鼻咽癌螺旋断层放疗患者生活质量变化及影响因素分析

Analysis of quality of life and influencing factors in patients with nasopharyngeal carcinoma during tomotherapy

目的研究鼻咽癌患者螺旋断层放疗期间生活质量及其影响因素。方法选取2017年11月至2019年5月中国人民解放军总医院放疗科收治的鼻咽癌患者,采用EORTC QLQ‑C30量表测评生活质量,通过多因素分析筛查生活质量影响因素。结果91例鼻咽癌患者放疗前躯体功能、认知功能、食欲丧失、恶心呕吐、疲乏与营养不良风险存在相关性(P<0.05),疼痛与肿瘤分期存在相关性(P<0.05),而总健康水平与伴随疾病的相关性有统计学意义(P<0.05)。放疗后患者功能领域及总健康得分均低于放疗前(P<0.05),症状领域评分均高于放疗前(P<0.05)。放疗后疼痛程度与口腔黏膜炎有明显相关性(P<0.05),食欲丧失、恶心呕吐、失眠、疲乏、便秘与急性咽‑食管炎存在相关性(P<0.05)。放疗期间总健康水平、躯体功能的变化与营养状况变化存在明显相关性(P<0.05)。结论螺旋断层放疗后鼻咽癌患者生活质量下降,改善营养状况,减轻急性放射反应,控制伴随疾病症状,可以提高患者生活质量及治疗依从性。

Objective To investigate quality of life and influencing factors in patients with nasopharyngeal carcinoma during tomotherapy.Methods The nasopharyngeal carcinoma patients who received tomotherapy from November 2017 to May 2019 were enrolled for the study in the Chinese PLA General Hospital.EORTC QLQ⁃C30 questionnaires were used to evaluate the quality of life,the factors affecting the quality of life of the nasopharyngeal carcinoma patients were screened by multivariate analysis.Results There were 91 patients who completed questionnaires and submitted successfully.Physical function,cognitive function,loss of appetite,nausea and vomiting,fatigue were correlated with the risk of malnutrition(P<0.05),pain and tumor staging was correlated(P<0.05).The correlation between global quality of life and concomitant diseases was statistically significant(P<0.05).After tomotherapy,the scores of global quality of life and functional areas of patients were lower than those before tomotherapy(P<0.05),and the scores of symptom areas were higher than those before radiotherapy(P<0.05).The degree of pain after tomotherapy was significantly correlated with oral mucositis(P<0.05).Loss of appetite,nausea and vomiting,insomnia,fatigue and constipation were correlated with acute pharyngoesophagitis(P<0.05).There was a significant correlation between the changes of total health level,physical function and nutritional status during radiotherapy(P<0.05).Conclusion The quality of life of the nasopharyngeal carcinoma patients decreased after tomotherapy.Quality of life and treatment compliance of the patients can be improved by reducing adverse radiation reactions,improving the nutritional status and controlling concomitant disease symptoms.