为鼻咽癌患者制定预防肌肉减少症的支持性照护路径：一种情境敏感且面向实施的方法。
Developing a supportive care pathway for sarcopenia prevention in nasopharyngeal carcinoma: a context-sensitive and implementation-oriented approach.
文献信息
| PMID | 42834235 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Lijuan Xia |
| 作者单位 | Department of Radiotherapy, General Hospital of Ningxia Medical University, 804 Shengli South Street, Xingqing District, Yinchuan, 750004, Ningxia, China. 974286683@qq.com. |
| 期刊 | Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer |
| SCI 分区 | Q1 |
| IF | 3.7 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻咽癌 |
中文摘要
目的： 接受根治性治疗的鼻咽癌（NPC）患者常出现肌肉流失、营养状况恶化、症状负担和功能下降，从而增加肌肉减少症风险。本研究旨在制定一条情境敏感的支持性照护路径，整合多学科照护策略，以在NPC治疗全程中预防肌肉减少症。
方法： 一个多学科团队（MDT）在更新的医学研究理事会复杂干预框架指导下，迭代制定了该路径。制定过程整合了证据综合、对医疗专业人员的半结构化访谈、项目理论、经济与资源考量、情境分析，以及对患者和家庭照护者的非正式咨询。这些输入为实施要求、专业角色、纵向照护流程和核心支持性照护领域提供了依据。
结果： 营养干预的证据最为充分；运动和益生菌方法的证据较为有限且异质性较大。对21名医疗专业人员的访谈产生了三个主题，包含11个亚主题，并综合为四项实施要求：识别与专业能力；照护组织与MDT协调；纵向监测与照护连续性；以及患者自我管理和家庭支持照护。对患者和照护者的咨询为教育、居家自我管理和家庭参与方面的完善提供了信息。最终路径明确了MDT角色、六项纵向照护流程和五个整合领域：营养与免疫管理、运动管理、头颈部症状群管理、胃肠道症状群管理，以及心理行为支持。
结论： 由此形成的路径提供了一个情境敏感、以实施为导向的结构，用于在NPC治疗全程中协调多学科肌肉减少症预防。它纳入了临床工作流程、资源考量和照护连续性，但其可行性、实施和有效性仍需前瞻性评估。
英文摘要
PURPOSE: Patients with nasopharyngeal carcinoma (NPC) undergoing definitive treatment commonly experience muscle loss, nutritional deterioration, symptom burden, and functional decline, increasing sarcopenia risk. This study aimed to develop a context-sensitive supportive care pathway integrating multidisciplinary care strategies for sarcopenia prevention across the NPC treatment trajectory.
METHODS: A multidisciplinary team (MDT) developed the pathway iteratively, guided by the updated Medical Research Council framework for complex interventions. Development integrated evidence synthesis, semi-structured interviews with healthcare professionals, programme theory, economic and resource considerations, contextual analysis, and informal consultations with patients and family caregivers. These inputs informed implementation requirements, professional roles, longitudinal care procedures, and core supportive care domains.
RESULTS: Evidence was most extensive for nutritional interventions; evidence for exercise and probiotic approaches was more limited and heterogeneous. Interviews with 21 healthcare professionals generated three themes comprising 11 subthemes, synthesised into four implementation requirements: recognition and professional competency; care organisation and MDT coordination; longitudinal monitoring and continuity of care; and patient self-management and family-supported care. Patient and caregiver consultations informed refinements to education, home-based self-management, and family involvement. The final pathway specified MDT roles, six longitudinal care procedures, and five integrated domains: nutritional and immune management, exercise management, head and neck symptom cluster management, gastrointestinal symptom cluster management, and psycho-behavioural support.
CONCLUSION: The resulting pathway provides a context-sensitive, implementation-informed structure for coordinating multidisciplinary sarcopenia prevention across the NPC treatment trajectory. It incorporates clinical workflow, resource considerations, and continuity of care, but its feasibility, implementation, and effectiveness require prospective evaluation.