The Impact of a nutritional program based on symptom clusters on tolerance, immunity, and nutritional status in lung cancer patients undergoing chemotherapy

Xu Qianqian; Qu Shan; Liu Fang; Qin Jinfeng

doi:10.16689/j.cnki.cn11-9349/r.2026.01.015

PDF(952 KB)

Electronic Journal of Metabolism and Nutrition of Cancer ›› 2026, Vol. 13 ›› Issue (1) : 110-117. DOI: 10.16689/j.cnki.cn11-9349/r.2026.01.015

Original Articles

The Impact of a nutritional program based on symptom clusters on tolerance, immunity, and nutritional status in lung cancer patients undergoing chemotherapy

¹Xu Qianqian, ¹Qu Shan, ²Liu Fang, ³Qin Jinfeng

Author information +

History +

Abstract

Objective To explore the effects of a nutritional support program based on symptom cluster intervention on chemotherapy tolerance, immune function, and nutritional status in lung cancer patients. Method A cohort of 77 chemotherapy patients with lung cancer admitted to Qingdao Hospital (Qingdao Municipal Hospital) from October 2020 to October 2022 was designated as the control group, who received standard nutritional support. Meanwhile, 76 patients with lung cancer from November 2022 to October 2024 were selected as the observation group, who underwent symptom-based nutritional support interventions for lung cancer. The observation group (n=76) received nutritional support tailored to lung cancer symptom clusters, while the control group (n=77) received routine nutritional care. After 6 months of chemotherapy, between-group comparisons were conducted for the following outcomes. Symptom burden: Chinese version of the Anderson symptom assessment scale (MDASI-C) scores; nutritional status: subjective global nutritional assessment (PG-SGA) scores, transferrin (TF), albumin (ALB), prealbumin (PA), brachial muscle circumference (MAMC), triceps skinfold thickness (TSF), and body mass index (BMI);Immune function: percentages of CD4⁺, CD3⁺, and CD8⁺T lymphocytes; Safety outcomes: incidence of adverse reactions and chemotherapy interruption rate. Result Both groups showed significant reductions in MDASI-C and PG-SGA scores post-intervention (P<0.05). The observation group demonstrated greater improvements in symptom distress (3.68±1.43 points) and total cancer symptom scores (51.14±6.53 points) compared to the control group (P<0.001). Nutritional indicators (TF: 3.14±0.31 g/L; ALB: 41.16±3.15 g/L; PA: 168.97±11.21 g/L) were significantly higher in the observation group (P<0.001), whereas no between-group differences were observed for MAMC, TSF, or BMI (P>0.05). Immune markers [CD4⁺:(39.58±3.51)%; CD3⁺:(67.84±4.13)%; CD8⁺:(25.67±2.32)%] were also superior in the observation group (P<0.001). The observation group had a lower incidence of adverse reactions (11.84% vs. 27.27%, P=0.016), including nausea, vomiting, and bone marrow suppression (P<0.05), and a reduced chemotherapy interruption rate (3.95% vs. 12.99%, P=0.045). Conclusion The symptom cluster-based nutritional program effectively improves nutritional status, enhances immune function, reduces adverse reactions, and increases chemotherapy tolerance in lung cancer patients, supporting its clinical application.

Key words

Lung cancer symptom cluster / Nutritional support program / Lung cancer / Chemotherapy / Tolerance / Immune function / Nutritional status / Adverse reactions

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

Xu Qianqian, Qu Shan, Liu Fang, Qin Jinfeng. The Impact of a nutritional program based on symptom clusters on tolerance, immunity, and nutritional status in lung cancer patients undergoing chemotherapy[J]. Electronic Journal of Metabolism and Nutrition of Cancer. 2026, 13(1): 110-117 https://doi.org/10.16689/j.cnki.cn11-9349/r.2026.01.015

References

[1] NOORELDEEN R, BACH H. Current and future development in lung cancer diagnosis[J]. Int J Mol Sci,2021,22(16):8661.
[2] GONG S, LI Q, YU X, et al. Efficacy and safety of different immunotherapies combined with chemotherapy as first-line therapy in patients with small cell lung cancer: a network meta-analysis[J]. Front Immunol,2024,15(12):1362537.
[3] AVANCINI A, BELLUOMINI L, BORSATI A, et al. Integrating supportive care into the multidisciplinary management of lung cancer: we can't wait any longer[J]. Expert Rev Anticancer Ther,2022,22(12):725-735.
[4] CHEN M, YANG L, YU H, et al. Early palliative care in patients with non-small-cell lung cancer: a randomized controlled trial in Southwest China[J]. Am J Hosp Palliat Care,2022,39(11):1304-1311.
[5] 赵小兰,刘红,李莉,等. 远程消化道症状群监测在胃癌患者居家营养管理中的应用[J]. 中华现代护理杂志,2023,29(17):2310-2315.
[6] 施如意,鲁敏,徐静静,等. 规范化营养支持模式对非小细胞肺癌化疗患者的影响[J]. 国际护理学杂志,2023,42(21):3940-3945.
[7] 李东航,姚颐,耿庆. 中国临床肿瘤学会肺癌诊疗指南(2018版)更新解读[J]. 临床外科杂志,2019,27(1):36-39.
[8] 王长霞,居玲玲,钱湘云,等. 胃癌根治术后患者化疗症候群和营养状况分析[J]. 新疆医科大学学报,2020,43(12):1589-1594.
[9] PORTENOK R K, THALER H T, KORNBLITH A B, et al. The memorial symptom assessment scale: an instrument for the evaluation of symptom prevalence, characteristics and distress[J]. J Clin Oncol,1994,12(6):1213-1223.
[10] 赵慧,李方,朱媛. 老年肺癌患者术后症状群发生情况及其影响因素[J]. 中华老年多器官疾病杂志,2025,24(4):255-259.
[11] KARAYAMA M, INOUE Y, YOSHIMURA K, et al. Association of the geriatric nutritional risk index with the survival of patients with non-small cell lung cancer after nivolumab therapy[J]. J Immunother,2022,45(2):125-131.
[12] MATSUURA S, MORIKAWA K, ITO Y, et al. The geriatric nutritional risk index and prognostic nutritional index predict the overall survival of advanced non-small cell lung cancer patients[J].Nutr Cancer,2022,74(5):1606-1613.
[13] PENG S M, YU N, REN J J, et al. The geriatric nutritional risk index as a prognostic factor in patients with advanced non-small-cell lung cancer[J]. Nutr Cancer,2021,73(11):2832-2841.
[14] LI W, LIU B. Comparing cotinine and NNAL verification of self-re ported smoking status among lung cancer screening eligible population from the 2007-2014 national health and nutrition examination survey (NHANES)[J]. Biomarkers,2021,26(8):45-54.
[15] ROTHPLETZ-PUGLIA P, SMITH J, PAVUK C, et al. A theoretical explanation for how a nutrition counseling and medically tailored meal delivery program benefitted participants living with lung cancer[J]. Support Care Cancer,2024,32(7):428.
[16] LI J, WANG Y, WU Y, et al. Prognostic value of pretreatment albumin to globulin ratio in lung cancer: a meta-analysis[J]. Nutr Cancer,2021,73(1):75-82.
[17] GUNSEL-YILDIRIM G, CEYLAN K C, DIKMEN D. The effect of perioperative immunonutritional support on nutritional and inflammatory status in patients undergoing lung cancer surgery: a prospective, randomized controlled study[J]. Support Care Cancer,2023,31(6):365.
[18] CACCIALANZA R, LAVIANO A, BOSETTI C, et al. Clinical and economic value of oral nutrition supplements in patients with cancer: a position paper from the survivorship care and nutritional support working group of alliance against cancer[J]. Support Care Cancer,2022,30(11):9667-9679.
[19] 孙彩云,李静,陈艳芳,等. 肺癌症状群干预联合营养支持在肺癌化疗患者中的应用[J]. 保健医学研究与实践,2025,22(2):142-149.
[20] NAKYEYUNE R, RUAN X, WANG X, et al. Comparative analysis of malnutrition diagnosis methods in lung cancer patients using a bayesian latent class model[J]. Asia Pac J Clin Nutr,2022,31(2):181-190.
[21] 杨鑫,王吉平,邬丽红. 多学科营养支持小组对肺癌化疗患者营养状况及生命质量的影响[J]. 中国实用护理杂志,2024,40(1):27-33.
[22] HEATH A K, MULLER D C, VAN DEN BRANDT P A, et al. Diet-wide association study of 92 foods and nutrients and lung cancer risk in the European prospective investigation into cancer and nutrition study and the netherlands cohort study[J]. Int J Cancer,2022,151(11):1935-1946.
[23] SWAN F, CHEN H, FORBES C C, et al. Cancer behavioural nutrition and exercise feasibility trial (canbenefit); phase i qualitative interview findings[J]. J Geriatr Oncol,2021,12(4):641-648.
[24] BURNETT C, BESTALL J C, BURKE S, et al. Prehabilitation and rehabilitation for patients with lung cancer: a review of where we are today[J]. Clin Oncol,2022,34(11):724-732.
[25] LIM J E, WEINSTEIN S J, LIAO L M, et al. Multivitamin use and overall and site-specific cancer risks in the national institutes of health-aarp diet and health study[J].J Nutr,2022,152(1):211-216.
[26] 张进科,储美清,李燕,等. 营养支持联合姑息治疗对晚期非小细胞肺癌患者的影响[J]. 中国医药导报,2022,19(14):93-96,116.
[27] LI Y, POND G, VAN OSCH A, et al. Enhancing nutrition support for esophageal cancer patients: understanding factors influencing feeding tube utilization[J]. Nutr Cancer,2024,76(3):271-278.
[28] FERREIRA V, LAWSON C, EKMEKJIAN T, et al. Effects of preoperative nutrition and multimodal prehabilitation on functional capacity and postoperative complications in surgical lung cancer patients: a systematic review[J].Support Care Cancer,2021,29(10):5597-5610.
[29] MILLER L J, DOUGLAS C, MCCULLOUGH F S, et al. Impact of enteral immunonutrition on infectious complications and immune and inflammatory markers in cancer patients undergoing chemotherapy: a systematic review of randomised controlled trials[J].Clin Nutr,2022,41(10):2135-2146.
[30] AKCAM T I, TEKNECI A K, KAVURMACI O, et al. The significance of immunonutrition nutritional support in patients undergoing postoperative adjuvant chemotherapy for lung cancer: case–control study[J]. World J Surg Oncol,2023,21(1):183.
[31] 马丽娟,康林瑛,崔杰. 肺癌症状群干预联合姑息营养支持对化疗耐受性及营养状况的影响[J]. 河北医药,2024,46(20):3142-3145.
[32] HU D, YANG Y. High-quality nursing combined with nutritional intervention improves lung function, quality of life, and compliance of patients with lung cancer after chemotherapy[J]. Curr Top Nutraceut R,2024,22(2):478-484.
[33] BARGETZI L, BRACK C, HERRMANN J, et al. Nutritional support during the hospital stay reduces mortality in patients with different types of cancers: secondary analysis of a prospective randomized trial[J]. Ann Oncol,2021,32(8):1025-1033.
[34] KOSHIMOTO S, YAMAZAKI T, AMANO K, et al. Psychosocial factors and the need for multidisciplinary support in nutrition counselling for cancer chemotherapy patients[J]. Nutrients,2023,15(12):2712.
[35] VOORN M J J, SCHRDER C D, BOOGAART VEMVKD, et al. The clinical decision-making process of healthcare professionals within a personalized home-based rehabilitation program during sequential chemoradiotherapy for stage III non-small lung cancer: a case study[J].Physiother Res Int,2023,28(2):e1979.