Lee Warren Tak Keung, Chan Hung Fai, Wong Eric
Postgraduate Program of Epidemiology and Biostatistics, School of Public Health, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
Support Care Cancer. 2005 Dec;13(12):1051-6. doi: 10.1007/s00520-005-0859-7. Epub 2005 Aug 19.
Feeding independence is important to improve the quality of life (QOL) of patients receiving palliative care. Studies on feeding independence among cancer patients under palliative care are unavailable. This study aimed to evaluate the effectiveness of occupational therapy in promoting feeding independence in end-stage cancer patients in palliative care.
Thirty-six end-stage cancer inpatients with feeding difficulties attributable to improper positioning (58.3%), one-handedness (22.2%), and upper limb impairment (11.1%) were enrolled from two hospitals in Hong Kong. The feeding independence level (level 1> or =25% assistance; level 2<25% assistance) of patients was assessed weekly for 3 weeks. Major treatment modalities included positioning (58%), feeding aid support (25%), and upper limb support (11%). Multilevel models were used for comparing feeding independence levels at baseline and weekly intervals.
There was a significant improvement in feeding independence from baseline to week 1 (P<0.0001). Multilevel models showed that there were no significant differences in the level of feeding independence between weeks 1 and 2 (P=0.246) and between weeks 1 and 3 (P=0.165) among the subjects after controlling for age and sex, indicating that the improved feeding independence in week 1 was sustainable through weeks 2 and 3.
The prospective study showed for the first time that the provision of appropriate feeding supports could markedly enhance feeding independence in end-stage cancer patients receiving palliative care, which might improve activities of daily living and QOL, and minimize excessive disability. Furthermore, it merits cooperation among occupational therapists, caregivers, and ward staff to promote feeding independence in this group of patients.
进食独立性对于提高接受姑息治疗患者的生活质量至关重要。目前尚无关于姑息治疗下癌症患者进食独立性的研究。本研究旨在评估职业治疗对促进姑息治疗中晚期癌症患者进食独立性的有效性。
从香港两家医院招募了36名因体位不当（58.3%）、单手功能障碍（22.2%）和上肢损伤（11.1%）导致进食困难的晚期癌症住院患者。对患者的进食独立水平（1级：≥25%的协助；2级：<25%的协助）进行为期3周的每周评估。主要治疗方式包括体位调整（58%）、进食辅助支持（25%）和上肢支持（11%）。采用多水平模型比较基线和每周的进食独立水平。
从基线到第1周，进食独立性有显著改善（P<0.0001）。多水平模型显示，在控制年龄和性别后，受试者在第1周和第2周（P=0.246）以及第1周和第3周（P=0.165）之间的进食独立水平没有显著差异，这表明第1周改善的进食独立性在第2周和第3周得以持续。
这项前瞻性研究首次表明，提供适当的进食支持可以显著提高接受姑息治疗的晚期癌症患者的进食独立性，这可能改善日常生活活动能力和生活质量，并最大限度地减少过度残疾。此外，职业治疗师、护理人员和病房工作人员之间的合作对于促进这类患者的进食独立性具有重要意义。
