個人化營養支持對於大腸直腸癌病患手術後營養狀態、生活品質之影響

Abstract

題目：個人化營養支持對於大腸直腸癌病患手術後營養狀態、生活品質之影響。 目的：藉由早期個人化之營養支持與長期追蹤、比較病患其生理指標、生活品質與營養狀態之差異，以評估營養介入之成效。 方法：本研究為前瞻性、隨機分派之對照臨床試驗研究，於2014年9月至2015年5月期間共收取84名罹患大腸直腸癌之受試者，分為營養介入組（實驗組）與常規照護組（控制組），各有42名受試者。受試者於手術治療並開始腸道進食後，經隨機分派分組行初次營養教育介入訪視並評估其營養狀態與收集生活品質相關問卷（EORTC QLQ - C30、EORTC QLQ - CR29）等，於初訪後第一個月以及第三個月進行後續資料收集，以評估個人化的營養支持對於大腸直腸癌病患後續之營養與生活品質相關成效。 結果：於營養狀態方面，營養介入組（實驗組）之第一個月與第三個月的營養狀態皆顯著優於常規照護組（控制組）；生活品質方面，在EORTC QLQ - C30問卷部份，受試者於第一個月追蹤發現其身體功能（Physical functioning）、疲勞感（Fatigue）與財務困難（Financial difficulties）等項目，營養介入組（實驗組）皆顯著優於常規照護組（控制組），於第三個月追蹤發現其身體功能（Physical functioning）、角色功能（Role functioning）、認知功能（Cognitive functioning）、疲勞感（Fatigue）、呼吸困難（Dyspnoea）、腹瀉（Diarrhoea）與財務困難（Financial difficulties）等項目，營養介入組（實驗組）皆顯著優於常規照護組（控制組）；在EORTC QLQ - CR29問卷部份，受試者於第一個月追蹤發現其血便與黏液便情形（Blood and mucus in stool）、排便頻率（Stool frequency）以及因治療而掉髮情形（Hair loss）等項目，營養介入組（實驗組）皆顯著優於常規照護組（控制組），於第三個月追蹤發現其體重（Weight）、血便與黏液便情形（Blood and mucus in stool）、解尿疼痛（Dysuria）、腹痛（Abdominal pain）與口乾（Dry mouth）等項目，營養介入組（實驗組）皆顯著優於常規照護組（控制組）。 結論：適時、適切與持續的個人化營養介入對於大腸直腸癌經手術切除病灶之受試者而言，能顯著提升攝食量而達到其自身營養需求，並能改善營養狀態與生活品質。

Study title: Impact of individualized nutritional support in patients with colorectal cancer after surgery. Objectives: To investigate the impact early individualized nutritional support on long-term physiological, quality of life (QoL), and nutritional outcomes in patients with colorectal cancer after surgery. Methods: In this prospective randomized clinical trial that was carried out between September 2014 to May 2015, patients who were diagnosed colorectal cancer and underwent surgery (n=84), were randomly arranged in a 1:1 ratio to receive either individualized nutritional counseling (interventional group, n=42), or usual care (control group, n=42). Nutritional intake (diet history), status (Patient-Generated Subjective Global Assessment), and QoL (EORTC QLQ - C30, QLQ - CR29) were evaluated at baseline and after one month and three months of surgery. Results: At the one month and the three month followed ups, two groups were compared with nutritional status were significant improved in interventional group (p = 0.0352 and p < .0001). There were significant differences in EORTC QLQ - C30 scores and QLQ - CR29 scores between two groups in physical functioning (p= 0.0020), fatigue (p= 0.0002), financial difficulties (p= 0.0042), blood and mucus in stool (p< .0001), stool frequency (p= 0.0045) and hair loss (p= 0.0039) at the one month followed up. Besides, at the three months followed up, there were significant differences in EORTC QLQ - C30 scores and QLQ - CR29 scores between two groups in physical functioning (p= 0.0085), role functioning (p= 0.0043), cognitive functioning (p= 0.0062), fatigue (p= 0.0426), dyspnea (p= 0.0012), diarrhea (p= 0.0121), financial difficulties (p= 0.0331), weight (p< .0001), blood and mucus in stool (p< .0001), dysuria (p= 0.0358), abdominal pain (p= 0.0213) and dry mouth (p= 0.0002). Conclusions: Early, timely and continuous individualized nutritional intervention was the key to the improvement of nutritional outcomes and quality of life to the patients with colorectal cancer after surgery.