Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Princess Margaret Cancer Centre Research Institute, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
Departamento de Nutrição, Instituto do Câncer do Estado de São Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Eur J Oncol Nurs. 2022 Feb;56:102065. doi: 10.1016/j.ejon.2021.102065. Epub 2021 Nov 20.
This study aimed to explore whether adherence to intensive nutritional care during radiotherapy would avoid a meaningful worsening in quality of life in head and neck cancer patients; and whether adherence was associated with better nutritional outcomes.
Observational prospective study that assessed head and neck cancer patients treated with radiotherapy at a large oncology hospital, between August 2018 and April 2019. The main outcome was minimal clinically important difference in quality of life, assessed with EORTC QLQ-C30 and EORTC QLQ H&N35, between baseline and 12 weeks. To illustrate clinically significant changes in quality of life over timeby adherence, a heat map analysis was performed. We also evaluated nutritional outcomes.
Eighty patients were included, half of them (53.8%) were considered adherent. There were no significant difference in quality of life between groups at baseline, with the exception of swallowing (p = 0.029) and coughing (p < 0.01). After treatment, the heat map demonstrated that adherent patients had nonsignificant clinical change in function scales, while non-adherent patients had a clinically significant worsening in physical, cognitive and social function. The prevalence of malnutrition increased significantly only in non-adherent patients (p < 0.01).
Adherence to intensive nutritional care may be able to avoid a meaningful worsening in quality of life and result in better nutritional outcomes in head and neck cancer patients. Our results may help to increase the awareness of the assessment of adherence and minimal clinically important difference in quality of life for research purposes and clinical practice.
本研究旨在探讨头颈部癌症患者在放疗期间是否坚持强化营养护理，是否能避免生活质量出现有意义的恶化；以及坚持治疗是否与更好的营养结局相关。
这是一项观察性前瞻性研究，评估了 2018 年 8 月至 2019 年 4 月期间在一家大型肿瘤医院接受放疗的头颈部癌症患者。主要结局是使用 EORTC QLQ-C30 和 EORTC QLQ H&N35 评估的 12 周内生活质量的最小临床重要差异。为了说明通过坚持治疗随时间变化对生活质量的临床显著变化，进行了热图分析。我们还评估了营养结局。
共纳入 80 例患者，其中一半（53.8%）被认为是坚持治疗的。在基线时，两组患者的生活质量没有显著差异，除了吞咽（p=0.029）和咳嗽（p<0.01）。治疗后，热图表明坚持治疗的患者功能量表的临床变化不显著，而不坚持治疗的患者身体、认知和社会功能的临床恶化明显。仅在不坚持治疗的患者中，营养不良的患病率显著增加（p<0.01）。
坚持强化营养护理可能能够避免头颈部癌症患者生活质量出现有意义的恶化，并带来更好的营养结局。我们的研究结果可能有助于提高对强化营养护理评估的认识，并为研究和临床实践提供最小临床重要差异在生活质量评估中的应用。
