目的 探讨PG-SGA评估2~3分的复发或转移的胃部肿瘤患者化疗期间实施营养干预对患者生活质量及化疗依从性的影响。方法 选取2015-06至2017-05收治的PG-SGA评估的2~3分(可疑营养不良组)复发或转移的胃部肿瘤化疗患者86例,随机分为观察组、对照组,每组43 例。观察组采用饮食联合口服营养补充(oral nutritional supplements,ONS)施行营养干预,对照组采用饮食联合营养教育施行营养干预,采用欧洲肿瘤研究与治疗组织(EORTC)肿瘤患者生活质量量表(QLQ-C30)对两组患者化疗前与化疗后7~14 d 的生活质量进行调查。结果 观察组健康状况、躯体功能、角色功能、情绪功能、认知功能、社会功能、乏力评分较对照组高,差异均有统计学意义(P值分别为0.006、0.012、0.040、0.039、0.028、0.017、0.006;P＜0.05);观察组患者化疗减量、延迟化疗、中止化疗的比例均明显低于对照组,差异有统计学意义(P＜0.05)。结论 基于PG-SGA 的2~3分的复发或转移的化疗胃部肿瘤患者实施饮食联合口服营养补充的营养干预措施较饮食联合营养教育的营养干预措施更能提高患者总体生活质量,改善其乏力症状,提高患者的躯体功能,提高患者化疗依从性。
Abstract
Objective To investigate the effect of nutritional intervention on quality of life and chemotherapy compliance of patients with relapsed or metastatic gastric cancer and with PG-SGA scores ranging from 2 to 3 during chemotherapy.Methods A total of 86 patients with recurrent or metastatic gastric cancer who had got 2-3 points according to the PG-SGA method and received treatment between June 2015 and May 2017 were enrolled in this study, who were randomly divided into the observation group and control group (n=43). The control group was treated with diet combined with oral nutritional supplements (ONS), while the control group was treated with diet combined with dietary nutrition education. The EORTC(European Organization for Research on Treatment of Cancer)cancer patients' quality-of-life scale (QLQ-C30) was used to evaluate the quality of life of these patients before chemotherapy and after 7 to 14 days of chemotherapy.Results Scores of general health, physical function, role function, emotional function, cognitive function, social function and fatigue were significantly different between the two groups (t=0.006, 0.012, 0.040, 0.039, 0.028, 0.017, 0.006;P＜0.05). The proportion of reduced chemotherapy, delayed chemotherapy and discontinuation of chemotherapy in the observation group was significantly lower than that of the control group(P＜0.05).Conclusions Diet combined with oral nutrition can improve the quality of life of patients with recurrent or metastatic gastric cancer and with PG-SGA scores of 2 to 3 more significantly than diet combined with diet nutrition education, leading to less fatigue, better physical function and higher compliance with chemotherapy.
关键词
胃部肿瘤 /
化疗 /
营养干预 /
生活质量
Key words
gastric cancer /
chemotherapy /
nutritional intervention /
quality-of-life
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Mccreery E, Costello J. Providing nutritional support for patients with cancer cachexia[J]. Int J Palliat Nurs,2013,19(1):32-37.
[2] Attar A,Malka D,Sabaté J M,et al.Malnutrition is high and underestimated during chemotherapy in gastrointestinal cancer:an AGEO prospective cross-esctional multicenter study[J].Nutr Cancer,2012,64(4):535-542.
[3] Pan H,Cai S,Ji J,et al.The impact of nutritional status,nutritional risk,and nutritional treatment on clinical outcome of 2248 hospitalized cancer patients:a multi-center,prospective cohort study in Chinese teaching hospital[J].Nutr Cancer,2013,65(1):62-70.
[4] Van C E, Sagaert X, Topal B, et al.Gastric cancer[J]. Lancet,2016,388(10060):2654-2664.
[5] Dewys W D, Begg C, Lavin P T, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group[J].Am J Med,1980,69(4):491-497.
[6] 石汉平, 赵青川, 王昆华, 等. 营养不良的三级诊断[J]. 肿瘤代谢与营养电子杂志,2015,2(2):31-36.
[7] 石英英, 张晓伟, 袁凯涛, 等.PG-SGA 操作标准介绍[J]. 中华肿瘤防治杂志,2013,20(22):1779-1782.
[8] Bae H J,Lee H J,Han D ,et al Prealbumin levels as a useful marker for predicting infectious complications after gastric surgery[J].Gastrointestinal,2011,15(12):2136-2144.
[9] Sakurai K,Ohira M,Tamura T,et al.Predictive potential of preoperative nutritional status in long-term outcome projections for patients with gastric cancer[J]. Ann Surg Oncol, 2016,23(2):525-533.
[10] Bossola M. Nutritional interventions in head and neck cancer patients undergoing chemoradiotherapy: a narrative review[J].Nutrients,2015,7(1):265-276.
[11] 石汉平,李苏宜,王昆华,等.中国抗癌协会肿瘤营养与支持治疗专业委员会.胃部肿瘤患者营养治疗指南[J].肿瘤代谢与营养电子杂志, 2015,6(2):37-40.
[12] Brenner H,Rothenbacher D,Arndt V.Epidemiology of stomach cancer[J].Methods Mol Biol,2009,472(2):467-477.
[13] 印义琼.胃部肿瘤患者营养风险筛查临床现状调查及分析[J].华西医学, 201l, 26(10):1536-1539.
[14] Sachlova M, Majek O, Tucek S. Prognostic value of scores based on malnutrition or systemic inflammatory response in patients with metastatic or recurrent gastric cancer[J]. Nutr Cancer,2014,66(8):1362-1370.
[15] 郭苗苗, 袁 玲,李善萍,等. 胃肠癌化疗患者营养状况影响因素分析[J]. 护理学杂志,2012,27(19):30-32.
[16] 郭华鑫.肠内营养干预对胃肠道肿瘤患者术后炎性反应和预后的影响[J].武警医学,2016,27(6):597-600.
[17] 蔡铭泉, 汤玮玮, 安汉祥, 等. 肠内营养联合化疗治疗晚期胃部肿瘤的临床疗效研究[J]. 肠外与肠内营养, 2017,1(4): 205-208.
[18] Muscaritoli M, Molfino A, Laviano A, et al. Parenteral nutrition in advanced cancer patients[J]. Crit Rev Oncol Hematol,2012,84(1):26-36.
[19] 石汉平, 李 薇, 王昆华, 等. PG-SGA肿瘤患者营养评估操作手册[M]. 2版. 北京:人民卫生出版社,2015:31-36.
[20] Makay O, Kaya T, Firat O, et al. ω-3 Fatty acids have no impact on serum lactate levels after major gastric cancer surgery[J]. Enteral Nutr,2011,35(4):488-492.
PDF(710 KB)
