接受同步化學及放射治療頭頸癌病人進食困難及營養狀態之改變

The Changes of Eating Difficulties and Nutritional Status in Head and Neck Cancer Patients Receiving Concurrent Chemoradiotherapy

蘇鈺婷(Yu-Ting Su)

指導教授 ： 賴裕和

國立臺灣大學/醫學院/護理學研究所/碩士(2020年)

https://doi.org/10.6342/NTU202003053

摘要

因疾病位置及多重治療，進食困難為頭頸癌病人最常發生的症狀之一，且對營養狀態造成負面影響，而現有對治療期間頭頸癌病人進食困難及營養狀態之長期追蹤的研究有限。本研究目的為探討接受化學合併放射線治療的頭頸癌病人之: (1)進食困難、症狀嚴重度、身體活動功能及憂鬱狀態之變化；(2)營養狀態變化；(3)人口學特性、疾病及治療因素、進食困難、症狀嚴重度、身體活動功能及憂鬱與營養狀態變化之相關性。本研究採前瞻式縱貫性研究設計，分別於病人接受放射線治療前(T1)、治療第一個月(T2)、第二個月(T3)、第三個月(T4) 及第六個月(T5)，以結構式問卷及實際測量進行資料蒐集，包含:進食困難量表、測量張口大小、症狀嚴重度量表、身體活動功能量表、醫院焦慮憂鬱量表內之憂鬱子量表、迷你營養評估量表。以廣義估計方程式(General Estimating Equation, GEE)分析影響營養狀態變化的相關因素。共80位受試者完成六個月的評估，研究結果發現：(1)進食困難、症狀嚴重度、身體活動功能及憂鬱狀態在治療第二個月達高峰，症狀嚴重度、憂鬱狀態在治療三個月後仍高於治療前；進食困難、身體活動功能在治療六個月後仍高於治療前；進食困難以進食感覺改變最明顯；(2)營養狀態在治療第二個月最差，治療三個月時開始改善，優於治療前，但平均體重低於治療前；(3)人口學特性的不同與營養狀態無關；疾病特性中，第三、四期的營養狀態較第一、二期差；身體活動功能、張口大小與營養狀態變化呈正向相關；晚期診斷、進食困難量表之吞嚥及進食感覺、症狀嚴重度與營養狀態變化呈負向相關。研究結果可提供臨床醫護人員對於接受化學合併放射線治療之頭頸癌患者營養狀態的了解，並針對影響營養的因素包括: 晚期診斷、進食困難、症狀嚴重度及身體活動功能，適時予以營養狀態的評估、症狀處理及介入合適的營養支持措施，預防病人在治療期間遭受嚴重的營養不良，影響疾病治療情形。

關鍵字

頭頸癌 ； 化學合併放射線治療 ； 進食困難 ； 營養 ； 身體活動功能 ； 症狀嚴重度 ； 憂鬱

並列摘要

Due to the anatomical location and multiple treatments, eating difficulties are among the most common distress for patients with head and neck cancer (HNC). However, this topic requires further discussion as there are limited long-term studies on HNC patients with eating difficulties and nutritional status currently. The purposes of this study are to explore (1) the changes of eating difficulties, symptom severity, performance status, depression levels, and (2) the changes of nutritional status, and (3) the relationship among demographic and disease characteristics and the above-mentioned variables. A prospective longitudinal study was designed to collect data since pre-CCRT (T1), and then at the 1st , 2nd , 3rd , and 6th month after receiving CCRT (T2, T3, T4, and T5, respectively). A set of questionnaire which included the Chewing Swallowing Inventory (CSI), measurement of Maximal interincisal opening (MIO), Symptom Severity Scale (SSS), Karnofsky Performance Scale (KPS), Hospital Anxiety and Depression Scale (HADS)- depression subscale, and Mini Nutritional Assessment (MNA). The Generalized Estimating Equations were used to analyze the factors influencing changes in nutritional status. A total of 80 patients were recruited from a medical center in Northern Taiwan. The results indicated: (1) the overall eating difficulties, symptom severity, performance status, and depression levels reached a peak at T3, eating difficulties remained higher than T1; and sensation dysfunction were the most significant. (2) The nutritional status was the worst at T3 but recovered gradually at T5. However, the average weight of T5 was lower than T1. (3) Disease stages, performance status, maximal mouth opening, swallowing, sensation of eating, and symptom severity correlated with nutritional status significantly. The study may provide knowledge of nutritional status of HNC patients during chemoradiotherapy. Symptom management and proper intervention of nutritional support measures are needed, focusing on factors influencing nutritional status including late-stage diagnosis, eating difficulties, symptom severity and performance status can be useful for preventing the patients from suffering severe malnutrition during therapy.

並列關鍵字

head and neck cancer ； chemoradiotherapy ； eating difficulties ； nutrition ； physical function ； symptom ； depression

參考文獻

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