癌症病人因疾病分期及治療過程會造成營養的流失及攝食量減少，易有營養不良情況發生。研究指出利用病人主觀性整體營養評估表（Patient-Generated Subjective Global Assessment，PG-SGA）進行早期篩檢、評估癌症病患營養狀況，以作為營養需求之依據。本研究於台中某醫學中心化學治療室進行，受試者179位癌症病人，經由營養介入，包括：營養師針對初次到院進行抗癌治療之病人進行營養評估及飲食指導、針對體重及進食量減少之營養不良高風險病人進行持續追蹤及問題解決、如有進食障礙，教導腸道供給營養品使用、灌食配方製作及正確食用量，以提升癌症病人營養狀況。結果發現，癌症病人經由營養衛教介入後一個月，在醣類、脂肪、蛋白質及熱量攝取上顯著增加，進一步探討營養攝取與營養指標相關性，發現醣類、脂肪、蛋白質及熱量之攝取與體重顯著正相關；醣類及熱量攝取與血紅素顯著正相關，另外針對衛教前營養攝取及營養指標狀況較差之癌症病人，營養衛教介入有助於其營養指標—白血球及持續接受化學治療指標—嗜中性白血球之維持。本結論，經由營養衛教介入可增加營養攝取狀況，進而改善白血球及化學治療指標。

Due to cancer stages and harsh treatment process, cancer patients lose nutrients and reduce dietary intake, which easily causes malnutrition. The relevant researches indicate that Patient-Generated Subjective Global Assessment (PG-SGA) can be a tool to do early screening and assess nutritional status of cancer patients. In this study, subjects are 179 cancer patients who accept chemotherapy in a medical center’s chemotherapy room in Taichung. These cancer patients are given nutritional interventions as follows, including nutritional assessment and dietary guidance on those who accept anti-cancer treatment for the first time and dietitian’s regular follow-up and problem-solving on those who are high-risk malnutrition patients due to body weight loss and factors reducing dietary intake. If some of cancer patients have oral intake problems, dietitian will give nutritional education about enteral nutrition through intestinal supply, or about formula preparation as well as proper consumption through tube feeding in order to improve their nutritional status. The study found that those cancer patients had significant increase in carbohydrate, fat, protein and calorie intake through nutritional intervention and education. When further discussion is about the relevance between nutritional intake and nutritional indicators, it’s found that carbohydrate, fat, protein and calorie intake are highly positive correlated with body weight. It’s also found that carbohydrate and calorie intake have significant correlation with hemoglobin. In conclusion, cancer patients can improve nutrition intake through nutritional interventions, which further make nutritional indicators better.

誌 謝 I
中文摘要 II
ABSTRACT III
第一章 緒 論 1
第一節 研究背景 1
第二節 研究動機 2
第三節 研究目的 3
第二章 文獻探討 4
第一節 癌症流行病學、診斷及治療 4
第二節 治療副作用 11
第三節 營養篩選及評估 14
第四節 飲食評估方法簡介 16
第五節 營養支持 17
第三章 研究方法 18
第一節 研究設計 20
第二節 研究流程 21
第三節 研究進行方法 22
第四節 統計方法 24
第四章 研究結果 25
第五章 討 論 41
第六章 參考文獻 43
附錄 48

Amaral TF, Antunes A, Cabral S, Alves P, Kent-Smith L. An evaluation of three nutritional screening tools in a Portuguese oncolog y c ent r e. J Hum Nutr Diet. 2008;21(6):575-583.
Arnold, C. & Richter, M.P. The effect of oral nutritional supplements on head and neck cancer. Int J Radiat Oncol Biol Phys. 1989; 16: 1595–9.
ASPEN Board Directors and the Clinical Guidelines Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr 2002; 26(1 Suppl):1SA-138SA.
Bauer J, Capra S. Comparison of a malnutrition screening tool with subjective global assessment in hospitalised patients with cancer--sensitivity and specificity. Asia Pac J Clin Nutr 2003;12(3):257-260.
Breast International Group (BIG) 1-98 Collaborative Group, Thürlimann B, Keshaviah A, Coates AS, Mouridsen H, Mauriac L, Forbes JF, Paridaens R, Castiglione-Gertsch M, Gelber RD, Rabaglio M, Smith I, Wardley A, Price KN, Goldhirsch A. A Comparison of Letrozole and Tamoxifen in V3menopausal Women with Early Breast Cancer . N Engl J Med 2005; 353: 2747-2757.
Chertow GM: Assessing the nutritional status of patients with end-stage renal disease. 1997; 10:108-14.
Crawford J, Dale DC, Lyman GH. Chemotherapy-induced neutropenia: risks, consequences, and new directions for its management. Cancer. 2004; 100: 228-37.
DeWys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR, Cohen MH, Douglass HO Jr, Engstrom PF, Ezdinli EZ, Horton J, Johnson GJ, Moertel CG, Oken MM, Perlia C, Rosenbaum C, Silverstein MN, Skeel RT, Sponzo RW, Tormey DC. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Am J Med. 1980; 69: 491-7
Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010 Jun; 17(6):1471-4.
Gerber DE. Targeted therapies: a new generation of cancer treatments. Am Fam Physician. 2008 Feb 1;77(3):311-9.
Gonçalves Dias MC, Nunes Marucci MF, Nadalin W, Waitzberg DL. Nutritional intervention improves the caloric and proteic ingestion of head and neck cancer patients under radiotherapy. Nutr Hosp. 2005; 20: 320–5.
Gottschlich MM, ed. The ASPEN Nutrition Support Core Curriculum: A Case-based Approach: the Adult Patient. Silver Spring, MD ASPEN; 2007:649-675.
Huhmann MB, August DA. ,Review of American Society for Parenteral and Enteral Nutrition (ASPEN) Clinical Guidelines for Nutrition Support in Cancer Patients: nutrition screening and assessment. Nutr Clin Pract. 2008 Apr-May;23(2):182-8.
Ingenbleek Y, Van Den Schrieck HG, De Nayer P, De Visscher M. Albumin, transferrin and the thyroxine-binding prealbumin/retinol-binding protein (TBPA-RBP) complex in assessment of malnutrition. Clin Chim Acta. 1975 Aug 18;63(1):61-7.
International Dietetics & Nutrition Terminology (IDNT) Reference Manual: Standardized Language for the Nutrition Care Process, Chicago.IL:American Dietetic Association; 2008.1287-93.
Isenring E, Cross G, Daniels L, Kellett E, Koczwara B：Validity of the malnutrition screening tool as an effective predictor of nutritional risk in oncology outpatients receiving chemotherapy. Support Care Cancer. 2006; 14: 1152–6.
Isenring E, Bauer J, Capra S. The scored patient–generated subjective global assessment (PG-SGA) and its association with quality of life in ambulatory patients receiving radiotherapy. Eur J Clin Nutr 2003;57(2):305- 309.
Isenring E, Bauer J, Capra S. Nutrition support using the American Dietetic Association medical nutrition therapy protocol for radiation oncology patients improves dietary intake compared. J Am Diet Assoc. 2007; 107: 404-12.
Kondrup J, Rasmussen HH, Hamberg O, Stanga Z, Ad Hoc ESPEN Working Group. Nutritional Risk Screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 2003;22(3),321-336.
Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN Guidelines for Nutrition Screening 2002. Clin Nutr. 2003; 22(4):415-421.
Koretz, R.L., Avenell, A., Lipman, T.O., Braunschweig, C.L. & Milne, A.C. Does enteral nutrition affect clinical outcome? A systematic review of the randomized trials. Am J Gastroenterol. 2007; 102: 412–29.
Kouba J. Nutritional care of the individual with cancer. Nutr Clin Pract. 1988; 3: 175-182.
Le Prise E, Etienne PL, Meunier B, Maddern G, Ben Hassel M, Gedouin D, Boutin D, Campion JP, Launois B. A randomized study of chemotherapy, radiation therapy, and surgery versus surgery for localized squamous cell carcinoma of the esophagus. Cancer. 1994 Apr 1;73(7):1779-84.
Leuenberger M, Kurmann S, Stanga Z. Nutritional screening tools in daily clinical practice: the focus on cancer. Supportive Care in Cancer. 2010; 18: S17–27.
Lee RD and Nieman DC: Nutrition assessment 「Chart Three」p91-141, second edition. The McGraw-Hill Companies, Inc. 1995.
Mary M. Clinical Nutrition for Oncology Patients. 2010.
National Cancer Institute. Effects of Cancer Treatment on Nutrition. http://www.cancer.gov/. Accessed March 6, 2013.
Nelms M, Long S, Kathryn P. Sucher K. Nutrition Therapy And Pathophysiology. Belmont, CA: Thomson Higher Learning; 2007: 101-135, 751-783.
Pereira Borges N, D''Alegria Silva B, Cohen C, Portari Filho PE, Medeiros FJ. Comparison of the nutritional diagnosis, obtained through different methods and indicators, in patients with cancer. Nutr Hosp 2009;24(1):51-55.
Ravasco, P., Monteiro-Grillo, I., Vidal, P.M. & Camilo, M.E. Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. J Clin Oncol. 2005; 23: 1431–8.
Richey LM, George JR, Couch ME, Kanapkey BK, Yin X, Cannon T, Stewart PW, Weissler MC, Shores CG. Defining cancer cachexia in head and neck squamous cell carcinoma. Clin Cancer Res 2007; 12: 6561-7.
Stratton RJ, Hackston A, Longmore D, Dixon R, Price S, Stroud M, King C, Elia M. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ''malnutrition universal screening tool'' (''MUST'') for adults. Br J Nutr 2004;92(5),799-808.
Van Wayenburg CA, Rasmussen-Conrad EL, Van den Berg MG, Merkx MA, Van Staveren WA, Van Weel C, Van Binsbergen JJ. Weight loss in head and neck cancer patients little noticed in general practice. J Prim Health Care. 2010; 2: 16-21.
von Meyenfeldt M. Cancer-associated malnutrition: an introduction. Eur J Oncol Nurs. 2005; 9 Suppl 2:S35-8.
Wilcock A: Anorexia: a taste of things to come? Palliat Med. 2006; 20: 43-5.
行政院衛生署100年死因統計結果分析
尹彙文、陳淑娟, 臨床營養學 膳食療養 (2008)