Sun Virginia, Kim Joseph, Kim Jae Y, Raz Dan J, Merchant Shaila, Chao Joseph, Chung Vincent, Jimenez Tracy, Wittenberg Elaine, Grant Marcia, Ferrell Betty
Division of Nursing Research and Education, Department of Population Sciences, City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA.
Division of Surgical Oncology, Department of Surgery, City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA.
Eur J Oncol Nurs. 2015 Aug;19(4):343-8. doi: 10.1016/j.ejon.2015.01.008. Epub 2015 Feb 17.
The surgical treatment of upper gastrointestinal (GI) cancers, specifically esophageal and gastric cancers, often result in extensive health-related quality of life (HRQOL) concerns, particularly those associated with dietary adjustments. This paper provides a review of HRQOL changes following esophagectomy and gastrectomy, and describes key components of an intervention to improve dietary adjustments following surgery.
Intervention development was informed by 1) current published evidence on HRQOL changes for patients following upper GI surgery, 2) examination of usual post-operative care related to dietary restrictions to identify areas for continued education and support and 3) the inclusion of a conceptual framework (the Chronic Care Model) to guide intervention design and inform the selection of appropriate outcome measures.
Three key components of an HRQOL intervention are identified, and should focus on HRQOL concerns associated with dietary alterations and restrictions following treatment, involve family caregivers, and be tailored and flexible to patient and family caregiver's needs and preferences.
Evidence-based interventions to support long-term dietary alterations and restrictions following upper GI surgery are lacking, despite evidence confirming its impact on morbidity and mortality. Interventions are needed to support dietary adjustments, prevent malnutrition and excessive weight loss, and enhance HRQOL following surgery for upper GI cancers.
上消化道（GI）癌，尤其是食管癌和胃癌的外科治疗，常常引发诸多与健康相关的生活质量（HRQOL）问题，特别是那些与饮食调整相关的问题。本文综述了食管癌切除术和胃切除术后HRQOL的变化，并描述了一项旨在改善术后饮食调整的干预措施的关键组成部分。
干预措施的制定基于以下几点：1）当前已发表的关于上消化道手术后患者HRQOL变化的证据；2）对与饮食限制相关的常规术后护理进行检查，以确定需要持续教育和支持的领域；3）纳入一个概念框架（慢性病护理模型），以指导干预措施的设计并为选择合适的结局指标提供依据。
确定了HRQOL干预措施的三个关键组成部分，应聚焦于与治疗后饮食改变和限制相关的HRQOL问题，让家庭照顾者参与其中，并根据患者和家庭照顾者的需求及偏好进行定制且具有灵活性。
尽管有证据证实上消化道手术后长期的饮食改变和限制对发病率和死亡率有影响，但仍缺乏基于证据的干预措施。需要采取干预措施来支持饮食调整、预防营养不良和过度体重减轻，并提高上消化道癌手术后的HRQOL。
