頭頸癌病人於同步化學與放射線治療期間鼻胃管放置時間對體重改變之探討

蕭佳欣

doi:10.6342/NTU.2012.00376

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頭頸癌病人於同步化學與放射線治療期間鼻胃管放置時間對體重改變之探討

Time of Nasogastric Tube Insertion and Its Relationship to Body Weight Changes– An Assessment in Head and Neck Cancer Patients Undergoing Concurrent Chemoradiotherapy

蕭佳欣 , Masters　　Advisor：賴裕和　　Co-advisor ：孫秀卿;婁培人;王駿瑋

繁體中文 DOI： 10.6342/NTU.2012.00376

頭頸部癌症；同步化學與放射線治療；鼻胃管；營養；體重；認知； Head and Neck Cancer ； Concurrent Chemoradiotherapy ； Nasogastric tube ； Nutrition ； Body Weight ； Cognition

Abstract │ Reference (47) │ Altmetrics

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Concurrent chemoradiotherapy (CCRT) is the major treatment for patients with head and neck cancers (HNC) after surgery. Acute oral cavity side effects might decrease patients’ intake, nutrition and body weight. Nasogastric (NG) tube feeding has been recognized as one of the methods to prevent patients’ nutrition problems during CCRT. However, timing and duration of inserting NG tube are not yet been identified for the best nutrition improvement. Therefore, the purposes of this study are to : (1) examine the changes of nutrition, performance, common side effects of CCRT, severity of symptoms, and patients’ perception (cognition) about inserting NG tube (Cognition about Inserting NG) over the period of CCRT; and (2) explore the associations between  body weight changes and timing (week) of and duration of inserting NG tube (days) after controlling patients’ nausea severity (from chemotherapy side effects). A prospective longitudinal panel design with 10 times weekly assessments (T0-T9) was conducted to assess HNC patients from pre-treatment to following weeks across CCRT period. Patients were assessed by trained oncology nurse by NCI Toxicity Criteria, symptom severity scale, MNA (Mini Nutritional Assessment), performance status, NG tube cognition assessment scale, and background information form. Institutional Review Board (IRB) approval was obtained before data collection. The results showed: (1) a total of 50 patients were recruited with 16 patients having NG tube insertion during CCRT; (2) Overall, patients reported to have the most serious side effects around the end of CCRT; (3) for those having NG tube, they had less weekly body weight loss (0.58 kg) after inserting NG tube than pre-NG inserting phase (0.85 kg/week) after controlling for nausea factor; (4) patients with NG tube reported to have a more positive identity about inserting NG tube (p <0.01) compared to pre-NG insertion; (5) Inserting NG tube earlier was found to be significantly related to less body weight loss; (6) Therer is a trend of having longer duration (number of days) of inserting NG tube, the less of body weight loss. This finding is close to statistically significant. Results of this study strongly suggest that appropriate health education to support HNC patients about the NG insertion before CCRT may help them to better accept taking NG tube earlier to prevent the severe nutrition deficient and body weight loss. More patients subjects would be strongly to be recruited for better understanding this important clinical phenomena.

Reference ( 47 ) 〈TOP〉

行政院衛生署國民健康局﹙2008﹚．97年癌症登記報告．2011年10月20日取自http://www.bhp.doh.gov.tw/BHPnet/Portal/StatisticsShow.aspx?No=201105200001
連結：
王宏銘、廖俊達、范綱行、吳樹鏗、詹勝傑、閣紫宸﹙2009﹚•頭頸部鱗狀細胞癌治療的新進展•腫瘤護理雜誌，9﹙S﹚，51-67。
連結：
賴裕和 ﹙2009﹚•門診接受化學治療病人之症狀困擾及居家護理需求探討•護理研究，6﹙4﹚，279-289。
連結：
Adelstein, D. J., Li, Y., Adams, G. L., Wagner, H., Jr., Kish, J. A., Ensley, J. F., et al. (2003). An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. Journal of Clinical Oncoogyl, 21(1), 92-98.
連結：
Al-Othman, M. O. F., Amdur, R. J., Morris, C. G., Hinerman, R. W., & Mendenhall, W. M. (2003). Does feeding tube placement predict for long-term swallowing disability after radiotherapy for head and neck cancer? Head & Neck, 25(9), 741-747.
連結：

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