進行がん患者に対する専門のリハ栄養チーム

専門のリハ栄養チームが関わった進行がん患者では体重増加が主観的な身体機能改善と関連するという論文を紹介します。論文の内容よりもリハ栄養チームのほうが気になります。

Parmar MP, Swanson T, Jagoe RT. Weight changes correlate with alterations in subjective physical function in advanced cancer patients referred to a specialized nutrition and rehabilitation team. Support Care Cancer. 2013 Feb 26. [Epub ahead of print]

マギル大学ではspecialized nutrition and rehabilitation teamがあります。本文に以下のようにあります。以下、引用です。

As a group, these patients often have severe nutritional and functional impairment as well as a range of related symptoms, and the CNR-JGH clinic uses a comprehensive interdisciplinary approach to assess and, where possible, control symptoms, combined with individualized dietary interventions and physical rehabilitation.

つまり、栄養介入とリハを同時に行っているということになります。心リハを除くとこのようなリハ栄養の取り組みは、海外では他にあまり聞いたことがありません。
がん悪液質（がん以外の悪液質でも）に対して、栄養も運動・リハも薬剤も含めて、多職種で包括的に対応するのがベストであることは明らかです。ただ、既存のチーム医療では包括的な対応が十分にできているとは言い難いです。リハ栄養チームが悪液質に対するチーム医療のモデルになればと思います。

Abstract

PURPOSE:

The aim of this study is to assess whether short-term weight gain correlates with improvements in subjective markers of quality of life and physical function in patients referred to a clinic for management of cancer cachexia.

METHODS:

A retrospective review of the records of 306 patients referred to a specialized multi-disciplinary supportive care team with particular interest in treating cancer cachexia. Weight changes between each of the first three clinic visits, were correlated with the corresponding changes in patient-rated performance status, perceived strength and quality of life. In a second cohort of 56 patients, the correlation between perceived strength and quality of life was re-tested using a more detailed quality of life tool.

RESULTS:

Even over short time intervals positive correlations were observed for weight change vs. change in patient-rated performance status (R (s) > 0.15, P < 0.05), and for changes in perceived strength vs. quality of life (R (s) > 0.33, P < 0.001). The correlation between changes in patient-rated strength and quality of life was consistent across all subgroups studied and was reproducible when using a different, validated, quality of life tool (FAACT) in a second independent patient cohort.

CONCLUSIONS:

Weight gains are associated with subjective improvements in physical functioning, and changes in perceived physical strength are consistently correlated with quality of life.