Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, 386 Bevier Hall, 905 S Goodwin Ave, Urbana, IL, 61801, USA.
Carle Foundation Hospital, Urbana, IL, USA.
J Cancer Surviv. 2018 Aug;12(4):479-494. doi: 10.1007/s11764-018-0687-7. Epub 2018 Mar 20.
PURPOSE: It is estimated that more than 90% of head and neck cancer (HNC) survivors who underwent chemoradiotherapy experience one or more nutrition impact symptoms (NIS) in the months or years thereafter. Despite the high prevalence, there is limited research addressing long-term impact of NIS on outcomes such as nutrition and quality of life in HNC survivors treated with chemoradiotherapy. OBJECTIVE: To conduct a systematic review of the literature pertaining to the presence of nutrition impact symptoms and their associated outcomes in post-chemoradiotherapy head and neck cancer survivors. EVIDENCE REVIEW: A systematic review was conducted across three databases according to PRISMA guidelines and used to identify current literature regarding NIS in HNC survivors. A keyword search was conducted in PubMed, Scopus, and Web of Science from 2007 to 2017. Studies that met all of the following criteria were included in the review: (1) studies must include human subjects with a HNC diagnosis; (2) study participants must have received chemoradiotherapy; (3) study participants must have been post-treatment for a minimum of 3 months at the time of data collection; (4) full-text articles must have appeared in peer-reviewed journals; (5) papers must have been published in English; (6) studies must be quantitative in nature; (7) studies must have reported at least one NIS; and (8) studies must address at least one of the following outcomes: nutrition, functional status, or quality of life. Two independent reviewers assessed study quality using a predefined set of criteria. FINDINGS: A systematic search yielded 1119 papers, of which 15 met the inclusion criteria. The study reviewed existing evidence of NIS in a variety of HNC survivors ranging from 3 months to greater than 10 years post-chemoradiotherapy treatment. Eight hundred forty-nine study participants were included in the review. Of the 15 studies, 10 were designed as prospective cohort studies, 4 were cross-sectional studies, and 1 was a retrospective cohort study. Functional impairments as a result of chemoradiotherapy to the head and neck are prevalent in research and include dysphagia, xerostomia, trismus, salivary issues, mucositis, and oral pain. CONCLUSIONS: NIS negatively influence HNC survivors beyond the acute phase of treatment. These symptoms are associated with decreased nutrition and quality of life. Interventions are necessary to improve survivors' eating challenges beyond the completion of treatment. If practitioners do not follow patients long term, patients may suffer consequences of NIS including malnutrition risk, weight loss, and decreased food intake and quality of life. IMPLICATIONS FOR CANCER SURVIVORS: The prevalence and consequences of nutrition impact symptoms are substantial among head and neck cancer survivors beyond the acute phase of cancer treatment. Oncology clinicians should continuously monitor and manage these symptoms throughout the cancer continuum.
目的:据估计,超过 90%接受放化疗的头颈部癌症(HNC)幸存者在治疗后的数月或数年内会经历一种或多种营养影响症状(NIS)。尽管患病率很高,但针对放化疗后 NIS 对 HNC 幸存者营养和生活质量等结果的长期影响的研究有限。
目的:系统回顾文献,了解放化疗后头颈部癌症幸存者 NIS 的存在及其相关结局。
证据综述:根据 PRISMA 指南进行了系统综述,并用于确定目前关于 HNC 幸存者 NIS 的文献。在 2007 年至 2017 年期间,在 PubMed、Scopus 和 Web of Science 三个数据库中进行了关键词搜索。符合以下所有标准的研究被纳入综述:(1)研究必须包括 HNC 诊断的人类受试者;(2)研究参与者必须接受放化疗;(3)研究参与者在数据收集时必须至少在治疗后 3 个月;(4)全文文章必须发表在同行评议期刊上;(5)论文必须以英文发表;(6)研究性质必须是定量的;(7)研究必须报告至少一种 NIS;(8)研究必须至少涉及以下结果之一:营养、功能状态或生活质量。两名独立评审员使用一套预先确定的标准评估研究质量。
发现:系统搜索产生了 1119 篇论文,其中 15 篇符合纳入标准。该研究回顾了放化疗后各种 HNC 幸存者的 NIS 现有证据,时间从 3 个月到 10 年以上。综述纳入了 849 名研究参与者。在 15 项研究中,10 项为前瞻性队列研究,4 项为横断面研究,1 项为回顾性队列研究。头颈部放化疗引起的功能障碍在研究中很常见,包括吞咽困难、口干、牙关紧闭、唾液问题、黏膜炎和口腔疼痛。
结论:NIS 在治疗的急性期后对 HNC 幸存者产生负面影响。这些症状与营养和生活质量下降有关。有必要采取干预措施,以改善幸存者治疗结束后的进食挑战。如果临床医生没有对患者进行长期随访,患者可能会因 NIS 而遭受不良后果,包括营养不良风险、体重减轻以及食物摄入和生活质量下降。
对癌症幸存者的意义:放化疗后,HNC 幸存者在癌症治疗的急性期后,NIS 的患病率和后果相当大。肿瘤临床医生应在整个癌症病程中持续监测和管理这些症状。
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