影響接受同步放射治療及化學治療食道癌病人營養狀況之相關因素探討

Nutritional Status of Esophageal Cancer Patients on Concurrent Chemoradiotherapy

10.6880/TJON.201906_19(1).03

陳昭如(Chao-Ju Chen)；陳彥豪(Yen-Hao Chen)；施麗雪(Li-Hsueh Shih)；饒坤銘(Kun-Ming Rau)

食道癌 ； 同步放射治療及化學治療 ； 營養評估 ； esophageal cancer ； concurrent chemoradiotherapy ； nutrition assessment

腫瘤護理雜誌

19卷1期（2019 / 06 / 01）

23 - 36

繁體中文

背景：食道癌病人在接受同步化學及放射治療期間營養狀況不良，會加重治療過程合併症及降低治療成效，若能積極給予營養評估及營養支持，就能增加治療耐受性及減少合併症發生。目的：接受同步放射治療及化學治療食道癌病人營養狀況之相關因素探討。方法：縱貫性研究設計，以立意取樣於台灣南部某醫學中心腫瘤科及放射腫瘤科門診和病房，共收集100位病人，以結構式問卷進行資料收集，問卷內容包括個人基本資料、醫療變項、營養評估等，並使用SPSS 19/Windows統計軟體進行資料分析。結果：三次問卷包含接受治療前、開始放射治療後21天及放射治療結束後30天，平均PG－SGA分數16.34（p ＜ 0.001）。在第一次問卷前有接受營養評估及飲食指導者，體重下降百分比會比無接受營養評估及飲食指導者少約50%（－3.03%比上－6.83%）（p = 0.017），其他的變項，如營養會診次數及化學治療方式，都不會影響營養狀況。結論：病人在接受治療前，給予積極營養評估與飲食指導，對於避免營養不良及體重減輕有顯著幫助。建議護理人員利用簡易、有效的營養不良篩檢工具，早期發現病人營養問題，適時介入照護措施，確保適當的營養攝取及體重維持，才能提供更好的照護品質及減少合併症的發生。

Background: Poor nutritional status intensifies the treatment complications and reduces the efficacy of treatment in esophageal cancer patients receiving concurrent chemoradiotherapy (CCRT) while aggressive nutrition assessment and nutritional support may increase the tolerability and reduce the complications of CCRT. Purpose: To determine the nutrition associated factors in esophageal cancer patients on CCRT. Method: A total of 100 patients with esophageal cancer were enrolled from the outpatient clinic of the medical oncology, radiation oncology, and oncology ward in a medical center in southern Taiwan. A structured questionnaire was used as the assessment tool, including personal data, medical variables, patient-generated subjective global assessment (PG-SGA), and nutritional assessments, etc. The statistical analysis was performed using the SPSS version 19 software. Results: The questionnaires were distributed at three different points in time during the treatment, which were pre-treatment, day 21 after start of CCRT, and day 30 after completion of CCRT. The PG-SGA score was significantly lower for the post-treatment stage in comparison with that for the pre-treatment stage (P＜0.001). In addition, patients who received nutrition assessment and dietary guidance before treatment showed a lower rate by 50% in body weight loss compared to those without the nutrition assessment or dietary guidance (-3.03% vs. -6.83%, P=0.017). Other variables, such as the number of nutritional consultations and chemotherapy, were not associated with the nutritional status. Conclusions: Proactive nutrition assessment and dietary guidance before treatment significantly reduce malnutrition and body weight loss. In order to improve quality of life and reduce the treatment complications, early detection and intervention of malnutrition status is critical for esophageal cancer patients who receive CCRT.

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