGA level,weight loss,stomatitis and age of patients, which could explain the variation of QOL at 54.8%level.The nutritional interventions made little increase in protein intake,little reduction in QOL without significance.
Conclusions:During RT,the head and neck cancer patients had radiation reflections commonly.The percentage of patients with malnutrition at the end of RT increased to 91%. The energy and protein intake were less than needed.The nutritional interventions made little increase in protein intake,little reduction in QOL without significance.No effectiveness might due to radiation reflection and absence of routes of nutritional support.
研究目的1、描述头颈部肿瘤患者放疗期间营养状态、能量蛋白摄入情况、放射治疗毒副反应症状、生活质量的变化及影响因素。2、验证营养支持对头颈部肿瘤患者放疗期间营养状态、能量蛋白摄入情况及生活质量的影响。
研究方法研究采用目的抽样方法,选取84名于2007年3月～2007年8月在北京协和医院、中国医学科学院肿瘤医院行放疗的成年头颈部肿瘤病人作为第一部分研究对象。在放疗起始时取得病人知情同意,完成一般资料收集,进行身高、体重、SGA分级、放疗毒副反应、24小时膳食回顾以及EORTC QLQ-C30的测定。并分别在放疗2周、4周及结束时对病人的体重、SGA分级、放疗毒副反应、24小时膳食回顾以及EORTCQLQ-C30进行测定。第二部分为历史性对照研究,以第一部分研究样本作为对照组,选取45名于2007年9月～2007年12月在上述两家医院行放疗的成年头颈部肿瘤病人作为第二部分干预组研究对象,在放疗起始后,除进行同对照组一致的各项指标评测外,接受由放疗医生、营养医生及护士组成的营养干预小组的干预。步骤如下:在放疗起始,干预组病人接受标准营养健康教育,由护士根据SGA进行营养状态分级,将中度营养不良(B级)或重度营养不良(C级)的病人转诊营养医生门诊,由营养医生根据病人情况,进行个体化营养支持,支持手段包括营养咨询、饮食配方调整、经口补充营养制剂、管饲补营养制剂以及肠外营养支持,一周后随诊。在放疗2周、4周及结束时对病人的体重、SGA分级、放疗毒副反应、24小时膳食回顾以及EORTC QLQ-C30进行测定,评价后再根据SGA分级分流病人。
结果
1、头颈部肿瘤病人放疗期间放疗毒副反应在放疗2周后普遍存在,4周后程度最重并持续到放疗结束。
2、头颈部肿瘤病人放疗期间,88.1%病人出现体重下降,体重平均下降2.68kg,体重丢失大于等于5%的病人占50%;中重度营养不良病人从放疗起始时的35.8%增加到结束时的90%;体重指数明显下降;血清白蛋白明显下降;淋巴细胞绝对值明显减少;体重下降与放疗毒副反应呈正相关(r,0.369～0.209,P＜0.05)。
3、放疗期间病人能量和蛋白摄入低于机体需要量。放疗4周后,能量摄入仅达到所需能量的66.9%,人均缺少670-690kcal/日;蛋白摄入仅达所需蛋白的66.7%,人均缺少21g-22g/日。能量和蛋白摄入与放疗毒副反应呈负相关(r,-.340～-.234,P＜0.05)。
4、头颈部肿瘤病人放疗期间生活质量各维度评分存在显著差异。其中角色功能、社会功能、总体健康状况明显下降,疲倦感、疼痛、睡眠障碍、没有食欲等症状明显恶化。多元逐步回归分析显示病人SGA营养状态分级、放疗期间体重丢失、口腔炎以及年龄是影响生活质量的重要因素,可以解释生活质量54.8%的变异。
5、营养干预使患者放疗期间蛋白摄入有所增加,生活质量下降减少。但对放疗期间的体重丢失、能量蛋白摄入以及生活质量没有产生显著影响。
结论头颈部肿瘤病人放疗期间放疗毒副反应普遍存在,营养不良比例增高,能量蛋白摄入不足,生活质量下降。营养干预使蛋白摄入有少量增加,生活质量下降减少,但由于放疗毒副反应的存在以及营养支持途径不足,使得营养干预效果未产生统计学意义。
Background:Nutritional decline is often accepted as a part of the cancer course and its treatment.Malnutrition is the most common secondary diagnosis in patients with cancer.The prevalence of malnutrition in head and neck cancer patients were reported to be high. Malnutrition has a lot of significant negative impacts.In patients with cancer,malnutrition increases the risk of infections,treatment toxicity,health care cost and quality of life as well as survival.Over the past two decades greater attention has been focused on the strategies to manage the malnutrition.There are various interventional strategies used to support patients with a declining nutritional status.However,little studies have been done with the head and neck cancer patients in China.The researcher would describe the nutritional status of the head and neck cancer patients undergoing radiotherapy,and identify the effectiveness of nutritional interventions on the head and neck cancer patients.The result of the research will supply the baseline of supportive ways for the nutritional status as well as quality of life for cancer patients in China.
Objectives:To investigate the radiation reflections,nutritional status,weight loss,nutrient intake,quality of life at the onset and at the end of radiation theropy(RT).The relationships among radiation reflection,the nutrition status,nutrient intake as well as quality of life were identified also.To explore whether the nutritional interventions in this study will be able to enhance nutrient intake and whether the latter influence the patients' quality of life.
Methods:A descriptive study were used to describe the nutritional status,nutrient intake, radiation reflections,quality of life of the head and neck cancer patients undergoing radiotherapy.The purposive sampling method was used to select patients referred to radiation therapy departments of PUMC hospital,as well as the cancer special hospital from Mar 2007 to Sep 2007.The information about demographic data,disease status,SGA, anthropometric measures,albumin,24h diet recall,EORCT QLQ c-30 were gathered at onset of RT,as well as 2~(nd) week,4~(th) week and the end of RT.The sample in 2~(nd) part of research were all head and neck cancer patients referred to radiation therapy in the same two hospitals from Sep 2007 to Dec 2007.The information gathered was same as which in the observing group,and patients in this group received nutritional interventions.The interventional program included following steps,patients received standard nutritional education at onset of RT.Then patients in SGA-B or SGA-C levels,were transferred to nutritional doctor.It was the nutritional doctor who supplied nutritional supports according to patients' food habits and nutritional changes.The major supportive methods include diet counseling,nutritional supplyments by oral,and EN or PN.The measurement same as observational group were repeated at 2~(nd) week,4~(th) week and the end of RT.Whenever patients was in SGA-B or SGA-C,would be transferred to nutritional doctors.
Result:Radiation reflections existed commonly in the head and neck cancer patients from the 2~(nd) week in RT,which became more serious in the 4~(th) week in RT.The average of weight loss in the head and neck cancer patients was 2.68kg.There was 50%patients reduced their weight more than 5%.BMI,ALB reduced significantly.The percentage of patients with malnutrition in the end of RT increased to be 90%.The energy as well as protein intake were always lower than needed.There were positive correlations between radiation reflections and energy and protein intake.The scores of each dimensions in QLQ C-30 reduced at the end of RT.The influencing factors included SGA level,weight loss,stomatitis and age of patients, which could explain the variation of QOL at 54.8%level.The nutritional interventions made little increase in protein intake,little reduction in QOL without significance.
Conclusions:During RT,the head and neck cancer patients had radiation reflections commonly.The percentage of patients with malnutrition at the end of RT increased to 91%. The energy and protein intake were less than needed.The nutritional interventions made little increase in protein intake,little reduction in QOL without significance.No effectiveness might due to radiation reflection and absence of routes of nutritional support.
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