Farhangfar Arazm, Makarewicz Marcin, Ghosh Sunita, Jha Naresh, Scrimger Rufus, Gramlich Leah, Baracos Vickie
Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Canada.
Division of Medical Oncology, Department of Oncology, University of Alberta, Canada; Alberta Health Services - Cancer Control, Cross Cancer Institute, Edmonton, Alberta, Canada.
Oral Oncol. 2014 Sep;50(9):877-83. doi: 10.1016/j.oraloncology.2014.06.009. Epub 2014 Jul 10.
To evaluate the impact of 17 symptoms on reduced dietary intake, weight loss, and survival of patients with Head and Neck Cancer (HNC).
635 Consecutive patients were screened (Patient- Generated Subjective Global Assessment©, Head and Neck Symptom Checklist©) before radiation and/or chemotherapy. Multivariate regression analyses were used to relate severity of symptoms to reduced dietary intake and weight loss and identify prognostic individual symptoms impact on dietary intake. Cox proportional hazards model was used to find significant predictors of survival.
Aggregate burden of symptoms was a significant independent predictor of reduced intake, weight loss and survival. Patients with a highest total symptom scores survived significantly less (205days, 95% CI=146-264) compared to patients with lowest total symptom score (577days, CI=429-725), log-rank P<0.001). Loss of appetite, difficulty chewing, dry mouth, thick saliva and pain were individual symptoms that significantly associated with reduced dietary intake in the entire cohort. In subgroup analyses, tumor location, disease stage, performance status, and presence of dysphagia altered the profile of individual symptoms that predict intake. However across all subgroups loss of appetite had the highest impact (OR=4.6; 95% CI=3.1-6.8), followed by difficulty chewing (OR=2.5; 95% CI=2.0-3.9).
HNC patients experience significant symptom burden prior to radiation and chemotherapy. The nutritional impact of these symptoms on dietary intake is revealed by multivariate analysis and support the suggestion that unique individual symptom profiles require management to improve nutritional status.
评估17种症状对头颈癌（HNC）患者饮食摄入量减少、体重减轻及生存的影响。
对635例连续患者在放疗和/或化疗前进行筛查（患者生成的主观全面评定法©、头颈症状清单©）。采用多变量回归分析将症状严重程度与饮食摄入量减少和体重减轻相关联，并确定对饮食摄入量有预后影响的个体症状。使用Cox比例风险模型找出生存的显著预测因素。
症状的总体负担是摄入量减少、体重减轻和生存的显著独立预测因素。症状总分最高的患者生存时间显著短于症状总分最低的患者（分别为205天，95%可信区间=146 - 264；577天，可信区间=429 - 725），对数秩检验P<0.001）。食欲减退、咀嚼困难、口干、唾液黏稠和疼痛是整个队列中与饮食摄入量减少显著相关的个体症状。在亚组分析中，肿瘤位置、疾病分期、体能状态和吞咽困难的存在改变了预测摄入量的个体症状特征。然而，在所有亚组中，食欲减退的影响最大（比值比=4.6；95%可信区间=3.1 - 6.8），其次是咀嚼困难（比值比=2.5；95%可信区间=2.0 - 3.9）。
头颈癌患者在放疗和化疗前经历了显著的症状负担。多变量分析揭示了这些症状对饮食摄入量的营养影响，并支持了这样的建议，即需要针对独特的个体症状特征进行管理以改善营养状况。
