Abstract
Objective: To investigate the effect of comprehensive nursing on the appearance and recovery of oral squamous cell carcinoma. Methods: 52 patients with oral squamous cell carcinoma admitted to our hospital from February 2019 to February 2020 were selected and divided into a control group (n = 26, conventional nursing care) and an observation group (n = 26, comprehensive nursing). The postoperative hospital stay and postoperative intravenous infusion time, quality of life score, postoperative complications, nursing satisfaction, shape recovery, SAS score, etc. were compared between the two groups. Results: (1) The observation group had a shorter postoperative hospital stay and postoperative intravenous infusion time compared to the control group. The observation group also showed higher scores of ADL, psychological function, physical function, and social function after nursing. Regarding the incidence of postoperative complications, the observation group was lower than the control group; the observation group had higher nursing satisfaction (92.31%) than the control group (61.54%) (All P < 0.05). (2) The satisfaction rate in terms of postoperative appearance recovery and overall recovery in the observation group were all significantly higher than the control group (P < 0.05). (3) The ASA score in observation group was significantly lower compared to the control group (inter-group effect: F = 76.210, P < 0.001), and the ASA score of both groups had a tendency to decrease with time (time effect: F = 36.580, P < 0.001); There is an interaction effect between grouping and time (interaction effect: F = 11.770, P < 0.001). (4) After nursing, the VAS score of the two groups of patients was lower than that before nursing, and the score of observation group patients was much lower (P < 0.05). Conclusion: The application of comprehensive nursing in patients with oral squamous cell carcinoma is remarkable, which can promote the recovery of patients’ disease and their appearance, decrease postoperative complications, and relieve the anxiety feelings of patients, with a higher satisfaction rate.
Keywords: Comprehensive care, oral squamous cell carcinoma, appearance, recovery, effect
Introduction
Oral squamous carcinoma is a malignant tumor that occurs in the epidermis or appendant organ cells of the oral cavity [1]. Squamous carcinoma is usually in the shape of cauliflowers, which can produce necrosis and abscess of cancer tissues and cause ulcers, leading to a rotten odor in the mouth. Meanwhile, cancer cells can not only develop into deep layers and become invasive but also metastasize to secondary tumors, seriously harming the physical and mental health of patients [2,3]. At present, the most effective clinical treatment for oral squamous carcinoma is the radical resection of oral carcinoma, but postoperative nursing still plays a great role in the recovery effect of patients. Therefore, on the premise of effective, professional and systematic treatment given by clinicians to patients, an effective nursing mode is of great significance to accelerate postoperative rehabilitation and to improve the quality of life of patients [4]. Comprehensive nursing is a systematic and comprehensive nursing method, which can improve patients’ rehabilitation and reduce complications by implementing a series of nursing measures [5]. Since there are few reports on the application of comprehensive nursing in oral squamous carcinoma patients at present, this study investigated the influence of comprehensive nursing on the appearance and recovery effect of oral squamous carcinoma patients, so as to provide a reference for the clinical development and implementation of an effective nursing plan for oral squamous carcinoma.
Materials and methods
General materials
Patients with oral squamous cell carcinoma treated in our hospital from January 2018 to July 2019 were selected as study subjects. Inclusion criteria: ① Patients who met the clinical diagnostic criteria for oral squamous cell carcinoma prior operation [6]; ② Radical resection of oral carcinoma was conducted; ③ Patients who received the treatment for the first time; ④ Patients who signed the informed consent. Exclusion criteria: ① Patients with heart and lung dysfunction; ② Patients with no contraindications [7]; ③ Patients who received treatments other than those in present study; ④ Patients with clotting dysfunction. Finally, 52 cases were included and divided into a control group (n = 26) and an observation group (n = 26) by the random number table method. No statistically significant difference existed in terms of gender, age, body mass index, cancer type, etc. (P > 0.05), as shown in Table 1. The Ethics Committee of Qingdao Chengyang District People’s Hospital approved the study.
Table 1.
Comparison of general materials in the two groups
| Group | Gender (case) | Age (x ± s, years old) | BMI (x ± s, kg/m2) | Cancer types (case) | ||||
|---|---|---|---|---|---|---|---|---|
|
|
|
|||||||
| Male | Female | Tongue cancer | Carcinoma of mouth floor | Cavioris bucca cancer | Gingival carcinoma | |||
| Control group (n = 26) | 12 (46.15) | 14 (53.85) | 62.25±9.27 | 23.04±3.31 | 9 (34.62) | 7 (26.92) | 4 (15.38) | 6 (23.08) |
| Observation group (n = 26) | 15 (57.69) | 11 (42.31) | 61.79±9.13 | 22.68±3.25 | 8 (30.77) | 9 (34.62) | 6 (23.08) | 3 (11.54) |
| χ2/t/Z | 0.693 | 0.18 | 0.396 | -0.238 | ||||
| P | 0.405 | 0.858 | 0.694 | 0.812 | ||||
Methods
Control group
Conventional nursing care was given during the perioperative period [8]. (1) Preoperative nursing: after admission, the patient was given oral cleaning, especially around the periodontal area, and cetyl pyridinium Chloride Gargle was given, 4 times/d; Prior operation, patients were required to abstain from drinking for 8 h and fasting for 12 h, and to prevent skin damage in the donor area. (2) Postoperative care: pay attention to the recovery status, drainage volume, and changes of vital signs of the transplanted flap of the patient in real time after the operation, and inform the physician to take corresponding treatment measures when abnormalities were found; After the operation, patients received nasal feeding for nutrition and high-calorie food. When the patients’ swallowing function recovered well (no coughing) 7 d after the operation, oral liquid food could be given, and the gastric tube could be removed about 9 d after the operation. Patients’ perineum part with indwelling urethral catheters was routinely cleaned after operation, and oral cleaning was strengthened. When patients felt pain after the operation, the nursing staff should give a timely explanation, and could use the method of diverting attention to help relieve the pain. When the pain was unbearable, appropriate analgesia can be used.
Observation group
Comprehensive nursing was adopted based on the above treatment [9]. (1) Preoperative nursing: nursing staff should provide targeted health education according to the disease progression of patients, and popularize basic medical knowledge, surgical methods, disease recovery and precautions of oral squamous carcinoma to patients; Attention should be paid to the psychological changes of patients to eliminate patients’ negative emotions as much as possible; Patients were told about successful cases of oral squamous carcinoma, to enhance their compliance and confidence in getting cured; Before surgery, patients were told to abstain from smoking and alcohol and to pay attention to clean the mouth to prevent the stimulation of cancer tissues. For patients with ulcers and dental caries, symptomatic treatment measures should be taken to reduce the risk of postoperative infection; Patients were helped to complete the preoperative examination and told to abstain from drinking and fasting for respectively 2 h and 6 h before the operation, and were given 250 mL oral glucose to avoid physiological stress reaction during the operation. Patients with diabetes and hypertension should be given the corresponding treatment of lowering blood glucose and blood pressure. (2) Intraoperative nursing: patients were adjusted to the position suitable for surgery under guidance, and the vital signs were observed in real time; In order to avoid hypothermia during the operation, thermal insulation blanket, appropriate heating injection solution, increasing the operating room temperature and other measures could be taken to keep warm. According to the vital signs and blood loss during the operation, the patients were given transfusion and blood transfusion care correspondingly. (3) Postoperative nursing: the head of the bed should be appropriately raised about 15° after the surgery to make the patient comfortable. After waking up, the patient should be in the semi-lying position and the vital signs were monitored. It was checked whether the patient can breathe normally, and they were guided to expel or clear sputum and foreign matter in the respiratory tract; Timely treatment of distortion, shedding, compression and other conditions were given to ensure the smooth flow of the drainage tube; Attention was paid to the changes in the properties of the drainage liquid, and abnormal changes in its flow rate and color were dealt with; Nasal feeding was adopted on the 7th day after the operation. When the patient recovered to the edible stage, slow eating was encouraged, and the amount of food should be less. The daily eating frequency should be rationally planned according to the actual situation. Patients were guided to carry out relevant recovery training of swallowing and language function; swallowing training was based on the principle of eating slowly, eating less with more meals, and language training was to make the tongue curl back and up repeatedly. Clean patient’s mouth on time, at least 3 times a day; Mechanical aid to expectorate properly was carried out every day.
Outcome measures
Postoperative hospital stay and postoperative intravenous infusion time: (1) patients’ postoperative hospital stay (d) and postoperative intravenous infusion time (d) were recorded. (2) Quality of life score: the patient’s quality of life was evaluated on the day of discharge, including ADL and Gqol-74, in which ADL was evaluated by activities of daily living [7,10], and Gqol-74 included psychological function, physical function and social function. It was evaluated by the comprehensive quality of life questionnaire. A higher score indicates a higher quality of life. (3) Postoperative complications: postoperative pneumonia, urinary tract infection and gastrointestinal dysfunction were counted. The complication rate = (pneumonia + urinary tract infection + gastrointestinal dysfunction) cases/total cases × 100%. (4) Nursing satisfaction: patients filled in the self-made satisfaction questionnaire of our hospital on the day of discharge. The quality of nursing work, the attitude of nursing staff, and the treating environment were assessed. Patients were required to fill in the questionnaire before discharge. Altogether 52 questionnaires were distributed and collected back with a recovery rate of 100%. Total score was 100 points, dissatisfaction is defined as < 70 points, satisfaction is 70-85 points, very satisfied is > 85 points; Satisfaction rate = (satisfied + very satisfied) cases/total cases × 100% [11]. (5) Appearance recovery: Patients’ appearance recovery was measured, including postoperative appearance recovery and overall recovery satisfaction; The defects in the bottom of the mouth, buccal and tongue being successfully repaired were considered as satisfactory postoperative appearance recovery. The patients were followed up for 6 months, and the symptoms of the patients were obvious mucosa formation of the skin flap, basic recovery of chewing function, and no abnormal changes in speech function after tongue and mouth floor squamous cell carcinoma, which was regarded as satisfactory overall recovery. The satisfaction rate = number of satisfied cases/total cases × 100% [12]. (6) SAS score: Patients were assessed at 1 h before surgery, 2 h after surgery, 7 d after surgery, and on the day of discharge with the Self-Rating Anxiety Scale (SAS). There were 20 items with 1 to 4 points for each, the score ranging from 20 to 80 points. A higher score indicated a higher degree of anxiety [13]. (7) The visual analog scale (VAS) method [14] was used to evaluate the pain degree of the two groups of patients before and after nursing: The VAS score was graded from 0 to 10 points, of which 0 was painless, and 10 was the most severe pain, and one cannot bear it. The patients were asked to score from 0 to 10 according to his immediate pain.
Statistical analysis
SPSS 20.0 software was used to analyze the data. The qualitative data were represented by n (%) and examined by the rank test or χ2 test. When 1≤ theoretical frequency < 5, the chi-square value needed to be corrected. The quantitative data were expressed as x̅ ± s, and comparisons between the two groups were examined by t test. Data comparisons at different time points between the groups were conducted by repeated measurement analysis of variance. P < 0.05 was considered statistically significant. EXCEL software was applied to plot the graphics.
Results
Comparison of postoperative hospital stay and intravenous infusion time
The observation group had a significantly less postoperative hospital stay and intravenous infusion time compared to the control group (P < 0.05, Table 2).
Table 2.
Comparison of postoperative hospital stay and intravenous infusion time (d, x ± s)
| Group | Postoperative hospital stay | Postoperative intravenous infusion time |
|---|---|---|
| Control group (n = 26) | 14.16±3.04 | 7.42±1.48 |
| Observation group (n = 26) | 10.18±2.15 | 4.27±1.26 |
| t | 5.450 | 8.264 |
| P | < 0.001 | < 0.001 |
Comparison of quality of life score after nursing
After nursing, the observation group had significantly higher scores of ADL, psychological function, physical function and social function compared to the control group (P < 0.05). See Table 3.
Table 3.
Comparison of quality of life score after nursing (point, x ± s)
| Group | ADL | GQOL-74 | ||
|---|---|---|---|---|
|
| ||||
| Psychological function | Physical function | Social function | ||
| Control group (n = 26) | 12.11±2.23 | 55.89±8.31 | 53.21±7.54 | 52.03±6.69 |
| Observation group (n = 26) | 17.27±2.64 | 67.35±8.69 | 60.44±8.52 | 59.44±7.03 |
| t | 7.614 | 4.860 | 3.240 | 3.893 |
| P | < 0.001 | < 0.001 | 0.002 | < 0.001 |
Comparison of the occurrence of postoperative complications
The incidence of postoperative complications was 11.54% in the observation group, while the incidence was 46.15% in the control group, and significant difference was noted (P < 0.05). See Table 4.
Table 4.
Comparison of the occurrence of postoperative complications [n (%)]
| Group | Pneumonia | Urinary tract infection | Gastrointestinal dysfunction | Total complications |
|---|---|---|---|---|
| Control group (n = 26) | 6 (23.08) | 5 (19.23) | 3 (11.54) | 12 (46.15) |
| Observation group (n = 26) | 2 (7.69) | 0 (0) | 1 (3.85) | 3 (11.54) |
| χ2 | 5.996 | |||
| P | 0.014 |
Comparison of nursing satisfaction
The observations group had a nursing satisfaction rate of 92.31%, which was significantly higher than 61.54% in the control group (P < 0.05). See Table 5.
Table 5.
Comparison of nursing satisfaction rate [n (%)]
| Group | Dissatisfied | Satisfied | Very satisfied | Satisfaction rate |
|---|---|---|---|---|
| Control group (n = 26) | 10 (38.46) | 8 (30.77) | 8 (30.77) | 16 (61.54) |
| Observation group (n = 26) | 2 (7.69) | 10 (38.46) | 14 (53.85) | 24 (92.31) |
| χ2 | 5.308 | |||
| P | 0.021 |
Comparison of postoperative appearance recovery
The observation group had a satisfaction rate of 96.15% (25/26) in terms of postoperative appearance recovery, which was significantly higher than 73.08% (19/26) in the control group (χ2 = 5.883, P = 0.015); The satisfaction rate of overall recovery was 100.0% (26/26) in the observation group, which was significantly higher than 96.15% (25/26) in the control group (χ2 = 1.406, P = 0.236).
Comparison of ASA score
ASA scores in the observation group were significantly lower compared with that in the control group (intergroup effect: F = 76.210, P < 0.001) (Figure 1). ASA scores in both groups tended to decrease with time (time effect: F = 36.580, P < 0.001), while the grouping and time had interaction effect (interaction effect: F = 11.770, P < 0.001).
Figure 1.
ASA score comparison between the two groups.
Comparison of pain score
Before nursing, the difference in VAS scores between the two groups of patients was not statistically significant; after nursing, the VAS scores of the two groups of patients were lower than before nursing, and the observation group was much lower (P < 0.05). See Table 6.
Table 6.
Comparison of pain scores between the two groups before and after nursing
| Index | Time | Control group (n = 26) | Observation group (n = 26) | t | P |
|---|---|---|---|---|---|
| VAS | before nursing | 6.46±2.14 | 6.51±2.33 | 2.41 | 0.326 |
| after nursing | 3.12±1.51 | 2.23±1.86 | 4.33 | < 0.001 | |
| t | 5.14 | 6.47 | |||
| P | < 0.001 | < 0.001 |
Discussion
Oral cancer is a malignant tumor that occurred in head and neck, which may be divided into tongue cancer, oropharyngeal cancer, gingival cancer, oral cancer, hard and soft palate and buccal carcinoma, etc. based on the primary lesion. Among which, tongue cancer is the most common one, and squamous carcinoma is its main pathological type. Therefore, the treatment of oral squamous carcinoma and nursing is one of the emphases of clinical work [15,16]. Surgical treatment of oral squamous carcinoma leaves wounds and affects the patient’s eating, swallowing, pronunciation and other functions. So, excellent surgical techniques are very meaningful, but it is prone to have postoperative complications such as pneumonia, gastrointestinal dysfunction, and urinary tract infection. Therefore, it is of necessity to offer integrated and effective nursing intervention for effective clinical treatment of the disease [17].
In the present study, the observation group had a significantly less postoperative hospital stay, postoperative intravenous infusion time, postoperative complications and ASA score compared to the control group; it also had significantly higher ADL score, psychological function, physical function, social function, and nursing satisfaction scores; After nursing, the VAS score of the two groups of patients was lower than that before nursing, and the VAS score of observation group patients was lower than that of control group patients, indicating that compared with conventional nursing, comprehensive nursing for the oral squamous carcinoma can reduce the length of hospital stay, postoperative intravenous infusion time, the risk of postoperative complications, anxiety, improve patients’ quality of life and nursing satisfaction.
The reason may be that in the comprehensive nursing intervention mode, the nursing staff took the patient as the center, and the effective nursing measures were carried through the three stages of the operation, namely before, during, and after the operation. Preoperative psychological nursing, by focusing on patients’ mental changes, helped them relieve anxiety, panic and other negative emotions, and reduced their psychological burden so as to be actively cooperative with the treatment. This was not only helpful to improve prognosis, and reduce postoperative infusion time, shorten the hospital stay, but also to make more patients recognize the nursing service with a higher satisfaction rate; A series of basic nursing and oral cleaning before operation ensured the smooth operation and reduced the risk of postoperative complications as much as possible. Intraoperative nursing included warm care, and blood transfusion and infusion according to the actual condition of patients, having reduced the physiological stress brought by the operation, and promoting patients’ postoperative rehabilitation. At the same time, position, respiratory tract, drainage tube, functional rehabilitation, diet nursing and other intervention were given, which improved the effect of postoperative rehabilitation and the quality of survival, and reduced the occurrence of complications [18,19]. Since oral cancer patients are mostly middle-aged and elderly patients, there may be some problems with cardiopulmonary function before treatment. Coupled with the immobilization of the head and neck after treatment, patients cannot get timely back pat and functional training, and lung infections sometimes occur. Once a lung infection occurs, the extubation time of the tracheal tube is delayed, and the patient’s hospital stay is prolonged, which increases the economic burden of the patient. Therefore, standardized postoperative disinfection measures, scientific airway management, and preoperative nursing interventions should be performed to control the incidence of tracheostomy complications [20]. Active and effective comprehensive nursing intervention before surgery, patients’ irritability and lung infection were significantly controlled after surgery, indicating the effectiveness and necessity of comprehensive nursing intervention. The application of comprehensive nursing intervention in patients with oral and maxillofacial malignant tumor tracheotomy has good nursing effect, which not only reduces the incidence of patient complications, but also improves their comfort. In this study, the observation group saw a significantly higher satisfaction rate of postoperative appearance recovery compared to the control group, and its satisfaction rate of overall recovery was significantly higher than the latter. It is indicated that comprehensive nursing can accelerate the recovery of oral squamous carcinoma patients’ appearance and better meet the cosmetic needs [21,22]. This study may have a certain data bias as a result of the small sample size, which needs to be further confirmed by studies with a larger sample size.
To conclude, the application effect of comprehensive nursing in oral squamous carcinoma patients is remarkable, which can promote the rehabilitation of disease and the appearance recovery of patients. Meanwhile, the quality of life of patients can be effectively improved, and postoperative complications and anxious feelings can be reduced.
Disclosure of conflict of interest
None.
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