| 摘要: | 肝癌和結直腸癌患者是消化器官癌症中發生率與死亡率最高的前兩位，常出現營養不良的問題，對於出院的癌症患者，追蹤營養狀況並提供營養照護非常重要。近年遠距醫療照護用於居家患者照護的實證增加，而口服營養補充劑（oral nutrition supplements, ONS）也已被證實是對營養不良患者有效的營養支持方式，但目前尚未確定最理想的癌症患者營養介入方式，且台灣癌症患者出院後與遠距營養照護之研究有限。因此本研究聚焦於癌症患者出院後營養照護，探討遠距營養照護結合ONS對肝癌和結直腸癌患者的營養狀態和生活品質的影響。本研究招募有營養不良風險的肝癌和結直腸癌患者（病人主觀性整體營養狀況評量表簡版（Abridged Patient-Generated Subjective Global Assessment, aPG-SGA）評估4-9分），隨機分為遠距營養照護對照組（C組）和遠距營養照護搭配ONS組（C+O組），介入三個月。在C組中，營養師每月一次透過手機應用程式（LINE）或電話，為患者進行遠距營養評估與指導。在C+O組中，除了遠距營養評估與指導外，提供患者每日一罐237ml ONS補充（Nutreatcare HN，Nutreat Life Science Co., Limited, New Taipei City，Taiwan），425 kcal（醣類34%，蛋白質18%，脂肪48%）和19.1 g蛋白質。每月進行一次血液檢驗以及生活品質問卷 （歐洲癌症治療與研究組織癌症患者生活品質問卷；EORTC QLQ-C30）評估。結果顯示C+O組相較C組在第1、2、3個月時皆更顯著降低以aPG-SGA評估的營養不良風險分數，第3個月時顯著改善營養指標預後營養指數（Prognostic nutritional index, PNI）並顯著改善EORTC QLQ-C30評估的腹瀉與呼吸困難生活品質分數。因此，對於有營養不良風險的肝癌與結直腸癌症患者以LINE或電話進行遠距營養照護搭配ONS是降低營養不良風險、改善營養指標PNI、改善腹瀉與呼吸困難更有效的方式。
Liver and colorectal cancer are the two most prevalent and fatal digestive organ cancers, often associated with malnutrition issues. For discharged cancer patients, monitoring nutritional status and providing appropriate nutritional care is crucial. Recent years have seen an increase in evidence supporting the use of telehealth for home-based care, and oral nutritional supplements (ONS) have been proven to be effective in supporting malnourished patients. However, the optimal nutritional intervention approach for cancer patients remains uncertain, and research on post-discharge telehealth nutritional care for cancer patients in Taiwan is limited. This study focuses on post-discharge nutritional care for cancer patients, examining the impact of telehealth-based nutritional care combined with ONS on the nutritional status and quality of life in patients with liver and colorectal cancer. We plan to recruit liver and colorectal cancer patients at risk of malnutrition (assessed using the abridged patient-generated subjective global assessment scoring 4-9) and randomly assign them to either the telehealth nutritional care-control group (Group C) or the telehealth nutritional care combined with the ONS group (Group C+O) for a three-month intervention. In Group C, a dietitian provided monthly remote nutritional assessments and guidance through a mobile application (LINE) or phone calls. In Group C+O, in addition to remote nutritional assessments and guidance, patients received a daily 237ml can of ONS supplement (Nutreatcare HN, Nutreat Life Science Co., Limited, New Taipei City, Taiwan), providing 425 kcal (34% carbohydrates, 18% protein, 48% fat) and 19.1g of protein. Blood tests and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were conducted monthly for assessments. The results showed that the C+O group significantly reduced malnutrition risk scores, as assessed by the aPG-SGA, at the 1st, 2nd, and 3rd-month marks. By the 3rd month, the C+O group showed significant improvement in the Prognostic Nutritional Index (PNI), and notable improvements in diarrhea and respiratory distress scores, as assessed by the EORTC QLQ-C30. Therefore, for liver and colorectal cancer patients at risk of malnutrition, telehealth-based nutritional care combined with ONS through LINE or phone calls is a more effective approach to reducing malnutrition risk, improving nutritional indicators such as PNI, and alleviating symptoms like diarrhea and dyspnea. |
