個人化之營養支持對於接受手術治療之大腸直腸癌病患其營養狀態、生活品質之影響

The impact of individualized nutritional support for patients with colorectal cancer who had undergone surgery

目標：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（EORTCQLQ - C30、EORTC QLQ - CR29）等，於初訪後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）於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，受試者於第三個月追蹤發現其整體健康狀況與生活品質、身體功能、角色功能、情緒功能、認知功能、疲勞感、噁心與嘔吐、疼痛、呼吸困難與食慾不振等項目，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，受試者於第三個月追蹤發現其焦慮、體重、解尿頻率、血便與黏液便、尿失禁、腹痛、腹脹、口乾、味覺、大便失禁與肛門皮膚痠痛等項目，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支持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。

Objectives: To investigate the impact of early individualized nutritional support on long-term physiology, quality of life (QoL), and nutritional outcome in patients with colorectal cancer after surgery. Methods: This prospective randomized clinical trial was carried out between September 2014 and May 2015; patients who were diagnosed with colorectal cancer and underwent surgery (n = 84), were randomly assigned in a 1:1 ratio to receive either individualized nutritional counseling (intervention group, n=42), or the usual care (control group, n = 42). Nutritional intake (dietary history), status (Patient-Generated Subjective Global Assessment), and QoL (EORTC QLQ - C30, QLQ - CR29) were evaluated at baseline and three months after surgery. Results: At the three month follow up, the groups were compared and nutritional status was significantly improved in the intervention group (p ＜ .0001). There were significant differences in EORTC QLQ - C30 scores and QLQ - CR29 scores between two groups in terms of global health status/ QoL (p = 0.0017), physical function (p = 0.0005), role function (p = 0.0001), emotional function (p = 0.0228), cognitive function (p = 0.001), fatigue (p = 0.0002), nausea and vomiting (p = 0.0011), pain (p = 0.0431), dyspnea (p = 0.0006), appetite loss (p = 0.001), anxiety (p ＜ .0001), weight (p ＜ .0001), urinary frequency (p = 0.0185), blood and mucus in stool (p = 0.0061), urinary incontinence (p = 0.0042), abdominal pain (p ＜ .0001), bloating (p ＜ .0001), dry mouth (p ＜ .0001), taste (p = 0.0115), faecal incontinence (p = 0.0042) and sore skin (p = 0.0223). Conclusions: Early, timely and continuous individualized nutritional intervention was key to improvement in nutritional outcome and quality of life for patients with colorectal cancer after surgery.