Objective: To observe the effect of heat-sensitive moxibustion on the quality of life in the elderly patients with malignant tumor based on palliative treatment.
Methods: A total of 100 elderly patients with malignant tumor were randomly divided into an observation group (50 cases, 3 cases dropped out) and a control group (50 cases, 4 cases dropped out). The conventional palliative treatment was performed in the control group. On the basis of conventional palliative treatment, heat-sensitive moxibustion was added at Shenque (CV8) and Zhongwan (CV12) in the observation group, once a day, 5 times a week, one course of treatment was composed of 2 weeks, and 2 consecutive courses of treatment were given. In the observation group, 15 patients voluntarily continued heat-sensitive moxibustion treatment, which was collected in the sub-observation group No.1, these patients were treated 3 times a week and for 6 months consecutively. Using the propensity score matching method, 15 patients who only completed 2 courses of treatment were assigned into the sub-observation group No.2. Before and after treatment, the scores of European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30), the Karnofsky performance status (KPS), and the anorexia/cachexia subscale-12 (A/CS-12), as well as the immune indexes (the contents of serum immune globulin [Ig]G, IgA, IgM and complements C3 and C4) were observed in the patients of the observation group and the control group. The monthly survivals were recorded in the two sub-observation groups after 6 months of treatment completion. The coordination was analyzed on the score of deqi scale of heat-sensitive moxibustion at the probing stage before treatment and the change in the score of EORTC QLQ-C30 before and after treatment in the patients of the observation group.
Results: After treatment, except the score related to the financial difficulties, the score of every items in EORTC QLQ-C30 was greater than that before treatment in the observation group (P<0.05); the scores for overall health, nausea/vomiting, pain, short breath, constipation and diarrhea of the scale were higher than those before treatment in the control group (P<0.05). The score for each item of the scale in the observation group was higher when compared with that in the control group, except the score for financial difficulties (P<0.05). After treatment, KPS score increased in the observation group when compared with that before treatment (P<0.05), and the score was higher than that of the control group (P<0.05). After treatment, A/CS-12 score was elevated in comparison with that before treatment in each group (P<0.05), and the score in the observation group was higher than that of the control group (P<0.05). After treatment, in the observation group, the contents of serum IgG, IgA and IgM, and C3 and C4 increased in comparison with those before treatment (P<0.05); and in the control group, the contents of serum IgG, C3 and C4 were declined (P<0.05). After treatment, the contents of serum IgG, IgA and IgM, and C3 and C4 in the observation group were higher than those in the control group (P<0.05). After 6 months of treatment completion, the survival rate in the sub-observation group No.1 was higher than that of the sub-observation group No.2 (P<0.05). In the observation group, the positive coordination was presented between the score of deqi scale of heat-sensitive moxibustion and the change in the score of EORTC QLQ-C30 in the observation group (r>0, P<0.001).
Conclusion: On the basis of palliative treatment, heat-sensitive moxibustion can improve the quality of life, appetite and the immunity of the elderly patients with malignant tumor. Consecutive long-term moxibustion is contributed to prolonging the life span. The stronger deqi is felt during moxibustion delivery, the more significant the therapeutic effect is obtained.
目的：在姑息治疗基础上，观察热敏灸对老年恶性肿瘤患者生存质量的影响。方法：将100例老年恶性肿瘤患者随机分为观察组（50例，脱落3例）与对照组（50例，脱落4例）。对照组进行常规姑息治疗；观察组在常规姑息治疗的基础上加用热敏灸治疗，穴取神阙、中脘，每天1次，每周5次，2周为一疗程，连续治疗2个疗程。观察组中15例患者自愿继续坚持热敏灸治疗，作为观察组1，每周3次，共6个月。采用倾向性评分匹配法，从观察组中选取15例只完成2个疗程的患者作为观察组2。比较观察组和对照组患者治疗前后欧洲癌症研究和治疗组织核心生活质量问卷（EORTC QLQ-C30）评分、卡氏功能状态量表（KPS）评分、厌食/恶液质量 表-12(A/CS-12)评分、免疫指标[血清免疫球蛋白（Ig）G、IgA、IgM及补体C3、C4含量]；统计观察组1和观察组2治疗后6个月每月存活人数；分析观察组患者治疗前热敏灸灸感得气量表评分与EORTC QLQ-C30评分变化值的相关性。结果：治疗后，观察组除经济困难评分外EORTC QLQ-C30各项评分较治疗前升高（P<0.05），对照组总体健康情况、恶心呕吐、疼痛、气促、便秘、腹泻评分较治疗前升高（P<0.05）；除经济困难评分外，观察组各项评分均高于对照组（P<0.05）。治疗后，观察组KPS评分较治疗前升高（P<0.05），且高于对照组（P<0.05）。治疗后，两组患者A/CS-12评分均较治疗前升高（P<0.05），且观察组高于对照组（P<0.05）。治疗后，观察组血清IgG、IgA、IgM及补体C3、C4含量较治疗前升高（P<0.05），对照组血清IgG、C3、C4含量较治疗前降低（P<0.05）；观察组血清IgG、IgA、IgM及补体C3、C4含量均高于对照组（P<0.05）。观察组1治疗后6个月存活率高于观察组2（P<0.05）。观察组热敏灸灸感得气量表评分与EORTC QLQ-C30评分变化值呈正相关关系（r>0，P<0.001）。结论：在姑息治疗基础上，热敏灸可提高老年恶性肿瘤患者生存质量，改善食欲，增强免疫力，长期坚持施灸有助于延长生命时间，且施灸时得气感越强，疗效越显著。.
Keywords: heat-sensitive moxibustion; immunologic function; malignant tumor, elderly; palliative treatment; quality of life.