Morton Randall P, Crowder Victoria L, Mawdsley Robert, Ong Esther, Izzard Mark
Department of Otolaryngology - Head and Neck Surgery, Counties - Manukau District Health Board, Manukau, New Zealand.
ANZ J Surg. 2009 Oct;79(10):713-8. doi: 10.1111/j.1445-2197.2009.05056.x.
Chemoradiotherapy for treatment of advanced head and neck cancer (HNC) is used to achieve organ preservation without compromising survival. Because chemoradiotherapy usually impacts adversely on nutritional and functional status, feeding by percutaneous endoscopic gastrostomy (PEG) is often part of the management regimen for these patients, but the presence of a PEG tube can also be associated with reduced quality of life (QOL). This study aimed to examine the factors associated with PEG insertion and the effects of PEG use on QOL and functional outcomes in HNC patients receiving chemoradiotherapy.
Survey of 36 consecutive patients treated by primary chemoradiotherapy for HNC. Patient weight, age, tumour type, details of PEG insertion, feeding regimens and treatment were noted. The survey comprised the Performance Status Scale, the Functional Measure for Swallowing, Nutritional Mode and a self-assessment of QOL.
PEG insertion within 1 month of treatment was associated with smaller fall in body mass index at 12 months than PEG insertion 1 month or more after the start of the treatment (P < 0.05). Body mass index change was inversely correlated with health-related quality of life and significantly related to lower speech and swallowing function scores. Longer PEG duration correlated with poorer performance status and swallowing function (P < 0.01). Longer PEG duration also predicted poorer overall QOL (P < 0.01) and poorer swallowing (P < 0.01) and speech (P < 0.05). Nutritional mode was related to overall QOL (P < 0.01).
Nutritional support for HNC patients undergoing chemoradiotherapy is an essential component of patient care. Early PEG insertion and shorter PEG duration are associated with more favourable QOL-related outcomes.
晚期头颈癌（HNC）的放化疗用于在不影响生存率的情况下实现器官保留。由于放化疗通常会对营养和功能状态产生不利影响，经皮内镜下胃造口术（PEG）喂养常常是这些患者治疗方案的一部分，但PEG管的存在也可能与生活质量（QOL）下降有关。本研究旨在探讨与PEG置入相关的因素以及PEG使用对接受放化疗的HNC患者QOL和功能结局的影响。
对36例接受HNC初次放化疗的连续患者进行调查。记录患者体重、年龄、肿瘤类型、PEG置入细节、喂养方案和治疗情况。该调查包括体能状态量表、吞咽功能测量、营养模式和QOL自我评估。
治疗1个月内进行PEG置入的患者在12个月时体重指数下降幅度小于治疗开始1个月或更长时间后进行PEG置入的患者（P<0.05）。体重指数变化与健康相关生活质量呈负相关，与较低的言语和吞咽功能评分显著相关。PEG使用时间越长，体能状态和吞咽功能越差（P<0.01）。PEG使用时间越长，总体QOL也越差（P<0.01），吞咽功能（P<0.01）和言语功能（P<0.05）也越差。营养模式与总体QOL相关（P<0.01）。
接受放化疗的HNC患者的营养支持是患者护理的重要组成部分。早期PEG置入和较短的PEG使用时间与更有利的QOL相关结局有关。
