Department of Oncology, Western University, London, Ontario, Canada.
Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
BMJ Open Qual. 2024 Jan 12;13(1):e002439. doi: 10.1136/bmjoq-2023-002439.
Patients undergoing neoadjuvant chemoradiation for oesophageal cancer often experience dehydration from decreased fluid intake and increased losses. Despite frequent clinical visits during treatment, patients can still present with dehydration, suggesting the need for increased patient awareness and engagement around adverse event management at home. Evidence for benefits of self-monitoring may help motivate patients to engage proactively in their own care to improve their treatment experience.
We performed a randomised single-centre study of a urine colour self-monitoring card (UCC) during chemoradiation therapy for oesophageal cancer, compared with standard dietitian counselling. Primary outcome was self-efficacy as determined by the Self-Management Resource Centre Self-Efficacy for Managing Chronic Disease Scale (SMCD). Secondary outcomes included Burge thirst scores, Edmonton Symptom Assessment System scores (ESAS), patient-initiated hydrations, creatinine rise and satisfaction with the UCC.
Thirty-five patients were randomised. UCC use was not associated with improved SMCD or ESAS scores compared with standard counselling. The card was highly rated by patients as a welcome tool for self-monitoring.
No beneficial effect on self-efficacy or dehydration markers with UCC use was demonstrated. The study nonetheless drew attention to several factors potentially hindering its use for effective self-care: the unexpected severity of other symptoms consuming patients' attention, reduced sensitivity of urine colour due to chemotherapy, absence of active inquiry by the healthcare team and the inconvenient location of the UCC in wallet/purse. Urine colour monitoring in patients with oesophageal cancer to improve the patient experience during treatment warrants further study but supported by active healthcare provider inquiry, more accessible format of the card, and possibly home vital checks to increase its sensitivity in the clinical context.
接受新辅助放化疗的食管癌患者由于液体摄入减少和流失增加而经常出现脱水。尽管在治疗期间经常进行临床访视，但患者仍可能出现脱水，这表明需要提高患者对不良事件管理的认识并促使其在家中积极参与。自我监测的益处证据可能有助于激励患者主动参与自身护理，以改善治疗体验。
我们对食管癌放化疗期间使用尿液颜色自我监测卡（UCC）与标准营养师咨询进行了一项随机单中心研究。主要结局是通过自我管理资源中心慢性病管理自我效能量表（SMCD）确定的自我效能。次要结局包括 Burge 口渴评分、埃德蒙顿症状评估系统评分（ESAS）、患者发起的补液、肌酐升高和对 UCC 的满意度。
35 名患者被随机分配。与标准咨询相比，UCC 使用并未改善 SMCD 或 ESAS 评分。该卡受到患者的高度评价，是一种受欢迎的自我监测工具。
UCC 使用并未显示出对自我效能或脱水标志物的有益影响。然而，该研究仍引起了人们对几个可能阻碍其有效自我护理使用的因素的关注：其他症状的严重程度出乎意料地消耗了患者的注意力、化疗导致尿液颜色敏感性降低、医疗团队缺乏主动询问以及 UCC 在钱包/钱包中的不便位置。为改善治疗期间患者体验，有必要进一步研究使用尿液颜色监测来改善食管癌患者的治疗，但需要得到医疗服务提供者的积极询问、更便捷的卡片格式，以及可能在家中进行生命体征检查以提高其在临床环境中的敏感性。
