Investigation And Intervention On Nutritional Status Of Nasopharyngeal Carcinoma With Concurrent Chemoradiotherapy

Objective:?1?To investigate the nutritional status,dietary nutrition in take and quality of life of inpatients with nasopharyngeal carcinoma;?2?T o analyze the main influence factors of the nutritional status of patients with nasopharyngeal carcinoma;?3?To explore the correlation between nutrit ional status and quality of life in patients with nasopharyngeal carcinoma.?4?To explore the impact of individualized dietary nutrition intervention and health management based on mobile medical APP on improving patie nts'nutritional status and quality of life.Methods:?1?From June 2017 to December 2017 in the First Affiliat ed Hospital Of Guangxi Medical University and the Guangxi Medical Uni versity Affiliated Tumor Hospital and Ruikang Hospital Affiliated to Guan gxi University of Chinese Medical Radiotherapy department,260 cases of nasopharyngeal cancer patients were investigated,using the General informa tion questionnaire,Patient Generated Subjective Global Assessment?PG-SG A?,Diet surveys,EORTC QLQ H&N35 and evaluated the patient's radioac tive oral mucositis and nutrition-related blood indicators.?2?Use convenienc e sampling method to select from January 2018 to June 2018 in the First Affiliated Hospital Of Guangxi Medical University and the Guangxi Med ical University Affiliated Tumor Hospital and Ruikang Hospital Affiliated to Guangxi University of Chinese Medical Radiotherapy department of146 cases of nasopharyngeal cancer patients.Grouping was conducted acco rding to admission time sequence,74 patients included from January to M arch 2018 were in the control group,while 74 patients included from Ap ril to June 2018 were in the experimental group.The control group given routine nursing care for inpatients with nasopharyngealm cancer in the d epartment of radiotherapyand,intervention group giving individualized diet ary nutrition intervention patients and health management based on mobile medical APP.using the Patient Generated Subjective Global Assessment?PG-SGA?,EORTC QLQ H&N35 and evaluated the patient's radioactive o ral mucositis and nutrition-related blood indicators to evaluate.Results:1.Before,during and after concurrent chemoradiotherapy,respectively,the mean scores of PG-SGA of Patients with nasopharyngeal cancer were?4.53±2.35?,?11.16±5.06?and?17.41±5.74?.2.The actual daily energy intake of patients with nasopharyngeal cancer was?816.98±190.031?KJ,accounting for 57.5%of the standard intake.Actual protein intake accounted for 55.1%of the standard intake.The proportion of carbohydrate,protein and fat in total energy was 40.1%?16.18%?40.01%,respectively.3.During the concurrent chemoradiotherapy,the functional scores of all symptom domains in the quality of life survey of nasopharyngeal cancer patients were continuously increased.4.Before radiotherapy,the incidence of oral mucositis was 2.4%in patients with nasopharyngeal cancer,but 93.2%after 30 times of radiotherapy.5.The Influencing factors of nutritional status of patients with nasopharyngeal cancer with concurrent chemoradiotherapy:?1?univariate analysis was used to compare the pg-sga total score of patients with different clinical stages,and the difference was statistically significant?P<0.05?.?2?two independent sample t tests were used to compare the pg-sga total score of patients receiving or not receiving induction chemotherapy,and the difference was statistically significant?P<0.05?.?3?Using Spearson correlation analysis to analyze the correlation between PG-SGA nutritional status and QLQ H&N35.The results showed that head and neck pain,dysphagia,dental problems,dysphagia,eating difficulties,social problems,sensory problems and patients'conscious weight change were correlated with the nutritional status?P<0.05?.?4?Multiple stepwise regression analysis of nutritional status of nasopharyngeal cancer patients during concurrent chemoradiotherapy:Before radiotherapy,multiple stepwise regression showed that Teeth problems,head and neck pain,feel ill,were the main factors affecting the nutritional status of the patients,which could explain that the total variation coefficient of nutritional status of patients with nasopharyngeal cancer before radiotherapy was 74.8%,and the regression equation was:Y=3.706+0.019 X₂₈+1.275 X₁₄+0.05X₂₀;After15 times of radiotherapy,multiple stepwise regression showed that dysphagia,radioactive oral mucositis,sensory problems,weight loss and head and neck pain were the main factors affecting the nutritional status of the patients,which could explain that the total variation coefficient of nutritional status of the nasopharyngeal cancer patients after 15 times of radiotherapy and chemotherapy was 81.9%,and the regression equation was:Y=3.761+0.197 X₁₄+1.072X₁₂+0.121 X₁₅+0.017 X₂₈+0.19 X₁₃;After 30 times of radiotherapy,multiple stepwise regression showed that difficulty in eating,radiation oral mucositis,dysphagia and pathological sensation were the main factors affecting the nutritional status of patients,which could explain the total variation coefficient of nutritional status of nasopharyngeal cancer patients after 30 times of concurrent radiotherapy and chemotherapy was 86.6%.The regression equation was:Y=6.219+0.547 X₁₆+1.101 X₁₂+0.184 X₁₄+0.346 X₂₃.6.Individualized dietary nutrition intervention and mobile medical APP based health management:?1?the intervention effect of intervention group?37cases?51.4%of the patients received partial parenteral nutrition?PPN?support,the control group?52 cases?,74%of patients receiving PPN,and nutritional support time is higher than the average of intervention group,the difference had statistical significance?P<0.05?;The intervention group received nasal feeding in 0%of patients.?2?comparison of body mass index and pg-sga total score between the two groups:before intervention,there was no statistically significant difference in the comparison of body mass index and pg-sga total score between the two groups?t₁=1.238,P₁=0.218;t₂=1.587,P₂=0.115?;The body mass index?BMI?of the two groups before,15 times after and 30 times afterradiotherapywerecompared.Theresultsshowedthat F1=71.171,P₁<0.001.F2=0.004,P₂=0.947;F3=121.974,P₃<0.001.?2?The body mass index of the two groups before,15 times after and 30 times after radiotherapy was compared.The results showed that F1=53.867,P₁<0.001.F2=68.739,P₂<0.001;F₃=27.765,P₃<0.001.?3?comparison of nutrition-related blood indicators between the two groups:before intervention,there was no statistically significant difference in nutrition-related blood indicators between the two groups?P>0.05?;After intervention,15 times of radiotherapy and 30days later,the levels of hemoglobin and prealbumin in the intervention group were higher than those in the control group,and the difference was statistically significant?P<0.05?.?4?comparison of the response degree of radioactive oral mucositis between the two groups:before intervention,there was no statistically significant difference in the response degree of radioactive oral mucositis between the two groups?P>0.05?.After 15 times of radiotherapy,the incidence of oral mucositis was 67.1%in the control group and 40.3%in the intervention group.Radiotherapy after 30 times,the control group,1.4%of patients with radioactive oral mucosa inflammation?magnitude,the intervention group to0,and the differences were statistically significant?P<0.05?.?5?comparison of patients'quality of life between the two groups:before the intervention,there was no significant difference in the symptom scores of patients'quality of life between the two groups?P>0.05?.After the intervention,radiotherapy was given for 15 and 30 times,and the scores of head and neck pain,swallowing function,pain and other symptoms in the intervention group were lower than those in the control group?P<0.05?.Conclusion:1.During concurrent chemoradiotherapy,nutritional status and quality of life of patients with nasopharyngeal carcinoma decreased continuously,and the quality of life was positively correlated with nutritional status.2.Nasopharyngeal carcinoma patients have inadequate dietary nutrition intake and unbalanced dietary structure.3.The incidence rate of radioactive oral mucositis is high in patients with nasopharyngeal cancer with concurrent radiotherapy and chemotherapy.4.Before radiotherapy,dental problems,head and neck pain and morbid sensation were the main factors affecting the nutritional status of patients;After15 times of radiotherapy,dysphagia,radiation oral mucositis,sensory problems,weight loss and head and neck pain were the main factors affecting the nutritional status of patients.After 30 times of radiotherapy,the main factors affecting the nutritional status of the patients were eating difficulties,radiation oral mucositis,dysphagia and pathological sensation.5.Individualized dietary nutrition intervention and health management based on mobile medical APP can improve the nutritional status of patients and severity of radioactive oral mucositis and improve the quality of life of patients.