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基于WARM模型的早期多学科姑息治疗在非小细胞肺癌中的疗效

[Efficacy of early interdisciplinary palliative care based on WARM model in non-small-cell lung cancer].

作者信息

Chen M T, Yu H J, Yang L J, Wang S X, Tian L, Liu S H, Yu H Q

机构信息

Department of Clinical Nutrition, Chongqing University Cancer Hospital, Chongqing 400030, China.

College of Arts, Chongqing University, Chongqing 400030, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2021 Dec 7;101(45):3736-3741. doi: 10.3760/cma.j.cn112137-20210607-01298.

Abstract

To assess the therapeutic effect of the early interdisciplinary palliative care based on WARM model (whole, assessment, revaluation, management) on the quality of life, psychological state, pain and nutritional status in patients with non-small-cell lung cancer (NSCLC). A total of 60 patients from Chongqing University Cancer Hospital with newly diagnosed advanced NSCLC from Oct 15, 2019 to Jun 12, 2020 were enrolled. According to the method of random number table, the patients were divided into two groups: standard oncologic care group (SC, =30) and early palliative care group (EPC, =30). SC group only received standard oncological care, while EPC group received standard oncological care and additional comprehensive treatment from a MDT consisted of medical oncologists, palliative care nurses, dietitians and psychologists. The quality of life [functional assessment of cancer therapy-lung (FACT-L) scale], psychological state [hospital anxiety and depression scale (HADS) and patient health questionnaire-9 (PHQ-9)], nutritional status [patient-generated subjective global assessment (PG-SGA)], and cancer pain status [numerical rating scale (NRS)] were observed and compared between the two groups before and after the 6 months treatment, respectively. A total of 45 patients completed 6 months treatment, including 24 males and 21 females, aged 38-82 (60.5±1.7), with 23 patients in the EPC group and 22 patients in the SC group. Patients assigned to EPC group had a better quality of life than those assigned to SC group [FACT-L scale: (122.3±1.6) vs (111.8±2.1), <0.001]. Fewer patients had anxiety and depressive symptoms in the EPC group than those in the SC group [HADS anxiety subscale: (1.1±0.3) vs (2.9±0.4), <0.001; HADS depression subscale: (0.7±0.3) vs (3.6±0.4), <0.001]. The PHQ-9 results showed that 100.0% (23/23) patients were free of depression in the EPC group, while 45.5% (10/22) patients were free of depression in SC group (<0.001). Furthermore, patients in the EPC group had a better nutritional status [moderate malnutrition: 60.9% (14/23); no malnutrition: 39.1% (9/23)] than those in the SC group [severe malnutrition: 40.9% (9/22); moderate malnutrition: 50.0% (11/22); no malnutrition: 9.1% (2/22)] (<0.001). There was no significant difference in NRS score between EPC group and SC group (=0.140). Early interdisciplinary palliative care based on WARM model can improve the quality of life, psychological state and nutritional status in NSCLC patients.

摘要

评估基于WARM模型(全面、评估、再评估、管理)的早期多学科姑息治疗对非小细胞肺癌(NSCLC)患者生活质量、心理状态、疼痛及营养状况的治疗效果。选取2019年10月15日至2020年6月12日在重庆大学附属肿瘤医院新诊断的晚期NSCLC患者60例。采用随机数字表法将患者分为两组:标准肿瘤治疗组(SC组,n = 30)和早期姑息治疗组(EPC组,n = 30)。SC组仅接受标准肿瘤治疗,而EPC组在接受标准肿瘤治疗的基础上,还接受了由肿瘤内科医生、姑息治疗护士、营养师和心理医生组成的多学科团队提供的额外综合治疗。分别观察并比较两组患者在治疗6个月前后的生活质量[癌症治疗功能评估-肺癌(FACT-L)量表]、心理状态[医院焦虑抑郁量表(HADS)和患者健康问卷-9(PHQ-9)]、营养状况[患者主观整体评估(PG-SGA)]及癌痛状况[数字评分量表(NRS)]。共有45例患者完成了6个月的治疗,其中男性24例,女性21例,年龄38 - 82岁(60.5±1.7),EPC组23例,SC组22例。EPC组患者的生活质量优于SC组[FACT-L量表:(122.3±1.6) vs (111.8±2.1),P < 0.001]。EPC组出现焦虑和抑郁症状的患者少于SC组[HADS焦虑分量表:(1.1±0.3) vs (2.9±0.4),P < 0.001;HADS抑郁分量表:(0.7±0.3) vs (3.6±0.4),P < 0.001]。PHQ-9结果显示,EPC组100.0%(23/23)的患者无抑郁,而SC组45.5%(10/22)的患者无抑郁(P < 0.001)。此外,EPC组患者的营养状况[中度营养不良:60.9%(14/23);无营养不良:39.1%(9/23)]优于SC组[重度营养不良:40.9%(9/22);中度营养不良:50.0%(11/22);无营养不良:9.1%(2/22)](P < 0.001)。EPC组和SC组的NRS评分差异无统计学意义(P = 0.140)。基于WARM模型的早期多学科姑息治疗可改善NSCLC患者的生活质量、心理状态和营养状况。

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