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學
校 輔仁大學
名
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所 營養科學系
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系
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496866014
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研
究 鄭秦樓
生
(中)
研
究 Chin-Lou Cheng
生
(英)
論
文
台灣地區乳癌、頭頸癌及結腸直腸癌患者化學或放射線治療前之營養狀況
名
稱
(中)
論
文 Nutritional status of breast, head and neck and colorectal cancer patients before
名
chemo- or radiotherapy in Taiwan
稱
(英)
其
他
題
名
指
導
曾明淑
教
授
(中)
指
導
Min-Su Tzeng
教
授
(英)
校
內
全
文 2012.6.8
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案 封面 謝辭 摘要 目次 正文 第一章 正文 第二章 正文 第三章 正文 第四章 正
說 文 第五章 正文 第六章 參考書目 附錄
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位 碩士
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98
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版 99
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文 中文
別
關
鍵 癌症患者 營養狀況 營養評估 病患提供主觀性整體評估量表
字
(中)
關
鍵 cancer patients nutrition status nutritional assessment Patient-generated Subject
字 Global Assessment
(英)
營養不良為癌症患者常見的營養問題，且營養不良癌症患者有較差的預
後。目前國內癌症患者營養狀況之研究較少，且癌症患者飲食攝取研究更
是少見。本研究目的在了解國內乳癌、頭頸癌及結腸直腸癌患者於化學或
放射線治療前的營養狀況及飲食攝取情形。於國內六家醫院招募初次診斷
為乳癌、頭頸癌及結腸直腸癌患者共 350 名。以 PG-SGA、體組成、血液生
化數值及飲食頻率問卷評估癌症患者營養狀況。PG-SGA 評估結果顯示，
中度及嚴重營養不良患者佔 30.9%，營養狀況良好者佔 69.1%。其中頭頸癌
摘
及結腸直腸癌患者 PG-SGA 總分及營養不良比率均顯著高於乳癌患者。近
50%癌症患者在過去一個月出現體重降低的情形，且有 26%患者體重降低
要 大於 5%。三種癌症患者血紅素、血清總蛋白及血清白蛋白低於標準值之比
(中) 率分別為 50.5%、5.69%及 2.34%。頭頸癌及結腸直腸癌患者貧血比率顯著
高於乳癌患者，且血清白蛋白平均值顯著低於乳癌患者。男女性癌症患者
之每日熱量、葉酸、鈣、鋅及鎂的攝取以及女性癌症患者維生素 E 及維生
素 B6 的攝取量未達 DRI 之建議量。另以 Harris-Benedict equation 估計癌症
患者熱量需求，結果顯示三種癌症患者之熱量攝取量顯著低於需求量。綜
上所述，國內初次診斷乳癌、頭頸癌及結腸直腸癌患者於化學或放射線治
療前有營養不良之情形，其中頭頸癌及結腸直腸癌患者營養不良的風險較
乳癌患者高。建議國內醫院應加強對癌症患者的營養評估，以便適時給予
適當的營養治療與改善。
Malnutrition is a common problem in cancer patients and associated with poor
prognosis. There are few studies investigate nutritional status of cancer patients in
Taiwan, especially rare on dietary assessment. The purposes of the study were to
assess the nutritional status and nutrient intakes of breast, head and neck and
colorectal cancer patients before chemo- or radiotherapy. Totally 350 first diagnosed
cancer patients were recruited from six hospitals in Taiwan. Nutritional status was
assessed by Patient-generated Subject Global Assessment questionnaire (PG-SGA),
摘
body composition, blood biochemical data, and nutrients intake. According to PGSGA global rating, 30.9% of subjects were moderately or severely malnourished,
要 69.1% were well-nourished. PG-SGA score and rates of malnutrition assessed by PG(英) SGA among head and neck and colorectal cancer patients were significantly higher
than those of breast cancer patients. About 50% cancer patients had weight loss
within previous one month. Among them, 26% had lost more than 5% of their usual
body weight. Percentage of subjects with low concentrations of hemoglobin, serum
total protein and albumin were 50.5%、5.69% and 2.34% respectively. Head and
neck and colorectal cancer patients had higher percentage of anemia and lower
albumin level than breast cancer patients. The daily energy, folate, calcium, zinc and
magnesium intakes of all cancer patients and vitamin E, vitamin B6 intakes of female
cancer patients did not meet the DRIS. All cancer patients’ energy intakes were
significantly lower than requirements estimated by Harris-Benedict equation. In
conclusions, first diagnosed breast, head and neck and colorectal cancer patients
before their chemo- or radiotherapy were malnourished. Compared with breast cancer
patients, head and neck and colorectal cancer patients were at risk of malnutrition
relatively. It was suggested that nutritional assessment of cancer patients have to be
reinforced in Taiwan in order to improve their nutritional status and conduct optimal
nutrition therapy timely.
論
文
目
次
目 錄 中文摘
要.............................................................................................................................. i 英
文摘
要.............................................................................................................................. ii
目
錄....................................................................................................................................
v 表 目
錄.............................................................................................................................. viii
圖 目
錄.............................................................................................................................. ix
第一章 前
言...................................................................................................................... 1 第二
章 文獻回顧.............................................................................................................. 2
第一節 癌症發生率及死亡率.................................................................................. 2
一、 國外癌症發生率及死亡率.......................................................................... 2
二、 台灣地區癌症發生率及死亡率.................................................................. 5
第二節 癌症患者營養狀況之影響因子.................................................................. 8
一、 癌症對營養狀況之影響.............................................................................. 8
二、 癌症治療及其副作用對營養狀況之影響.................................................. 9
第三節 營養狀況對癌症患者所造成之影響..........................................................
11
一、 營養狀況對癌症患者治療之影
響.............................................................. 12
二、 營養狀況對癌症患者生活
品質之影響...................................................... 12
三、 營養狀況對癌症患者
整體存活率之影響.................................................. 13 第四節 癌症患者常用之
營養及飲食評估指標...................................................... 14
一、 癌症患者營
養狀況評估及指標.................................................................. 14
二、 癌症患
者飲食評估及工具.......................................................................... 18 第五節 癌
症患者營養狀況相關研究...................................................................... 19
一、 乳癌患者營養狀況相關研究...................................................................... 20
二、 頭頸癌患者營養狀況相關研究.................................................................. 21
三、 消化道癌患者營養狀況相關研究.............................................................. 22
第三章 研究設
計.............................................................................................................. 23 第一節
研究目的...................................................................................................... 23 第二
節 研究對象...................................................................................................... 24
第三節 研究流程...................................................................................................... 25
第四節 研究方法與工具..........................................................................................
26
一、 基本資料收
集.............................................................................................. 26
二、 營養評
估方法及工具.................................................................................. 26 第五節 資
料處理與統計分析.................................................................................. 31 第四章
研究結果.............................................................................................................. 33
第一節 乳癌、頭頸癌及結腸直腸癌患者基本資料...............................................
33 第二節 乳癌、頭頸癌及結腸直腸癌患者之營養狀
況........................................... 34
一、 癌症患者主觀性整體營養評估量表
（PG-SGA）....................................... 34
二、 癌症患者體組成分
析.................................................................................. 34
三、 癌症患者血液
生化分析.............................................................................. 36 第三節 乳癌、頭
頸癌及結腸直腸癌患者之飲食攝取狀況.................................... 37
一、 癌
症患者熱量及營養素之平均攝取量...................................................... 37
二、 癌症患者熱量及蛋白質攝取與估計需求量之比較.................................. 38
三、 癌症患者營養補充品使用情形.................................................................. 39
第四節 癌症患者各營養指標間之相關性..............................................................
40 第五章 討
論...................................................................................................................... 61 第
一節 癌症患者之營養狀況.................................................................................. 61
一、 以 PG-SGA 評量癌症患者之營養狀況....................................................... 61
二、 以體組成評量癌症患者之營養狀況.......................................................... 63
三、 以血液生化指標評量癌症患者之營養狀況.............................................. 64
第二節 癌症患者飲食攝取狀況..............................................................................
66 第三節 研究限制......................................................................................................
68 第四節 未來研究......................................................................................................
69 第六章 結論與建
議.......................................................................................................... 70 第一節 結
論.............................................................................................................. 70 第二節
建議.............................................................................................................. 71 參考文
獻.............................................................................................................................. 72
附錄一 主觀性整體營養評估量表（PGSGA）.................................................................. 90 附錄二 癌症患者飲食頻率問
卷記錄表............................................................................ 93 附錄三 癌症患者飲
食頻率問卷訪員手冊........................................................................ 100 表 目 錄
表一 十大癌症年齡標準化死亡率之十年變化率，
1998~2008...................................... 7 表二 乳癌、頭頸癌及結腸直腸癌患者基本
資料............................................................ 42 表三 乳癌、頭頸癌及結腸直腸癌
患者 PG-SGA 分數及營養狀況................................... 43 表四 乳癌、頭頸癌及
結腸直腸癌患者之體組成............................................................ 44 表五 乳癌、
頭頸癌及結腸直腸癌患者體組成分佈情形................................................ 45 表
六 乳癌、頭頸癌及結腸直腸癌患者血液生化狀
況.................................................... 47 表七 乳癌、頭頸癌及結腸直腸癌患者血
液生化分佈情形............................................ 48 表八 整體癌症患者每日平均熱
量及營養素攝取狀況.................................................... 49 表九 男性癌症患者每
日平均熱量及營養素攝取狀況.................................................... 50 表十 女性癌
症患者每日平均熱量及營養素攝取狀況.................................................... 51 表
十一 癌症患者熱量及蛋白質攝取與估計需求量之比
較............................................ 52 表十二 使用營養補充品癌症患者由營養補充
品提供之各營養素攝取情形................ 54 表十三 使用營養補充品乳癌患者由
營養補充品提供之各營養素攝取情形................ 55 表十四 使用營養補充品頭
頸癌患者由營養補充品提供之各營養素攝取情形............ 56 表十五 使用營養
補充品結腸直腸癌患者由營養補充品提供之各營養素攝取情形.... 57 表十六
整體癌症患者 PG-SGA 總分與體組成指標間之相關性.....................................
58 表十七 整體癌症患者 PG-SGA 總分與血液生化指標間之相關
性................................. 59 表十八 整體癌症患者體組成與血液生化指標間之相
關性............................................ 60 圖 目 錄 圖一 美國年齡標準化癌症發生率
之長期趨勢，1975~2005.......................................... 3 圖二 美國年齡標準化癌症
死亡率之長期趨勢，1930~2005.......................................... 4 圖三 十大癌症年齡
標準化發生率之五年變化率，2002~2006...................................... 5 圖四 歷年癌
症標準化死亡率變動趨勢圖，1997~2008.................................................. 6 圖五
半球狀漸進式食物模型碗........................................................................................
29 圖六 方格
板........................................................................................................................ 30 圖
七 厚度尺........................................................................................................................
30 圖八 （A）癌症患者過去一個月體重變化情形 （B）癌症患者過去一個
月平均
體重減輕百分率之比較 （C）癌症患者過去六個月體重變化
情形 （D）癌
症患者過去六個月平均體重減輕百分率之比
較.................................................. 46 圖九 癌症患者營養補充品使用百分
比............................................................................ 53
參
考
文
獻
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期
496866014 2010.6.8 17:46 59.112.241.248 new 01 496866014 2010.6.8 17:47
全 59.112.241.248 new 02 496866014 2010.6.8 17:48 59.112.241.248 new 03
文 496866014 2010.6.8 17:50 59.112.241.248 new 04 496866014 2010.6.8 17:51
檔 59.112.241.248 new 05 496866014 2010.6.8 17:52 59.112.241.248 new 06
存 496866014 2010.6.8 17:54 59.112.241.248 new 06 496866014 2010.6.8 17:56
取 59.112.241.248 new 07 496866014 2010.6.8 18:00 59.112.241.248 new 08
記 496866014 2010.6.8 18:01 59.112.241.248 new 09 496866014 2010.6.8 18:02
錄 59.112.241.248 new 10 496866014 2010.6.8 18:04 59.112.241.248 new 11
496866014 2010.6.8 18:05 59.112.241.248 new 12
C 496866014 Y2010.M6.D8 17:34 59.112.241.248 M 496866014 Y2010.M6.D8
17:39 59.112.241.248 M nutr2515 Y2010.M6.D8 18:06 59.112.241.248 M 030540
動
Y2010.M6.D9 8:25 140.136.209.54 M nutr2515 Y2010.M6.D10 13:47 140.136.181.3
記
M nutr2515 Y2010.M6.D10 13:47 140.136.181.3 I 030540 Y2010.M6.D11 8:44
錄
140.136.209.44
異