Lindsey A M, Larson P J, Dodd M J, Brecht M L, Packer A
University of California, Los Angeles School of Nursing 90024.
Cancer Nurs. 1994 Apr;17(2):113-24.
It is essential that nurses gain insight about the responses of older adults to standard anticancer therapies because there is ongoing concern about whether the elderly are affected adversely by the prescribed therapy. The purpose of this longitudinal prospective study was to describe selected outcomes and their relationships in a sample of 45 elderly (mean age 69.8 years; range 61-86) patients receiving radiotherapy for either breast (42%) or lung (58%) cancer. The outcome variables were weight and multidimensional functional status; moderator variables were co-morbidity, nutritional intake, estimated adequacy of intake, radiation dose, side effects, and social support. Data were collected at the beginning of radiation (T1), the middle of therapy (T2), the conclusion of therapy (T3), and three months post radiation (T4). Although 81.4% had some concurrent condition, those with a comorbid condition did not respond significantly differently from those without a comorbid condition on any of the major variables at any of the four times. At none of the four times was the caloric intake adequate to meet the estimated energy requirements for usual activity (range 67.9-71.5%). However, caloric intake was not significantly related to weight at any of the four times. There was a significant weight decrease from beginning of therapy to the middle of therapy and from the beginning of therapy to conclusion of therapy. The percentage of calories contributed by protein was significantly correlated with weight during radiotherapy, and protein calories consumed at the previous time were correlated with weight at T2 and T3. In contrast, the percentage of calories contributed by carbohydrate intake was significantly negatively correlated with two of the four functional status measures at each time, but was not related to weight. In addition carbohydrate calories consumed at the previous time also were related to one or more functional status measures at succeeding time points. Almost no relationships were found between social support and the outcome measures of weight and functional status. Scores on three of the four functional status measures suggest improvement over time from initiation of radiation to 3 months after therapy. Scores on the fourth measure, Overall Health Rating, suggest a slight decline; however, the average score reflects good overall health. These findings provide evidence that this group of elderly, the great majority of whom had at least one comorbid condition, tolerated the course of radiation with less than adequate intake for usual activity, a slight decrease in mean weight, but without major disruptions in functional status.(ABSTRACT TRUNCATED AT 400 WORDS)
护士必须深入了解老年人对标准抗癌疗法的反应，因为人们一直担心老年人是否会受到规定疗法的不利影响。这项纵向前瞻性研究的目的是描述45名老年患者（平均年龄69.8岁；范围61 - 86岁）的选定结果及其关系，这些患者因乳腺癌（42%）或肺癌（58%）接受放疗。结果变量是体重和多维功能状态；调节变量是合并症、营养摄入、估计摄入量充足程度、辐射剂量、副作用和社会支持。在放疗开始时（T1）、治疗中期（T2）、治疗结束时（T3）以及放疗后三个月（T4）收集数据。虽然81.4%的患者有一些并发疾病，但在四个时间点中的任何一个时间点，患有合并症的患者在任何主要变量上的反应与没有合并症的患者没有显著差异。在这四个时间点中的任何一个时间点，热量摄入都不足以满足日常活动的估计能量需求（范围为67.9 - 71.5%）。然而，在这四个时间点中的任何一个时间点，热量摄入与体重均无显著关联。从治疗开始到治疗中期以及从治疗开始到治疗结束，体重均有显著下降。放疗期间蛋白质提供的热量百分比与体重显著相关，前一次摄入的蛋白质热量与T2和T3时的体重相关。相比之下，碳水化合物摄入提供的热量百分比在每次与四个功能状态测量指标中的两个显著负相关，但与体重无关。此外，前一次摄入的碳水化合物热量在后续时间点也与一个或多个功能状态测量指标相关。几乎没有发现社会支持与体重和功能状态的结果测量指标之间存在关联。四个功能状态测量指标中的三个指标得分表明，从放疗开始到治疗后3个月，随着时间推移有所改善。第四个指标“总体健康评分”表明略有下降；然而，平均得分反映出总体健康状况良好。这些发现提供了证据，表明这群老年人中的绝大多数至少有一种合并症，他们在日常活动摄入不足、平均体重略有下降的情况下耐受了放疗过程，但功能状态没有受到重大干扰。（摘要截选至400字）
