School of Medicine and Public Health, University of Newcastle, Newcastle, Australia; Psycho-Oncology Department, Calvary Mater Newcastle, Newcastle, Australia.
School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
Int J Radiat Oncol Biol Phys. 2019 Feb 1;103(2):353-362. doi: 10.1016/j.ijrobp.2018.09.027. Epub 2018 Oct 5.
Malnutrition in head and neck cancer (HNC) treatment is common and associated with poorer morbidity and mortality outcomes. This trial aimed to improve nutritional status during radiation therapy (RT) using a novel method of training dietitians to deliver psychological techniques to improve nutritional behaviors in patients with HNC.
This trial used a stepped-wedge, randomized controlled design to assess the efficacy of the Eating As Treatment (EAT) program. Based on motivational interviewing and cognitive behavioral therapy, EAT was designed to be delivered by oncology dietitians and integrated into their clinical practice. During control steps, dietitians provided treatment as usual, before being trained in EAT and moving into the intervention phase. The training was principles based and sought to improve behavior-change skills rather than provide specific scripts. Patients recruited to the trial (151 controls, 156 intervention) were assessed at 4 time points (the first and the final weeks of RT, and 4 and 12 weeks afterward). The primary outcome was nutritional status at the end of RT as measured by the Patient-Generated Subjective Global Assessment.
Patients who received the EAT intervention had significantly better scores on the primary outcome of nutritional status at the critical end-of-treatment time point (β = -1.53 [-2.93 to -.13], P = .03). Intervention patients were also significantly more likely than control patients to be assessed as well-nourished at each time point, lose a smaller percentage of weight, have fewer treatment interruptions, present lower depression scores, and report a higher quality of life. Although results were not statistically significant, patients who received the intervention had fewer and shorter unplanned hospital admissions.
This trial is the first of its kind to demonstrate the effectiveness of a psychological intervention to improve nutrition in patients with HNC who are receiving RT. The intervention provides a means to ameliorate malnutrition and the important related outcomes and consequently should be incorporated into standard care for patients receiving RT for HNC.
头颈部癌症（HNC）治疗中的营养不良很常见，并且与较差的发病率和死亡率结果相关。本试验旨在通过一种新的方法来培训营养师，使其运用心理技术来改善 HNC 患者的营养行为，从而在放射治疗（RT）期间改善营养状况。
本试验采用了逐步楔形随机对照设计来评估“将进食作为治疗手段（EAT）”方案的疗效。EAT 是基于动机性访谈和认知行为疗法设计的，旨在由肿瘤营养师提供，并将其纳入临床实践。在对照阶段，营养师提供常规治疗，然后接受 EAT 培训并进入干预阶段。培训是基于原则的，旨在提高行为改变技能，而不是提供特定的脚本。招募到试验中的患者（对照组 151 例，干预组 156 例）在 4 个时间点（RT 的第一周和最后一周，以及之后的 4 周和 12 周）进行评估。主要结局是在 RT 结束时用患者生成的主观整体评估来衡量的营养状况。
接受 EAT 干预的患者在关键的治疗结束时的营养状况主要结局评分显著更好（β=-1.53[-2.93 至-.13]，P=0.03）。与对照组患者相比，干预组患者在每个时间点都更有可能被评估为营养良好，体重减轻的百分比更小，治疗中断更少，抑郁评分更低，生活质量更高。尽管结果没有统计学意义，但接受干预的患者的非计划住院次数更少且住院时间更短。
这是首例证明心理干预可改善接受 RT 的 HNC 患者营养状况的试验。该干预提供了一种改善营养不良和重要相关结局的方法，因此应将其纳入接受 HNC RT 患者的标准护理中。
