头颈癌患者放疗期间营养相关口咽部症状群管理的证据总结

An evidence summary on the management of oral and pharyngeal symptom cluster in patients with head and neck cancer during radiotherapy

目的检索头颈癌患者放射治疗(放疗)期间口咽部症状群管理的相关指南、共识和系统综述,并整合最佳证据。方法检索美国国家指南库等网站以及中国知网、PubMed等数据库。疼痛这一症状管理的文献检索时限为2016年1月至2023年3月,其他症状管理的文献检索时限为建库至2023年3月。对纳入的文献进行质量评价、证据提取和整合。结果纳入28篇指南、19篇专家共识和16篇系统综述,共总结144条证据,包括一般原则、评估、优化放疗方案、口腔护理、吞咽功能干预、营养管理、心理社会干预、物理治疗、药物干预、其他干预、健康教育及随访管理等12个方面。结论针对群内症状的证据充足,由于症状间相互作用、协同影响,医务人员可整合管理措施,构建多模式的头颈癌患者放疗期间口咽部症状群管理方案。

Objective To summarize the evidence from guidelines,consensus and systematic reviews and provide the optimal recommendations on the management of oral and pharyngeal symptom cluster in patients with head and neck cancer during radiotherapy.Methods National Guidelines Clearinghouse and databases such as CNKI and PubMed were searched for publications on pain management from January 2016 to March 2023,and for publications on other symptom management from the establishment of database to March 2023.Quality of included articles was evaluated,data were extracted,and evidence were synthesized.Results We included 28 guidelines,19 expert consensus,and 16 systematic reviews.The evidence synthesis included 144 items covering 12 aspects,namely general principles,assessment,optimizing radiotherapy plan,oral care,swallowing function intervention,nutritional management,psychosocial intervention,physical intervention,medication,other interventions,health education,and follow-up.Conclusion Evidence about the management of oral and pharyngeal symptom cluster was adequate.Considering the interaction between various symptoms,healthcare professionals could integrate management measures and construct multimodal management plan for the management of oral and pharyngeal symptom cluster in patients with head and neck cancer during radiotherapy.