| BackgroundCancer is a serious danger to the mankind and presents a trend of rising in the21st century. Malnutrition of patients with cancer is associated with disturbance of nutrients metabolism, bringing out emaciated, amyotrophy, acratia, anemia, and hypoproteinemia, etc. The incidence of malnutrition of patient with cancer was up to40%～80%. The development of malnutrition of patient with cancer was due to the interaction of various factors, including the disturbance of nutrients metabolism, anti-cancer therapy, psychological and social factors. Malnutrition has been associated with decreased tolerance to chemotherapy, possibly increased infection rates, and overall reduced well being and quality of life, and so on. Every year, there were about20%～50%(2millions) patients around the world dying from malnutrition rather than cancer.Chemotherapy as a major treatment for cancer not only attacks cancer cells, but also the normal cells. The main toxicities could be observed in the lung, digestive tract, marrow, mucous membrane, heart, live, renal, and so on. Malnutrition is a common symptom of patients with cancer and its pathogenesis is still unclear, not mention to the nutritional therapy, and nutritional nursing. There was few clinic-based evidence about how to and when to do the nutritional inventions due to the overlooked nutritional status of patients with cancer treated with chemotherapy. And varieties parameters of nutrition assessment lead to a controversial about uniform standard. By all accounts, this study aimed to explore the influencing factors of malnutrition and to provide a reference for proposing more effective nutrition management measures for inpatients with cancer treated with chemotherapy.ObjectivesTo explore chemotherapy-related symptoms and nutritional status of inpatients with cancer treated with chemotherapy in Guangzhou City.To investigate the influencing factors of malnutrition of inpatients with cancer treated with chemotherapy and provide a reference for proposing more effective nutrition management measures for inpatients with cancer treated with chemotherapy.To evaluate the nursing intervention’ effect of nutritional status, chemotherapy-related symptoms and the self-efficacy on inpatients with colorectal cancer.MethodsPart ITo explore chemotherapy-related symptoms, as well as nutritional status of inpatients with cancer treated with chemotherapy from5tertiary hospitals in Guangzhou City. Also investigate the influencing factors of malnutrition of inpatients with cancer treated with chemotherapy to provide a reference for proposing more effective nutrition management measures for inpatients with cancer treated with chemotherapy. Inclusion criteriaAge>16years; The hospitalization days>3days;No pleural effusion, malignant ascites, pitting edema, etc;No cognitive impairment;Cooperate.Exclusion criteriaAge≤16years;The hospitalization day≤3days;Suffering from pleural effusion, malignant ascites, pitting edema, etc;Suffering from cognitive impairment;Failed to cooperate.Research methods questionnaire and interview method. The questionnaire included:General data Including gender, age, country of origin, education background, marital status, medical expenses and nutrition management.Medical history Including diagnosis, stages, pathogenesis, treatment and past history, etc.Symptoms Including no appetite, nausea, vomiting, constipation, diarrhea, xerostomia, pain, parageusia, dyscoimesis, etc.Emotion state Including feeling satisfaction, nervous and worry, etc.Biomedicine parameter Including height, body weight, serum albumin, hemoglobin, total lymphocyte and upper arm circumference, etc.Part ⅡDifferent nursing interventions were given to48inpatients with rectal cancer treated with chemotherapy that was enrolled in October2012to March2013, from oncology unit of two tertiary general hospitals in Guangzhou City.Inclusion criteria:Age between40～69years; The score of NRS2002≥3;The chemotherapy plan was5-FU/CF or FOLFIRI;No pleural effusion, malignant ascites, pitting edema, etc;No cognitive impairment;The remain chemotherapy cycles>3;All patients informed consent, and voluntarily joined this research project.Exclusion criteria:Age<40or>69;The score of NRS2002<3;The chemotherapy plan was neither5-FU/CF nor FOLFIRI;Suffering from pleural effusion, malignant ascites, pitting edema, etc;Suffering from cognitive impairment;The remain chemotherapy cycles<3;Selected before other clinical trials may affect the results of those.The research contentThe research objects will be divided into2groups, respectively conventional care group (control group) or IASM group (experimental group).The evaluation methodThe control trail was carried out to explore the efficacy of nursing interventions by SUPPH, MDASI, NRS2002, and parameters of nutrition assessment.Data analysisAll statistical data were analyzed by using statistical software SPSS13.0. Measurement Data (such as age, the SUPPH score, NRS2002score, MDAIS score) were expressed as Mean±S.D. Enumeration Data (such as disease attributes) were expressed as Frequency, Percentage. Diffence of influence factors between normal nutrition group and malnutrition group was analyzed by X2test or Z test. Logistic regression was used to analyze the multiple factors of inpatients with cancer treated with chemotherapy. Between the two groups before the intervention of Measurement Data were compared by using t-test if homogeneity of variance, while Enumeration Data by using X2test. Between the two groups after the intervention of the SUPPH score, NRS2002score, MDAIS score and the parameters of nutrition assessment were compared by using Repeated Measures. P value<0.05was considered to be significant.ResultsThe incidence of malnutrition in inpatients with cancer treated with chemotherapy was65.0%.The common symptoms of inpatients with cancer treated with chemotherapy were no appetite (73.3%), lassitude (62.5%), nausea (54.3%), and xerostomia (48.5%), the interference with smell of food (48.5%), vomiting (42.8%), somnipathy (38.3%), constipation (28.8%), pain (23.3%), parageusia (19.8%), diarrhea (8.3%) and others (11.3%).Multivariate analysis showed that:compared with normal nutrition inpatients, inpatients with malnutrition had the statistical significance (P<0.05) in age (Age between40and59:OR=1.420,95%CI=0.556-3.625; Age between60and69: OR=3.474,95%CI=1.489-8.108; Age above70:OR=1.962,95%CI=0.798～4.826), un-taking meat and eggs (OR=2.769,95%CI=1.419～5.403), un-instilling amino acid (OR=0.497,95%CI=0.298～0.830), un-using Hormones chemotherapy drugs (OR=2.101,95%CI=1.348～3.275), the total score of chemotherapy-related symptoms higher than the average (OR=1.632,95%CI=1.049～2.537).Statistical differences (p<0.001) were observed between experiment group and the control group about confused sleep, amnesia, no appetite, the relationship with others, living amusement, the SUPP score and the NRS2002score, while no significant difference about parameters of nutrition assessment after intervention of AISM for1months and3months.ConclusionsMalnutrition was one of the most common symptoms in inpatients with cancer treated with chemotherapy and the incidence was high.The common chemotherapy-related symptoms were differences in occurrence rate. The risk factors of malnutrition in inpatients with cancer treated with chemotherapy included age, un-taking meat and eggs, un-instilling amino acid, un-using Hormones chemotherapy drugs, and the total score of chemotherapy-related symptoms higher than the average. Measures to manage chemotherapy-related symptoms should be taken into consideration due to the results.To some extent, compared with conventional care, intervention of I ASM reduced the chemotherapy-related symptoms and improved the malnutrition status of inpatients with cancer treated with chemotherapy. |
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