| Objective: To investigate the status,trends and differences of adverse effects of chemotherapy drugs,anxiety and depression levels,quality of life and sleep quality in patients with left or right colorectal cancer after different chemotherapy stages.Analyse the time points and characteristics of changes in occurrence of symptoms,and provide a theoretical basis for providing predictable and targeted clinical care programs.At the same time,we construct a dietary and nutritional care interventions programme of solution-focused approach combined with prebiotics on the basis of conventional cancer nursing.It improves the patient’s ability to cope with the disease in both physical and psychological terms,ameliorates the adverse effects of chemotherapy drugs,and achieves " both the human and gut microbiota get conservation ".Methods: The study was divided into two parts: an observational study and an intervention study.Observational study: From May 2021 to September 2022,a total of128 patients with primary colorectal cancer diagnosed with their first chemotherapy(oxaliplatin combined with capecitabine regimen(XELOX)or fluorouracil and oxaliplatin combined with chemotherapy(FOLFOX))were recruited as study subjects in the Department of Gastrointestinal Surgery and Department of Medical Oncology of a tertiary hospital in Wuxi,Jiangsu Province,grouped according to the location of tumour.Patients were followed up for four courses of chemotherapy.The General Information Questionnaire,Common Terminology Criteria for Adverse Events(CTCAE,version5.0),Quality of life questionnaire-caner 30,Hospital anxiety and depression scale,Pittsburgh sleep quality index and Bristol Stool Score were used as evaluation tools.We collected the blood from patients before and after chemotherapy in order to observe patients’ adverse effects of chemotherapy drugs,nutritional levels,and inflammation levels.To characterise the dynamics of adverse effects of chemotherapy drugs,quality of life,sleep quality and anxiety and depression levels during chemotherapy with colorectal cancer patients,and to analyse the differences between adverse effects of chemotherapy drugs in patients with left or right colorectal cancer.Interventional study: 63 patients diagnosed with primary colorectal cancer on their first chemotherapy treatment(oxaliplatin combined with capecitabine regimen(XELOX))were recruited between May 2022 and December 2022.Patients were randomly divided into control group and experimental group.Evaluation tools are same as the observational study.A total of 37 patients in the control group(XEL＿C)were administered conventional cancer nursing and a total of 26 patients in the experimental group(XEL＿X)were administered a dietary and nutritional care of solution-focused approach combined with prebiotics.Intervention time: Four interventions in total,lasting for 3 months.The first intervention was carried out on the day after the patient’s first chemotherapy,and subsequent interventions on the day before the patient’s second,third and fourth chemotherapy.The duration of each intervention was approximately 30 minutes.The results of the two groups of patients were compared before the first intervention and after the last intervention.Results:A total of 128 patients were included in this study and adverse effects occurred at all stages of chemotherapy.Myelosuppression and gastrointestinal adverse reactions are the most common adverse effects.The highest incidence of decreased leukocyte levels was seen in myelosuppression.The incidence of leukocyte and neutrophil decline was higher in the early stages of chemotherapy and increased in the late stages compared to the early stages.In the XELOX regimen,the haemoglobin levels were higher in the left colorectal cancer than right colorectal cancer(p<0.05)at the late stage.The incidence of nausea and constipation was higher among the gastrointestinal adverse reactions.Gastrointestinal symptoms were at a high level in the early stages of chemotherapy and subsequently subsided as the chemotherapy course progressed.Comparing the left and right colorectal cancer,significant differences were found in nausea at stage T1(p<0.05),diarrhoea at stage T3(p<0.05)and gastrointestinal distension and nausea at stages T2 and T4(p<0.05).Nutritional indicators(albumin,globular albumin,pre-albumin,total protein levels)decreased mid-chemotherapy period and inflammation levels increased as chemotherapy progressed.Negative emotions during chemotherapy were dominated by anxiety,with anxiety levels generally higher than depression levels.Anxiety and depression levels increased in the early stages of chemotherapy and decreased in the late stages.There was no significant difference between the left and right colorectal cancer.The incidence of sleep disturbance was higher during chemotherapy,with a decreasing trend in sleep disturbance scores with the course of chemotherapy.The level of sleep disturbance was higher in the right colorectal cancer than in the left colorectal cancer(p>0.05).Gastrointestinal symptom items in quality of life questionnaire-caner 30,nausea,vomiting and loss of appetite peaked at the early stages of chemotherapy,while constipation and diarrhoea peaked at the middle and late stages of chemotherapy.Nausea and vomiting and fatigue formed a significant difference with T0(p<0.0001)The left colorectal cancer of the XELOX regimen was superior to the right colorectal cancer in terms of emotional functioning and gastrointestinal response.Interventional study: A total of 63 individuals were included in this study.In Myelosuppression,the XEL＿X group had significantly higher levels of leukocyte and platelets than the XEL＿C group(P<0.05),and there was a trend for the levels of lymphocytes to differ from the XEL＿C group(P=0.088).Among the gastrointestinal symptoms,the incidence of nausea was higher in the XEL＿C group than in the XEL＿X group,with a trend towards a difference between the two groups(p=0.054).There were no significant differences in nutritional indicators or inflammation levels between the two groups.After the intervention,the XEL＿C anxiety score was(1.70±2.22)and depression score(1.50±2.05),while the XEL＿X group had anxiety score(1.69±1.96)and depression score(1.39±1.75).The anxiety and depression levels were higher in the intervention group than in the control group(p>0.05).The incidence of sleep disturbance was higher in the XEL＿C group(35.14%)than in the XEL＿X group(11.54%),which was significantly different(P<0.05).In quality of life after 4 courses of chemotherapy,insomnia was lower in the XEL＿X group than in the XEL＿C group,with a significant difference(P<0.05).Conclusion:(1)Adverse effects occur in all stages of chemotherapy of colorectal cancer patients.The damage to the digestive system,blood system,immune system,etc.occurs throughout the chemotherapy,and gastrointestinal reactions,myelosuppression are the most common adverse effects.The level of adverse reactions,inflammation,nutritional status,quality of sleep,anxiety and depression levels and quality of life in different chemotherapy stages are characterised by dynamic changes.It suggested that nursing staff need to combine the characteristics of symptoms in different chemotherapy stages to conduct comprehensive evaluation.Clarify the key points and priorities of nursing care,and provide timely and targeted nursing measures.(2)At the late stage of chemotherapy,patients with left halves of CRC had better myelosuppression than the right halves of CRC,and patients with left halves of CRC had more severe gastrointestinal dysfunction.There were no significant differences in quality of life,sleep quality,or anxiety and depression levels between the two groups.(3)The intervention of solution-focused approach combined with prebiotics can significantly improve adverse effects to chemotherapy,including gastrointestinal reactions and myelosuppression through the synergistic effect of both physical and psychological dimensions.It also can effectively relieve patients’ anxiety and depression levels,improve patients’ quality of life and increase the efficacy of chemotherapy. |
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