A Longitudinal Study On The Change Of Nutriture, Fatigue,quality Of Life And Their Influencing Factors In Patients With Head And Neck Nancer During Radiotherapy

[Object]Through describing the nutriture, mental health, neurotoxicity, fatigue, acute radiotoxicity, quality of life(QOL) of patients with head and neck cancer during the initial, mid-term and later stage of radiotherapy, our study analyzed the relationship of their changes with radiotherapy and the correlative factors of nutriture, fatigue, QOL in patients, which would provide a scientific basis for appropriate measures taken to improve the above indicators in radiotherapy.[Method]Our study emphasized on the patients with head and neck tumors who undergone radiotherapy in the first affiliate hospital of Fujian medical university from September,2013 to November, 2014. The demographic information, clinical information, and resilience information were gathered ahead of radiotherapy. The evaluation index of nutriture(deltoid skinfold, biceps circumference, height, weight, albumin,lymphocytes, red blood cells, hemoglobin, serum albumin, transferrin and psychological elasticity), anxiety, depression, acute radiotoxicity, chemotherapy neurotoxicity, fatigue, quality of sleeping and QOL were gathered in the beginning, 4weeks later and the end of radiotherapy, respectively. After that, analysis of variance of repeated measures was firstly applied to analyze the effects of radiotherapy on the nutriture, fatigue and QOL in patients. Then our study used the Bonferroni to deal with pairwise comparison. We employed generalized Estimating Equations in above three periods to further investigate whether the differences between the incidence of anxiety, depression, fatigue, and the distribution of nutriture, sleeping and QOL of patients was significant. In the end, the correlative factors of nutriture, fatigue and Qo L in patients during radiotherapy was analyzed by the linear mixed model.[Results]1. In 192 patients in accord with the participant standards, comparison was made before and after the radiotherapy. After the radiotherapy, the average marks of neurotoxicity(PQN),anxiety(HADS-A), depression(HADS-D) increased 0.69, 2.71,2.27, respectively; the average marks of sleeping(PSQI), fatigue(MFI-20), acute radiotoxicity(ARS), Malnutrition index(MI) separately rose by 2.61, 10.24, 15.58,2.00; the average marks of QOL drop by 13.72. All the differences of the above indexes were statistically significant(P<0.05).2. The analysis of nutriture correlative factors in participants during radiotherapy showed that nutriture and time(B=0.63, P<0.001), pathology type = 2(B=1.24,P=0.017), TNM stage(B=0.61, P<0.001), acute radiotoxicity(B=0.04, P<0.001) were positively correlated. The regression model between nutriture and the above indexes was random intercept-slope model. The nutriture trend of the every participant was different from each other at different stages of radiotherapy.3. The analysis of fatigue correlative factors in participants during radiotherapy showed that fatigue and age(B=0.13, P<0.001), time(B=0.88, P=0.017), the neurotoxic(B=1.31, P<0.001), anxiety(B=0.47, P<0.001), depression(B=0.57,P<0.001), acute radiotoxicity(B=0.16, P<0.001), nutriture(B=0.38, P=0.007),neurotoxicity(B=1.31, P<0.001), sleep disorders(B=0.59, P<0.001) were positively correlated, but fatigue and resilience(B=-0.05, P=0.023) was negatively correlated.4. The analysis of QOL correlative factors in participants during radiotherapy showed that QOL and education(B=-1.29, P=0.005), time(B=-0.87, P=0.030),anxiety(B=-0.70, P<0.001), depression(B=-0.43, P=0.001), acute radiotoxicity(B=-0.30, P<0.001), the neurotoxicity(B=-1.01, P<0.001), sleep disorders(B=-0.26,P=0.040), fatigue(B=-0.25, P<0.001) were negatively correlated, but QOL and resilience(B=0.06, P=0.027) was positively correlated.[Conclusion]1. The radiotherapy could lead to acute radiotoxicity and exacerbate anxiety,depression, sleep disorders and fatigue. Meanwhile, it could also result in the descent of nutriture and QOL in patients during radiotherapy.2. The patients with advanced cancer and severe acute radiotoxicity during radiotherapy were potential high-risk population of malnutrition.3. The risk factors of the severe fatigue in patients during radiotherapy included anxiety, depression, malnutrition, sleep disorders and severe acute radiotoxicity. The healthcare workers should regularly evaluate the acute radiotoxicity, mental status,nutriture, quality of sleep and fatigue to identify the patients with severe fatigue, and then take appropriate intervention measures in time to relieve fatigue of patients.4. The influencing factors of the QOL in patients during radiotherapy included anxiety, depression, sleep disorders, fatigue and severe acute radiotoxicity. The healthcare workers should regularly evaluate the patient’s acute radiotoxicity, mental status, quality of sleep, fatigue and QOL to identify the patients with poor QOL, and then take appropriate intervention measures in time to improve the QOL of patients.