A Clinical Research Of Partial Parenteral Nutrition On Non-Small Cell Lung Cancer Patients During Chemotherapy

Objective: A prospective clinical trial which applies partial parenteral nutrition (PPN) to non-small cell lung cancer (NSCLC) patients during chemotherapy was carried out to elucidate the effects of different nutritional support modes on nutritional status and immunological function during chemotherapy. Further more, a preliminary investigation concerning the effect of PPN support on Quality of Life (QOL) was given, and the results give theoretical support about apply PPN support during chemotherapy.Methods: 69 patients with NSCLC were divided into 3 groups randomly. These 3 groups were named as the control group, the low dose PPN group and the high dose PPN group. Exactly same chemotherapy regimen was applied to each patient of those 3 groups. During chemotherapy, the control group received conventional treatment; the low dose PPN group and the high dose PPN group received additional parenteral nutritional support besides diet to make sure that they were provided energy of 35kcal/kg per day. The difference between the low dose PPN group and the high dose PPN group lay on amounts of nitrogen provided per day: total amounts of nitrogen provided to patients of the low dose PPN group was 0.24g/kg per day and total amounts of nitrogen provided to patients of the high dose PPN group was 0.28g/kg per day. Indexes related to nutritional status (body weight, serum albumin), immunological function (subsets of the T lymphocytes, percentage of NK cells, IgG concentration, IgM concentration) and tumor marks (CEA, CA21-1) were detected respectively before and after chemotherapy. Change of solid tumors magnitude and adverse effects of chemotherapy was recorded. Further more, the QOL-ACD questionnaire was administered duringchemotherapy to evaluate quality of life.Results: ?Body weight and serum albumin of patients decreased significantly post-chemotherapy ( P < 0.05 & P < 0.01 respectively ) in the control group, while the decrease of these two indexes was not significant for the low dose PPN group and the high dose PPN group. ?For the control group, CD3+(%) and CD4+(%) decreased significantly ( P < 0.05 ) post-chemotherapy, the serum concentrations of IgG and IgM decreased very significantly ( P < 0.01 ) post-chemotherapy. Neither of these 4 indexes decreased significantly for the low dose PPN and the high dose PPN group. Further more, after chemotherapy, CD3+(%) and CD4+(%) of the low dose PPN group and the high dose PPN group were notably higher than those indexes of the control group. (3) Effective rate of chemotherapy in advanced lung cancer survivors of each group were 31%, 23% and 33% respectively, and there were no significant difference among each group( P > 0.05 ). ?Overall QOL of each group decreased during chemotherapy, especially scores for the physical and functional domains very significantly decreased ( P < 0.01 ). However the scores for these domains of the low dose PPN group and the high dose PPN group were remarkably higher than those of the control group (P < 0.05 ). (5) For each group, there were no conspicuous differences of certain indexes including CEA, CA21-1, hematological indexes, hepatic and kidney function between pre-chemotherapy and post-chemotherapy. Discrepancies in incidence rate and degree of adverse effects of digestive system and so on among each group were not significant.Conclusions: ? To apply chemotherapy to patients with stage II —IV NSCLC will possibly courses malnutrition and immunosuppression aggravation. The benefits of apply PPN undergoing chemotherapy include antagonizing nutrition status and immunological function aggravation, prevent body weight loss and serum albumin decrease, and maintain subsets of the T lymphocytes (including percentage of CD3+ and CD4+) and...