Ravasco Paula, Monteiro-Grillo Isabel, Marques Vidal Pedro, Camilo Maria Ermelinda
Unidade de Nutrição e Metabolismo, Instituto de Medicina Molecular Faculdade de Medicina da Universidade de Lisboa, Avenida Prof. Egas Moniz, 1649-028 Lisboa, Portugal.
Head Neck. 2005 Aug;27(8):659-68. doi: 10.1002/hed.20221.
We aimed to determine the effect of dietary counseling or oral supplements on outcome for patients with cancer, specifically, nutritional outcome, morbidity, and quality of life (QOL), during and 3 months after radiotherapy.
Seventy-five patients with head and neck cancer who were referred for radiotherapy (RT) were randomized to the following groups: group 1 (n = 25), patients who received dietary counseling with regular foods; group 2 (n = 25), patients who maintained usual diet plus supplements; and group 3 (n = 25), patients who maintained intake ad lib. Nutritional intake (determined by diet history) and status (determined by Ottery's Subjective Global Assessment), and QOL (determined by the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire version 3.0 [EORTC QLQ-C30]) were evaluated at baseline, at the end of RT, and at 3 months.
Energy intake after RT increased in both groups 1 and 2 (p < or = .05). Protein intake also increased in both groups 1 and 2 (p < or = .006). Both energy and protein intake decreased significantly in group 3 (p < .01). At 3 months, group 1 maintained intakes, whereas groups 2 and 3 returned to or below baseline levels. After RT, >90% of patients experienced RT toxicity; this was not significantly different between groups, with a trend for reduced symptomatology in group 1 versus group 2/group 3 (p < .07). At 3 months, the reduction of incidence/severity of grade 1+2 anorexia, nausea/vomiting, xerostomia, and dysgeusia was different: 90% of the patients improved in group 1 versus 67% in group 2 versus 51% in group 3 (p < .0001). After RT, QOL function scores improved (p < .003) proportionally with improved nutritional intake and status in group 1/group 2 (p < .05) and worsened in group 3 (p < .05); at 3 months, patients in group 1 maintained or improved overall QOL, whereas patients in groups 2 and 3 maintained or worsened overall QOL.
During RT, nutritional interventions positively influenced outcomes, and counseling was of similar/higher benefit; in the medium term, only counseling exerted a significant impact on patient outcomes.
我们旨在确定饮食咨询或口服补充剂对癌症患者放疗期间及放疗后3个月的结局的影响，具体而言，是对营养结局、发病率和生活质量（QOL）的影响。
75例因放疗（RT）前来就诊的头颈癌患者被随机分为以下几组：第1组（n = 25），接受常规食物饮食咨询的患者；第2组（n = 25），维持常规饮食并补充营养剂的患者；第3组（n = 25），随意饮食的患者。在基线、放疗结束时和3个月时评估营养摄入（通过饮食史确定）和营养状况（通过奥特里主观全面评定法确定）以及生活质量（通过欧洲癌症研究与治疗组织生活质量问卷第3.0版 [EORTC QLQ-C30] 确定）。
放疗后第1组和第2组的能量摄入均增加（p≤0.05）。第1组和第2组的蛋白质摄入也增加（p≤0.006）。第3组的能量和蛋白质摄入均显著下降（p<0.01）。在3个月时，第1组维持摄入量，而第2组和第3组恢复到基线水平或降至基线水平以下。放疗后，>90%的患者出现放疗毒性；各组之间无显著差异，第1组与第2组/第3组相比症状有减轻趋势（p<0.07）。在3个月时，1 + 2级厌食、恶心/呕吐、口干和味觉障碍的发生率/严重程度降低情况有所不同：第1组90%的患者症状改善，第2组为67%，第3组为51%（p<0.0001）。放疗后，第1组/第2组的生活质量功能评分随着营养摄入和营养状况的改善而改善（p<0.003）（p<0.05），第3组则恶化（p<0.05）；在三个月时，第1组患者的总体生活质量维持或改善，而第2组和第3组患者的总体生活质量维持或恶化。
在放疗期间，营养干预对结局有积极影响，咨询的益处相似或更高；从中期来看，只有咨询对患者结局有显著影响。
