Evaluation of nursing care for patients receiving radiation therapy for esophageal cancer at the radiation therapy department of Vinmec Times City Hospital

The article is written by Master, Doctor Nguyen Manh Ha - Radiotherapy Doctor - Radiation Therapy Center - Vinmec Times City International General Hospital.

Pham Thi Quynh(1), Bo Thi Minh Cham(1), Nguyen Thi Hang(1), Doan Trung Hiep(2), Nguyen Manh Ha(2).
(1)Nurse,(2) Radiotherapy Doctor - Radiotherapy Department - Vinmec Times City General Hospital.
Email: v.quynhpt@vinmec.com. Phone: (+84).362656223
SUMMARY
Objective: To evaluate the care of patients receiving radiation therapy for esophageal cancer at the Radiation Center of Vinmec Times City International Hospital.
Subjects and methods: A total of 33 patients with esophageal cancer were indicated for radical radiotherapy through the Tumorboard at the radiation therapy center of Vinmec Times City International Hospital from January 2019 to July 2020. Methods of retrospective, descriptive, cross-sectional study.
Results: Esophageal cancer occurs mainly in men. The number of sick people is usually in the age group of 40 ÷ 60 years old (accounting for 84.8%). Up to 96.0% of patients in this study had radiation dermatitis and no patients had severe dermatitis. 100% of patients undergoing radiation therapy for esophageal cancer have problems and control side effects on a daily basis. After receiving care from nurses: The patient's moderate and severe pain decreased from 57.6% to 18.2%. Moderate and severe dermatitis decreased from 59.4% to 21.8%. Nutritional status of patients also improved: good nutritional status increased from 15.2% to 66.7%. The level of patient satisfaction with nursing care at Vinmec Times City hospital's radiation therapy center is 96.9%.
Conclusion: Nursing care is extremely important, contributing to improving treatment efficiency, helping patients feel secure and cooperate in the treatment process. Improve the patient's quality of life.
Keywords: Esophageal cancer, Radiation therapy, Nursing care.

Esophageal cancer, including cancer arising from the gastroesophageal junction, ranks 9th among the most common cancers in the world and ranks 5th among the 10 most common cancers in Vietnam. Male [2]. In the United States each year there are about 17,000 new cases and 15,000 deaths due to this disease. [2]. Up to now, the cause of colorectal cancer has not been found, but some risk factors can lead to colorectal cancer, such as: Diet, lifestyle, alcoholism, smoking, damage to the esophagus, age and gender. Patients with early stage esophageal cancer often do not have any symptoms, in later stages, patients appear typical symptoms such as: Difficulty swallowing, weight loss, and difficulty swallowing. However, esophageal cancer is a rather silent disease, the possibility of early metastasis, treatment prognosis and patient survival (NB) is at a very low level. Currently, prostate cancer is treated by many methods such as: Surgery, chemotherapy, radiation therapy... In which, radiation therapy is an important treatment method with high efficiency, is the top priority and indicated. at all stages of the disease. Radical radiation therapy combined with chemotherapy in upper third rectal cancer at locally advanced stage. Preoperative chemoradiotherapy in middle and lower third rectal cancer reduces the risk of recurrence after surgery. Palliative radiotherapy in late stage rectal cancer helps to reduce swallowing choking [5].
The effectiveness of radiation therapy for patients is undeniable, but besides those benefits, radiation therapy also causes side effects that affect the patient's quality of life such as: burning pain, weight loss, and weight loss. , dermatitis, esophageal mucosal inflammation, dysphagia due to inflammation... To contribute to improving the quality of treatment as well as the quality of life of patients, the nursing care role is especially important for patients receiving radiation therapy. UTTQ. Caring for patients with rectal cancer is a very difficult task that requires nurses not only to firmly grasp professional knowledge but also to flexibly apply that knowledge in clinical practice, always caring, comforting patients and guiding them. lead patients to perform CS techniques to contribute to effective treatment. Nursing care is essential with many aspects including coordination of various support services, patient and family education, clinical assessment, nutritional management, swallowing status, management of effects extra. So we conducted research on this topic.

II.1. Subjects A total of 33 patients were diagnosed with rectal cancer and indicated for radical radiation therapy through the Tumorboard at Vinmec Times City International General Hospital from January 2019 to the end of July 2020. Selection criteria: patients with a diagnosis of rectal cancer received radical radiation therapy at Vinmec Times City hospital radiation center, fluent in Vietnamese, good receptivity. Exclusion criteria: patients receiving radiation therapy for preoperative esophageal cancer, palliative radiotherapy, cognitive impairment and those who did not agree to participate in the survey. II.2. Methods The retrospective, descriptive and cross-sectional study was used.
II.2.1. Research indicators Gender, age, occupation, history of smoking (based on Faderston scale), alcoholism, TNM stage.
II.2.2. Nursing care Assessment of the overall condition Assessment of pain according to the VAS scale (Visual Analig Scales)

Evaluation of the degree of dermatitis and care:
Grade 1: Erythema, dry peeling. Grade 2: Moist flaking in the folds or moderate edema. Grade 3: Damp skin in areas other than folds, edema, drainage Grade 4: Bleeding or as symptoms of infection. Assessment of the degree of choking: according to the world choking scale
Grade 0: No choking Grade 1: Choking on solid foods Grade 2: Choking on semi-solid foods Grade 3: Choking on liquid Grade 4: Complete choking Improves condition nutritional status, mental care.
Assess the risk of malnutrition according to the PG- SGA scale [3];
PG-SGA A (good nutrition): stable weight or recent weight gain, no reduction in dietary intake or recent improvement, no abnormalities in functioning in the past 1 month PG-SGA B (Mild or moderate malnutrition or risk of malnutrition) 5% weight loss in 1 month or 10% in 6 months; reduce rations consumption; presence of symptoms affecting nutrition; moderate functional impairment; loss of subcutaneous fat or moderate muscle mass. PG-SGA C (severe SDD): >5% weight loss in 1 month or 10% in 6 months; severe lack of rations; presence of symptoms affecting eating; severe or sudden decline in function; There are obvious signs of SDD (loss of subcutaneous fat, atrophy) Rate the satisfaction of patients according to the 28-index service standard of the American Society of Radiation Oncology (ASTRO). II.2.3. Data processing methods Data were collected and processed using SPSS (IBM) and Exel (Microsoft).

The research process on 33 patients receiving radiotherapy for radical rectal cancer at the Radiation Department of Vinmec Times City Hospital from January 2019 to March 2020 obtained the following results:
III.1. General characteristics of the NB group studied

All patients receiving radiation therapy for rectal cancer in this study were in men, accounting for 100%. The most common age of disease is from 40 to 60 years old (accounting for 84.8%). This result is equivalent to some published studies on prostate cancer [7]. Most of the patients were detected at the late stage (III, IV), accounting for 90.9%. All patients are diagnosed with the disease when they have clinical symptoms, so they often have anxiety, mental and physical depression. Nursing care needs to monitor the patient's psychological development to promptly encourage and encourage them to cooperate in treatment, share the burden of disease, and support care for the patient. As in another study [4] smoking, alcohol consumption and Baret's disease are high risk factors for patients diagnosed with rectal cancer (72.8%).
III.2. Assessment of patient's condition Table 2. Assessment of patient's general condition.

The common side effects were dermatitis accounted for 96.0%, burning pain caused by esophageal mucosal inflammation during radiation therapy was found in all patients (100%). Most of the patients were admitted to the hospital because of choking, eating difficulties, leading to weight loss of more than 5% of the patient's body weight, accounting for 75.7%. Therefore, the role of nurses in ensuring nutrition for patients undergoing radiation therapy for esophageal cancer is once again confirmed.
III.3. Assessment of pain level and effectiveness of nursing interventions

Vinmec Times City International General Hospital is one of the very few hospitals in the country that has been granted the JCI certificate (the leading prestigious certificate in the US for medical service quality assessment). The regulations and care procedures are very strict, especially in terms of pain assessment for patients. All 100% of patients who come for examination and treatment (including radiation therapy for rectal cancer) are managed and assessed in an objective and honest manner in accordance with JCI standards.
The pain assessment results shown in Table 3 show that: After receiving support, care management and health education (GDSK) about pain from nurses, the patient's pain level improved significantly. . Specifically, patients with severe pain (7 ÷ 10) and moderate (4 ÷ 6) decreased from 57.6% to 18.2% and no longer had severe pain. This is a very proud result, also an important factor to help patients feel comfortable and secure in treatment.
III.4. Evaluation of the degree of skin inflammation and the effectiveness of nursing interventions

Notes: Mild: Grade 0, 1; Moderate: Grade 2; Severity: Grade 3, 4.
Table 2 shows that up to 32 patients (96.0%) have dermatitis when performing radiation therapy for colorectal cancer. However, after receiving nursing care instruction, the degree of moderate and severe dermatitis (accounting for 59.4%) decreased to only 21.8% moderate dermatitis and no patients with severe dermatitis. heavyduty. This shows that nurses have an important role in the management of dermatitis care to help patients reduce side effects on the skin, without interrupting the treatment process.
III.5. Nutritional status of patients and effectiveness of nursing interventions

Nutrition is one of the very important issues that need the most attention and concern of patients undergoing radiation therapy for cervical cancer. All 100% of patients had pain, 84.8% of patients had choking, swallowing problems combined with fatigue, anorexia, greatly affecting nutritional status. However, after receiving the care of the nurse, promptly encouraging, explaining, guiding the diet, resting, and at the same time combining the nutritionist on the menu, the percentage of patients with this condition good nutrition improved from 15.2% to 66.7%. We offer nutritional care as the table below:

All 100% of the patients were specifically explained about the importance of nutrition and received dietary instructions from the nursing care. Improving nutritional status for the NB group in this study is extremely important because it greatly affects the treatment process and results. If the patient has lost more than 10% of the body weight compared to before the treatment, the treatment will have to be stopped to ensure the accuracy of the location and the radiation dose. In addition, 100% of patients in this study were encouraged, shared and consulted with health education for patients to feel secure in treatment.
III.6. Level of satisfaction of NB Table 7: Assessment of satisfaction of NB

The level of patient satisfaction in nursing care at the radiation therapy department of Vinmec Times City Hospital is highly appreciated, 96.9% of patients are very satisfied, 51.3% of patients are satisfied. Through these results, it shows that the Radiation Center of Vinmec Hospital creates a foundation of trust for patients to feel secure about radiation therapy. This is also one of the criteria for Vinmec to build a 5-star standard brand.

The role of nurses in the care of patients undergoing radiation therapy for esophageal cancer is extremely important, contributing to improving life, improving treatment efficiency, and at the same time reducing patient's anxiety and fear so that patients can be more motivated. strength to continue fighting the disease. We hope that nursing care will be more focused and perfected to be able to provide comprehensive care for cancer patients in the best way.

REFERENCES
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