Oates Justine E, Clark Jonathan R, Read Jane, Reeves Nicole, Gao Kan, Jackson Michael, Boyer Michael, O'brien Christopher J
Sydney Head and Neck Cancer Institute, Level 6, Gloucester House, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, New South Wales 2047, Australia.
Arch Otolaryngol Head Neck Surg. 2007 Jun;133(6):533-40. doi: 10.1001/archotol.133.6.533.
To prospectively assess quality of life in patients undergoing chemoradiation therapy for nasopharyngeal cancer. Concurrent chemoradiotherapy is standard for advanced nasopharyngeal cancer; however, the toxic effects of this treatment are substantial.
Prospective evaluation of quality of life and nutritional status before and after treatment for nasopharyngeal carcinoma.
A cohort of 14 patients, treated with concurrent chemoradiotherapy for 7 weeks, completed the European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire and Head and Neck Module before and 3, 6, 12, and 24 months after treatment. Changes in score were analyzed and correlated with the toxic effect grade.
Quality of life issues during the 24 months of follow-up included poorer global health (P = .01), fatigue (P = .01), appetite loss (P<.001), swallowing difficulties (P = .002), sense problems (P = .03), difficulty with social eating (P = .005), dental problems (P = .045), trismus (P = .001), xerostomia (P<.001), sticky saliva (P = .001), cough (P = .02), and feeling ill (P = .03). Pain (P = .004) and emotional functioning (P<.001) significantly improved from the pretreatment rating. The median weight loss was 7 kg, with most weight loss occurring during treatment, despite nutritional support with gastrostomy feeding tubes. One patient still required percutaneous endoscopic gastrostomy feeding at 2 years after treatment. Physician-scored toxic effects correlated poorly with quality-of-life scores.
Quality of life and functional assessment should be important end points in the follow-up of patients with nasopharyngeal cancer who receive chemoradiotherapy. This study supports the need for ongoing support and rehabilitation in a multidisciplinary setting.
前瞻性评估接受鼻咽癌放化疗患者的生活质量。同步放化疗是晚期鼻咽癌的标准治疗方法；然而，这种治疗的毒副作用很大。
对鼻咽癌治疗前后的生活质量和营养状况进行前瞻性评估。
一组14例患者接受了为期7周的同步放化疗，在治疗前以及治疗后3、6、12和24个月完成了欧洲癌症研究与治疗组织核心生活质量问卷及头颈模块。分析得分变化并与毒副反应分级相关联。
随访24个月期间的生活质量问题包括总体健康状况较差（P = 0.01）、疲劳（P = 0.01）、食欲减退（P<0.001）、吞咽困难（P = 0.002）、感觉问题（P = 0.03）、社交进食困难（P = 0.005）、牙齿问题（P = 0.045）、牙关紧闭（P = 0.001）、口干（P<0.001）、唾液黏稠（P = 0.001）、咳嗽（P = 0.02）以及身体不适（P = 0.03）。疼痛（P = 0.004）和情绪功能（P<0.001）较治疗前评分有显著改善。尽管通过胃造口喂养管给予营养支持，但中位体重减轻7 kg，且大部分体重减轻发生在治疗期间。1例患者在治疗后2年仍需经皮内镜下胃造口喂养。医生评分的毒副反应与生活质量评分相关性较差。
生活质量和功能评估应成为接受放化疗的鼻咽癌患者随访中的重要终点。本研究支持在多学科环境中持续提供支持和康复治疗的必要性。
