Evidence Summary for management of symptom clusters of gastrointestinal adverse reactions caused by radiotherapy and chemotherapy for lung cancer
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摘要:
目的 检索、汇总对肺癌放化疗所致的消化道不良反应的评估及管理的最佳证据，以支撑循证实践。 方法 检索各指南网及数据库关于肺癌放化疗所致消化道不良反应管理的相关证据，检索时限为建库至2024年8月。2名循证研究员负责文献筛选、质量评级、证据提炼与整合。 结果 纳入28篇文献，包括5篇荟萃分析，2篇系统评价，4篇证据总结，8篇专家共识，5篇指南，4篇临床决策。总结出关于评估、预防、治疗和干预3个维度的106条证据，涉及口腔黏膜炎、放射性食管炎、厌食、恶心和呕吐、放化疗相关性腹泻、便秘及营养不良7个主题。 结论 肿瘤团队应充分考虑患者个体差异，提供基于证据的恰当干预。 Abstract:Objective To search and summarize the best evidence for assessing and managing gastrointestinal adverse reactions caused by radiotherapy and chemotherapy for lung cancer, and support evidence-based practice. Methods Systematically searched each database and guideline networks for management evidence of gastrointestinal adverse reactions caused by radio- and chemotherapy for lung cancer. The search timeline was from database establishment to August 2024. Two trained researchers performed literature screening, quality evaluation, evidence extraction, and integration independently. Results Twenty-eight articles were included, including 5 meta-analyses, 2 systematic reviews, 4 evidence summaries, 8 expert consensuses, 5 guidelines, and 4 clinical decisions. One hundred and six recommendations in three dimensions of assessment, prevention, treatment, and intervention were summarized, involving seven themes of oral mucositis, radiation esophagitis, anorexia, nausea and vomiting, chemo- and radiotherapy-associated diarrhea/constipation, and malnutrition. Conclusion Tumor teams should fully consider the individual differences of patients and provide appropriate evidence-based interventions. -
Key words:
- Lung cancer /
- Radiotherapy /
- Chemotherapy /
- Gastrointestinal tract /
- Adverse reactions /
- Evidence summary
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表 1 28篇纳入文献的一般特征
Table 1. General characteristics of the 28 included studies
作者 主题 文献类型 年份 抗癌协会护理专委会[15] 《中国癌症症状管理指南》-厌食 指南 2019 抗癌协会营养专委会[20] 肺癌营养治疗专家共识 共识 2023 上海抗癌协会[21] 抗肿瘤治疗所致恶心呕吐全程管理 共识 2024 李野[28] 中医护理缓解化疗相关恶心呕吐 证据总结 2023 张兴瑜[29] 放化疗致口腔黏膜炎非药物预防与管理 证据总结 2022 张贵霖[34] 针刺治疗癌症化疗后恶心呕吐 meta分析 2022 肿瘤营养专委会[22] 肿瘤患者食欲下降的营养诊疗 共识 2022 丁娟[30] 癌症化疗相关性便秘的最佳证据 证据总结 2020 陈凤[35] 内关穴按压改善化疗相关恶心呕吐 meta分析 2020 姚小云[31] 癌症化疗相关性便秘评估与管理 证据总结 2020 李涛[23] 恶性肿瘤放疗患者营养治疗 共识 2018 李锐[36] 益生菌辅助防治化疗相关性腹泻 meta分析 2017 董良[37] 帕洛诺司琼预防成人化疗所致恶心呕吐 meta分析 2014 肿瘤化疗专委会[24] 中国肿瘤药物治疗相关恶心呕吐防治 共识 2022 马德健[38] 奥曲肽治疗放化疗相关性腹泻 meta分析 2020 老年保健肺癌专委[25] 老年肺癌护理共识(2022版) 共识 2023 ROCK C L[16] American nutrition and physical activity guideline for cancer 指南 2022 BRIAN G CZITO M[11] 放疗的消化道毒性 临床决策 2024 SUNEEL KAMATH M[12] 化疗相关腹泻、便秘和肠穿孔 临床决策 2024 CHARLES L LOPRINZI M[13] 癌症厌食_恶病质的治疗 临床决策 2024 CAROLE MACARON M[14] 急性化疗相关性腹泻的处理 临床决策 2024 FEYER P C[26] Radiotherapy-induced nausea and vomiting (RINV): MASCC/ESMO guideline for antiemetics 共识 2011 HESKETH P J[17] Antiemetics: ASCO Guideline Update 指南 2020 Cancer Care Alberta A H S[18] Endorsement of the 2020 American Society of Clinical Oncology's Guideline for Antiemetics 指南 2024 杨从容[27] 放射性食管炎的预防与治疗 共识 2023 ZHANG H W[32] Moxibustion for alleviating side effects of chemo- or radiotherapy in cancer 系统评价 2018 NCCN Antiemesis Panel Members[19] NCCN Clinical Practice Guidelines in Oncology: Antiemesis, v1, 2024 指南 2024 KISS N K[33] Effect of Nutrition Intervention in Lung Cancer of Chemo- or Radiotherapy 系统评价 2014 
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表 2 指南质量评价
Table 2. Quality assessment of guidelines
作者 各领域得分标准化百分比(%) ≥60%领域数 ≥30%领域数 推荐等级 范围目的 参与人员 严谨性 清晰性 应用性 独立性 中国抗癌协会[15] 86.11 91.67 83.33 75.00 54.17 79.17 5 6 A ROCK C L[16] 97.22 100.00 83.33 80.56 58.33 100.00 5 6 A HESKETH P J[17] 100.00 100.00 92.71 91.67 72.92 100.00 6 6 A CCA[18] 100.00 72.22 77.08 97.22 33.33 100.00 5 6 A NCCN Antiemesis Panel Members[19] 97.22 91.67 82.29 97.22 60.42 87.50 6 6 A
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表 3 专家共识质量评价
Table 3. Quality assessment of expert consensus
项目 营养专委[20] 康复姑息委[21] 营养专委[22] 李涛[23] 肿瘤化疗委[24] 李梅[25] FEYER P C[26] 杨从容[27] A B A B A B A B A B A B A B A B 1.是否明确标注观点的来源? 是 是 是 是 是 是 是 是 是 是 是 是 是 是 是 是 2.观点是否来源于该领域有声望的专家 是 是 是 是 是 是 是 是 是 是 是 是 是 是 是 是 3.所提出的观点是否以患者利益为中心? 是 是 是 是 是 是 是 是 是 是 是 是 是 是 是 是 4.结论是否基于分析?表述是否具有逻辑性 是 是 是 是 是 是 是 是 是 是 是 是 是 是 是 是 5.是否参考现有文献并正确标引？ 是 是 是 是 是 否 是 否 是 否 是 是 是 是 否 是 6.所提观点与以往有不一致? 否 否 是 是 是 是 否 否 是 是 是 是 是 是 是 是 注：A、B为评价人员。
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表 4 系统评价、meta分析质量评价
Table 4. Quality assessment of systematic reviews and meta-analyses
项目 张贵霖[34] 陈凤[35] 李锐[36] 董良[37] 马德健[38] ZHANG H W [32] KISS N K[33] A B A B A B A B A B A B A B 1.循证问题是否清晰? 是 是 是 是 是 是 是 是 是 是 是 是 是 是 2.文献纳入标准是否恰当? 是 是 是 否 是 是 否 是 否 是 是 是 是 是 3.检索策略是否恰当? 是 是 否 否 是 是 否 否 是 否 是 是 是 否 4.检索数据库或资源是否恰当? 是 是 是 否 是 是 是 是 是 是 是 是 是 是 5.文献质量评价标准是否恰当? 是 是 是 是 是 是 是 是 否 否 是 是 是 是 6.至少2人独立完成文献质量评价? 是 是 是 是 是 是 是 是 是 是 是 是 是 是 7.资料提取时使用措施减少误差? ? ? ? ? 是 是 是 是 是 是 是 是 是 是 8.综合/合并研究的方法是否恰当? 是 是 是 是 是 是 是 是 是 是 是 是 × × 9.是否评估发表偏倚? 是 否 是 否 是 是 是 是 是 是 是 是 否 否 10.推荐意见是否基于系统评价? 是 是 是 是 是 是 是 是 是 是 是 是 是 是 11.对未来研究方向是否提出适当建议? 是 是 是 是 是 是 是 是 是 是 否 否 是 是 注：A、B为评价人员。？为不清楚；×为不适用。
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表 5 证据总结质量评价
Table 5. Quality assessment of evidence summaries
维度 CASE的关键评估内容 李野[28] 张兴瑜[29] 丁娟[30] 姚小云[31] 主题 1.证据摘要的应用目的和范围是否具体 是 是 是 是 方法学 2.该证据摘要的作者身份是否透明？ 是 是 是 是 3.摘要的审阅人是否透明？ 是 否 是 否 4.检索方法是否透明和全面？ 是 是 部分是 是 5.证据分级系统是否透明和可解释？ 是 是 是 是 证据内容 6.建议/推荐证据是否明确？ 是 是 是 是 7.这些推荐意见是否被适当地引用？ 是 是 否 是 8.推荐证据是否符合当下实际？ 是 是 是 是 9.总结是否公正？ 是 是 是 是 证据应用 10.此证据是否可以应用于您的病人？ 是 是 是 是
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