ASSESSMENT OF THE GENERAL CONDITION OF PATIENTS IN THE DETECTION OF MALIGNANT TUMORS OF THE MOUTH AND OROPHARYNX BEFORE TREATMENT AND IN THE POSTOPERATIVE PERIOD

  • A. O. Kushta National Pirogov Memorial Medical University, Department of Surgical Dentistry and Maxillofacial Surgery, Vinnytsya, Ukraine https://orcid.org/0000-0001-8994-2560
Ключові слова: oral cavity, oropharynx, dysphagia, nutritional deficiency, cancer

Анотація

The aim is to study the dynamics of weight, pain, psycho-emotional state in cancer patients with pathology of the oral cavity and oropharynx from the beginning of the disease and at the stages of treatment.

Materials and methods The study included 45 patients, aged 38-55 years (men), who were treated in the Department of Head and Neck Tumors "Podilskyi Regional Oncology Center" with malignant tumors of the tongue, mouth and oropharynx stage I-III. All patients had problems with chewing and swallowing. The patient's weight, severity of the pain syndrome were determined by VAS, the degree of dysphagia and the psychological state according to the hospital scale of anxiety and depression (HADS) at the time of hospitalization and in the postoperative period for 3, 5, 7, 9, 12 days. The weight was determined 3-3 months after the first signs of the disease.

Results Weight loss from the first signs of the disease to diagnosis and treatment is 6-9 kg. Preoperative nutritional training, which we conducted 1-1.5 weeks before surgery allowed to increase the patient's weight by only 1.0-1.5 kg in 32% of patients, and in the remaining 68% - only to stabilize the existing condition. That is, in most patients, the correction of nutritional status is a big problem and in some cases is unsuccessful.

Patients have severe postoperative pain when swallowing, depending on the volume of surgery. Thus, it is more pronounced in patients with stage III, which manifested itself as weak and moderate. Mild stage patients were characterized by mild pain, and stage I patients were barely noticeable when swallowing. There were similar changes in dysphagia. Thus, patients with stage III disease had difficulty eating solid and gel foods, and some liquid, depending on the location of the tumor. Patients with stage II had problems mainly with the consumption of solid foods. Stage I patients mostly had stage I dysphagia. There is dysphagia of I-II degree up to 7 days in the postoperative period, which must be taken into account when choosing an additional therapeutic diet.

An important factor is the anxiety and emotional state and mental disorders at the first signs of the tumor process, so these figures reached high values. This is due to the emotional response to the diagnosis, the complexity of the treatment, the concern for possible recurrences and the potential threat of death.

Conclusions:

  1.  Weight loss from the first signs of the disease is 6-9 kg, and in the postoperative period 4-7 kg. At 9-12 days, the stabilization of this indicator.
  2. The appointment of additional nutrition in the preoperative period in only 1/3 of patients leads to a slight increase in weight, and in 2/3 - is not effective.
  3. Patients have a pronounced pain in the postoperative period when swallowing (1.63-3.63).
  4. In the postoperative period, depression (12.44-16.23) and anxiety (11.75-13).

Thus, patients in these groups need rational nutritional support in the form of additional nutrition and the development of their schemes, taking into account pain, dysphagia and correction of psycho-emotional state.

Thus, patients in these groups need rational nutritional support in the form of additional nutrition and the development of their schemes, taking into account pain, dysphagia and correction of psycho-emotional state.

Опубліковано
2021-10-06
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