Cotogni Paolo, De Carli Luca, Passera Roberto, Amerio Maria Luisa, Agnello Elena, Fadda Maurizio, Ossola Marta, Monge Taira, De Francesco Antonella, Bozzetti Federico
Department of Anesthesia and Intensive Care, University of Turin, Turin, Italy.
Unit of Parenteral Nutrition in Oncology, S. Giovanni Battista Hospital, Turin, Italy.
Cancer Med. 2017 Jul;6(7):1799-1806. doi: 10.1002/cam4.1111. Epub 2017 May 29.
Since there is little knowledge regarding the quality of life (QoL) of cancer patients on home parenteral nutrition (HPN), we planned a prospective, longitudinal, double-center study to investigate the changes of QoL in these patients. One hundred and eleven adult cancer patients who were candidates for HPN following the indications of the European guidelines were consecutively enrolled. For QoL analysis, EORTC QLQ-C30 questionnaires were filled at the HPN start and after 1, 2, 3, and 4 months, and scores changes over time were analyzed according to the univariate mixed-effects linear model for repeated measures. Most patients had gastrointestinal cancers, were severely malnourished, and were in stage IV; two-thirds were still receiving oncologic treatments. Median weight loss over 3 months and body mass index were 11.7% and 20.7, respectively. Median survival was 4.7 (1-42) months; 67 and 34% of patients survived 3 and 6 months, respectively. Global QoL, physical functioning, role functioning, emotional functioning, appetite loss, and fatigue scores had a statistically significant trend over time (P < 0.001, P < 0.001, P = 0.007, P < 0.001, P = 0.004, P = 0.022, respectively). At the univariate analyses, the determinants significantly associated with changes in trend over time for physical, role, and emotional functioning were oncologic treatments (P < 0.001, P = 0.014, P = 0.040, respectively) and for appetite loss they were weight loss and Karnofsky performance status (P = 0.003, P = 0.023, respectively). Global QoL, physical, role, and emotional functioning improved during HPN even in advanced cancer patients on oncologic treatments.
由于关于接受家庭肠外营养（HPN）的癌症患者的生活质量（QoL）的知识较少，我们计划开展一项前瞻性、纵向、双中心研究，以调查这些患者的生活质量变化。按照欧洲指南的指征，连续纳入了111例适合接受HPN的成年癌症患者。为了进行生活质量分析，在开始HPN时以及1、2、3和4个月后填写欧洲癌症研究与治疗组织（EORTC）QLQ-C30问卷，并根据重复测量的单变量混合效应线性模型分析随时间的得分变化。大多数患者患有胃肠道癌症，严重营养不良，处于IV期；三分之二的患者仍在接受肿瘤治疗。3个月内的体重减轻中位数和体重指数分别为11.7%和20.7。中位生存期为4.7（1 - 42）个月；分别有67%和34%的患者存活3个月和6个月。总体生活质量、身体功能、角色功能、情绪功能、食欲减退和疲劳得分随时间有统计学显著趋势（分别为P < 0.001、P < 0.001、P = 0.007、P < 0.001、P = 0.004、P = 0.022）。在单变量分析中，与身体、角色和情绪功能随时间趋势变化显著相关的决定因素是肿瘤治疗（分别为P < 0.001、P = 0.014、P = 0.040），而与食欲减退相关的是体重减轻和卡氏功能状态（分别为P = 0.003、P = 0.023）。即使是正在接受肿瘤治疗的晚期癌症患者，在接受HPN期间总体生活质量、身体、角色和情绪功能也有所改善。
