Clinical Study on Improving Quality of Life for Cancer Patients with Cachexia Syndrome Using Nutrition Support and Resistance Exercise

doi:10.12114/j.issn.1007-9572.2018.00.339

Abstract

Abstract: Background　Cachexia syndrome is a common symptom in patients with advanced cancer，which seriously affects the quality of life of patients and even accelerates the death.However，there are few reports on the study of nutrition support combined with resistance exercise to improve the quality of life of patients with advanced cancer cachexia syndrome.Objective　To investigate the efficacy of nutrition support combined with resistance exercise for cancer patients with cachexia syndrome.Methods　A total of 286 cancer patients with cachexia syndrome admitted to Palliative and Hospice Care Center of Ninth People's Hospital of Zhengzhou，Oncology Department of First Affiliated Hospital of Zhengzhou University，Oncology Department of Henan Province People's Hospital，Oncology Department of the Medical Group of Zhengzhou First People's Hospital from December 2014 to December 2016 were enrolled in the study.All patients were randomly divided into four groups by using a computer-generated random sequence：control group （n=70），nutrition support group （n=73），resistance exercise group （n=75），and nutrition support combined with resistance exercise group （NR group，n=75）．Patients in four groups were prescribed with megestrol acetate to improve appetite，while control group was given regular diet.Patients in nutrition support group were provided with nutrition support besides regular diet.Patients in resistance exercise group chose diet by themselves and were given resistance exercise，while those in NR group were given both nutrition support and resistance exercise.All patients were treated for eight weeks，with four weeks in hospital and four weeks after discharge.Outcome parameters were measured before and after interventions using the Patient-Generated Subjective Global Assessment （PG-SGA），Multidimensional Fatigue Symptom Inventory-Short Form （MFSI-SF），Hamilton Depression Scale （HAMD），and the Functional Assessment of Cancer Therapy （FACT-G）．Results　Nutrition improvement in nutrition support group，resistance exercise group and NR group at four and eight weeks after intervention was higher than　that in control group （P<0.05）．Moreover，nutrition improvement in NR group was higher than that in nutrition support group and resistance exercise group （P<0.05）．There was no interaction effect between intervention method and time course in terms of patients' MFSI-SF，HAMD and FACT-G scores （P > 0.05）．However，the intervention method and time course had a major impact on MFSI-SF，HAMD and FACT-G scores of patients （P<0.05）．MFSI-SF and HAMD scores of nutrition support group，resistance exercise group and NR group were lower than those of control group when assessed at 4 and 8 weeks after intervention，and FACT-G scores of nutrition support group，resistance exercise group and NR group were higher than that of control group （P<0.05）．MFSI-SF and HAMD scores of NR group were lower than those of nutrition support group，resistance exercise group when assessed at 4 and 8 weeks after intervention，and FACT-G scores of NR group were higher than that of nutrition support group，resistance exercise group（P<0.05）．Conclusion　Nutrition support combined with resistance exercise can delay the development of cachexia syndrome in cancer patients to a certain extent，and it can significantly relieve fatigue，depression，and improve quality of life.Therefore，it is worth promoting in clinical practice.

Key words: Neoplasms, Cachexia, Nutrition support, Motor activity, Quality of life

摘要： 背景　恶病质症候群是严重影响肿瘤患者生活质量甚至加速其死亡的重要原因，临床探讨营养支持治疗联合抗阻运动改善肿瘤恶病质症候群患者生活质量的研究鲜有报道。目的　探讨营养支持治疗联合抗阻运动改善肿瘤恶病质症候群患者生活质量的临床效果。方法　选取2014年12月—2016年12月郑州市第九人民医院姑息缓和治疗暨安宁疗护中心、郑州大学第一附属医院肿瘤内科、河南省人民医院肿瘤科、郑州市第一人民医院医疗集团妇科收治的符合纳入与排除标准的肿瘤恶病质症候群患者286例，采用电脑产生的随机序列将患者随机分为4组：对照组70例，营养支持组73例，抗阻运动组75例，营养+运动组68例。4组患者均给予醋酸甲地孕酮片改善食欲，对照组给予常规饮食；营养支持组在常规饮食基础上给予营养支持方案；抗阻运动组饮食由患者自行选择，并给予抗阻运动干预方案；营养+运动组在常规饮食基础给予营养支持方案和抗阻运动方案。4组患者均干预8周，即院内干预4周及出院继续干预4周。比较4组患者干预后营养状况改善情况〔采用主观营养评估（PG-SGA）量表进行评估〕，干预前后多维疲乏症状简表（MFSI-SF）、汉密顿抑郁量表（HAMD）、生活质量量表（FACT-G）评分情况。结果　营养支持组、抗阻运动组、营养+运动组干预后4、8周营养状况有效改善率高于对照组（P<0.05）；营养+运动组干预后4、8周营养状况有效改善率高于营养支持组、抗阻运动组（P<0.05）。干预方法与时间在患者MFSI-SF、HAMD、FACT-G评分上不存在交互作用（P>0.05）；干预方法和时间在患者MFSI-SF、HAMD、FACT-G评分上主效应显著（P<0.05）；营养支持组、抗阻运动组、营养+运动组干预后4、8周MFSI-SF、HAMD评分低于对照组，FACT-G评分高于对照组（P<0.05）；营养+运动组干预后4、8周MFSI-SF、HAMD评分低于营养支持组、抗阻运动组，FACT-G评分高于营养支持组、抗阻运动组（P<0.05）。结论　营养支持治疗联合抗阻运动能在一定程度上延缓肿瘤恶病质症候群患者的病情，显著改善患者的乏力、抑郁及生活质量，值得临床推广。

关键词: 肿瘤, 恶病质, 营养支持, 运动活动, 生活质量

LI Ling,MA Guixia,SI Zhuangli, et al. Clinical Study on Improving Quality of Life for Cancer Patients with Cachexia Syndrome Using Nutrition Support and Resistance Exercise　[J]. Chinese General Practice, 2019, 22(3): 319-323. DOI: 10.12114/j.issn.1007-9572.2018.00.339.
李玲,马桂霞,司壮丽等. 营养支持治疗联合抗阻运动改善肿瘤恶病质症候群患者生活质量的临床效果研究[J]. 中国全科医学, 2019, 22(3): 319-323. DOI: 10.12114/j.issn.1007-9572.2018.00.339.

References

［1］WATSON M S.Oxford handbook of palliative care［M］．New York：Oxford University Press，2006.
［2］JURDANA M.Cancer cachexia-anorexia syndrome and skeletal muscle wasting［J］．Radiology & Oncology，2009，43（2）：65-75．DOI：10.2478/v10019-009-0007-y.
［3］EZEOKE C C，MORLEY J E.Pathophysiology of anorexia in the cancer cachexia syndrome［J］．J Cachexia Sarcopenia Muscle，2015，6（4）：287-302．DOI：10.1002/jcsm.12059.
［4］BERGER A M，MOONEY K，ALVAREZ-PEREZ A，et al．Cancer-Related Fatigue，Version 2.2015.Clinical Practice Guidelines in Oncology ［J］．J Natl Compr Canc Netw，2015，13（8）：1012–1039.
［5］王新颖，黎介寿.癌性恶病质的代谢改变和营养干预策略［J］．肠外与肠内营养，2017，24（1）：4-9．DOI：10.16151/j.1007-810x.2017.01.002.
［6］PEN L C，CHU H，CHEN W C，et al．Reliability and validity of a Chinese version of the Multidimensional Fatigue Symptom Inventory-Short Form （MFSI-SF-C）［J］．J Clin Nurs，2011，20（15/16）：2224-2232．DOI：10.1111/j.1365-2702.2010.03691.x.
［7］CHASEN M，BHARGAVA R.Gastrointestinal symptoms，electrogastrography，inflammatory markers，and PG-SGA in patients with advanced cancer［J］．Support Care Cancer，2012，20（6）：1283-1290．DOI：10.1007/s00520-011-1215-8.
［8］CANTARERO-VILLANUEVA I，FEMANDEZ-LAO C，CUESTA-VARGAS A I，et al．The effectiveness of a deep water aquatic exercise program in cancer-related fatigue in breast cancer survivors：a randomized controlled trial［J］．Arch Phys Med Rehabil，2013，94（2）：221-230．DOI：10.1016/j.apmr.2012.09.008.
［9］汤毓华，张明园.汉密顿抑郁量表（HAMD）［J］．上海精神医学，1984（2）：61-63.
［10］万崇华，孟琼，汤学良，等．癌症患者生命质量测定量表FACT-G中文版评价［J］．实用肿瘤杂志，2006，21（1）：77-80．DOI：10.3969/j.issn.1001-1692.2006.01.027.
WANG C H，MENG Q，TANG X L，et al．Evaluation of the quality of life questionnaire for cancer patients in Chinese version FACT-G［J］．Journal of Practical Oncology，2006，21（1）：77-80．DOI：10.3969/j.issn.1001-1692.2006.01.027.
［11］AOYAGI T，TERRACINA K P，RAZA A，et al．Cancer cachexia，mechanism and treatment［J］．World J Gastrointest Oncol，2015，7（4）：17-29．DOI：10.4251/wjgo.v7.i4.17.
［12］FEARON K，STRASSER F，ANKER S D，et al．Definition and classification of cancer cachexia：an international consensus［J］．Lancet Oncol，2011，12（5）：489-495．DOI：10.1016/S1470-2045（10）70218-7.
［13］石汉平.肿瘤恶病质病人的蛋白质应用［J］．肿瘤代谢与营养电子杂志，2014，1（2）：1-5．DOI：10.16689/j.cnki.cn11-9349/r.2014.02.001.
［14］MENESES-ECHAVEZ J F，GONZALEZ-JIMENEZ E，RAMIREZ-VELEZ R.Effects of supervised multimodal exercise interventions on cancer-related fatigue：systematic review and meta-analysis of randomized controlled trials［J］．Biomed Res Int，2015，2015：328636．DOI：10.1155/2015/328636.
［15］汪立鑫，周岩冰.癌性恶病质肌肉减少的病理生理机制和治疗方法［J］．中华临床营养杂志，2016，24（3）：179-185．DOI：10.3760/cma.j.issn.1674-635X.2016.03.012.
WANG L X，ZHOU Y B.Pathophysiologic mechanisms and therapeutic methods of sarcopenia in cancer cachexia［J］．Chinese Journal of Clinical Nutrition，2016，24（3）：179-185．DOI：10.3760/cma.j.issn.1674-635X.2016.03.012.

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