Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Head Neck. 2010 Sep;32(9):1217-25. doi: 10.1002/hed.21322.
Functional decline in Brazilian patients with head and neck squamous cell carcinoma (HNSCC) is associated with impaired recovery, quality of life, and health care costs.
Sixty patients enrolled at the regional oncology center in Curitiba, Brazil, were assessed over 6 months for toxicities, nutritional status, anthropometry, fatigue, stress, and functionality.
Severe mid-arm and mid-calf circumference depletion accompanied weight loss. Total fatigue score increased 64% (p < .001), as did perceived stress and serum cortisol (p = .01). Instrumental activities of daily living (IADL) dependence doubled, and activities of daily living (ADL) dependence quadrupled (p < .001). Difficulty chewing or swallowing, weight loss, fatigue, perceived stress, and IADL dependence accounted for 48.2% of ADL dependence.
The physical and psychological impact of HNSCC and its treatment are universally experienced; yet, screening and intervention for symptoms such as fatigue and stress are not typical clinical practice. Moreover, assessment of functional status is usually limited to chewing and swallowing. This study identified symptoms that require systematic intervention and randomized trials with functional independence as the outcome.
巴西头颈部鳞状细胞癌（HNSCC）患者的功能下降与恢复不良、生活质量下降和医疗保健费用增加有关。
巴西库里蒂巴地区肿瘤中心共招募了 60 名患者，在 6 个月的时间里对他们的毒性、营养状况、人体测量学、疲劳、压力和功能进行了评估。
中臂和小腿中段周长严重减少伴随着体重减轻。总疲劳评分增加了 64%（p<0.001），同时感知压力和血清皮质醇也增加（p=0.01）。工具性日常生活活动（IADL）的依赖性增加了一倍，而日常生活活动（ADL）的依赖性增加了四倍（p<0.001）。咀嚼或吞咽困难、体重减轻、疲劳、感知压力和 IADL 的依赖性占 ADL 依赖性的 48.2%。
HNSCC 及其治疗的身体和心理影响是普遍存在的；然而，对疲劳和压力等症状的筛查和干预并不是典型的临床实践。此外，对功能状态的评估通常仅限于咀嚼和吞咽能力。本研究确定了需要系统干预的症状，并开展了以功能独立性为结局的随机试验。
