晚期頭頸癌患者安寧療護之挑戰：“高仁愛紀念病房”經驗

The Challenges to Provide Palliative Care for Advanced Head and Neck Cancer Patients: The Experience of Doctor Jean Landsborough Memorial Ward

許正眉(C-M Hsu) ； 郭集慶(Victor C. Kok) ； 楊嵐怡(Lan-Yi Yang) ； 蘇育德(Yu-Deh Su) ； 楊鴻振(Hung-Chen Yang) ； 機昑惠(C-H Chi)

《安寧療護雜誌》 7卷2期 (2002/05) Pp. 128-138

https://doi.org/10.6537/TJHPC.2002.7(2).3

摘要

在彰化基督教醫院高仁愛紀念病房，頭頸癌病患人數約佔7%，屬於數量大的一個癌症族群。頭頸癌具有如：疼痛、潰瘍性傷口、局部傷口反覆性感染、強烈惡臭氣味、無預警的大出血、上呼吸道阻塞、吞嚥及進食困難、構音溝通困難、身體心像改變、憂鬱．．．．等特殊照顧問題。因而造成醫護人員在照顧頭頸癌患者時，面臨較高難度的挑戰與壓力。在安寧療護的範疇內，醫護團隊常會面臨許多涉及安寧療護及醫學倫理的醫療決定；實務上，認為永久性氣切照口、灌食用空腸照口或腫瘤動脈栓塞等是無意義地延長患者生命的單方面觀點已然違背安寧療護尊重生命的大前提。在能極力保障患者及家屬的生活品質和醫療照護品質下，審慎做出建議及召開家庭會議來達到共識才是我們建議的做法。

關鍵字

頭頸癌 ； 緩和療護 ； 動脈出血 ； 上呼吸道阻塞 ； 生活品質

並列摘要

Patients with advanced head and neck cancer constitute a special care entity in hospice and palliative care. They account for roughly 7% of the hospice patients in our earlier study at Changhua Christian Hospital (CCH). Active problems such as recalcitrant pain, smelly fungating wound, repetitive local soft tissue infection or osteomyelitis, unpredictable massive tumor hemorrhage, upper airway obstruction, swallowing difficulty, impaired verbal communication, and body image change continue to challenge the palliative care team striving to provide quality of hospice care. Personal arguments against the administration of permanent tracheostomy, feeding jejunostomy, or prophylactic transcatheter arterial embolization to stop future tumor bleed contradict the hospice's prerequisite that hospice affirms life. Only through the judicious advice on choosing the respective procedure and gaining an informed consent and a consensus via a family meeting can we solve these problems with no regrets. In addition to literature review, methods of care and know-how gained from the team care experience at Doctor Jean Landsborough Memorial Ward of CCH are discussed and presented in this review article.

並列關鍵字

Head and neck cancer ； Palliative care ； Tumor bleed ； Upper airway obstruction ； Quality of Life