头颈部癌症治疗期间的管饲喂养——依从性和患者报告的障碍。

Tube feeding during treatment for head and neck cancer - Adherence and patient reported barriers.

机构信息

Centre for Dietetics Research (C-DIET-R), School of Human Movement Studies, The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia; Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia.

Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia.

出版信息

Oral Oncol. 2017 Sep;72:140-149. doi: 10.1016/j.oraloncology.2017.07.017. Epub 2017 Jul 25.

DOI:10.1016/j.oraloncology.2017.07.017

PMID:28797450

Abstract

OBJECTIVES

The main aim was to investigate the incidence of patient adherence to nutritional tube feeding recommendations in patients with head and neck cancer and to determine patient barriers to meeting tube feeding prescription.

MATERIALS AND METHODS

This was an observational study from a randomised controlled trial in patients with head and neck cancer deemed at high nutritional risk with prophylactic gastrostomy (n=125). Patients were randomised to receive early tube feeding prior to treatment (intervention group) or standard care. All patients in the intervention and standard care groups then commenced clinical tube feeding as required during treatment. Patients maintained a daily record of gastrostomy intake, main nutrition impact symptom necessitating gastrostomy use, and reasons for not meeting nutrition prescription. Adherence was defined as meeting ≥75% of total prescribed intake.

RESULTS

Patients were predominantly male (89%), median age 60, with oropharyngeal tumours (78%), stage IV disease (87%) treated with chemoradiotherapy (87%). Primary reasons for gastrostomy use were poor appetite/dysgeusia (week 2-3) and odynophagia/mucositis (week 4-7). Early tube feeding adherence was 51%. Clinical tube feeding adherence was significantly higher in the intervention group (58% vs 38%, p=0.037). Key barriers to both phases of tube feeding were; nausea, early satiety and treatment factors (related to hospital healthcare processes).

CONCLUSIONS

Early tube feeding can improve patient adherence to clinically indicated tube feeding during treatment. Low adherence overall is a likely explanation for clinically significant weight loss despite intensive nutrition interventions. Optimising symptom management and strategies to overcome other barriers are key to improving adherence.

CLINICAL TRIAL REGISTRATION

This trial has been registered in the Australian New Zealand Clinical Trials registry as ACTRN12612000579897.

摘要

目的

本研究旨在调查头颈部癌症患者对营养管饲建议的依从性，并确定患者在满足管饲处方方面存在的障碍。

材料和方法

这是一项针对高营养风险头颈部癌症患者预防性胃造瘘的随机对照试验的观察性研究（n=125）。患者随机分为治疗前早期管饲组（干预组）或标准治疗组。所有干预组和标准治疗组患者在治疗期间根据需要开始进行临床管饲。患者每日记录胃造瘘摄入量、因需要使用胃造瘘而导致的主要营养影响症状以及未满足营养处方的原因。依从性定义为满足≥75%的总规定摄入量。

结果

患者主要为男性（89%），中位年龄 60 岁，口咽肿瘤（78%），IV 期疾病（87%），接受放化疗（87%）。胃造瘘的主要原因是食欲减退/味觉障碍（第 2-3 周）和咽痛/黏膜炎（第 4-7 周）。早期管饲的依从性为 51%。干预组的临床管饲依从性明显更高（58%比 38%，p=0.037）。管饲两个阶段的主要障碍是：恶心、早饱和治疗因素（与医院医疗流程有关）。