末期肺癌患者之安寧療護

Palliative Care in Patients with Advanced Lung Cancer

蔡孟修(Meng-Hsiu Tsai) ； 柯獻欽(Shian-Chin Ko)

《內科學誌》 28卷6期 (2017/12) Pp. 325-333

https://doi.org/10.6314/JIMT.2017.28(6).02

摘要

肺癌是常見且死亡率很高的癌症，根據衛生福利部死因統計：2016年台灣有9,372人死於肺癌，佔所有死亡人數的5.4%，無論是男性或女性，肺癌都佔癌症死亡原因的第一位，肺癌的五年存活率僅19.7%，每年健保花費117億新台幣。末期肺癌患者深受症狀所苦，對生活品質的影響甚鉅。安寧緩和療護不刻意延長生命或改變病程，而是著重在症狀控制，顧及病人身體、心理、社會與靈性的受苦。與病人及家屬開誠佈公的溝通，以病人的舒適為前提，設定務實可達成的照護目標。臨床上醫師常常不知何時讓安寧療護介入，而且過度顧忌止痛藥與鎮靜劑的副作用，使得末期肺癌病人所接受到的緩和安寧醫療明顯不足。許多國外的腫瘤醫學會都建議：在病人與醫療團隊辛苦抗癌的歷程中，緩和醫療的早期介入，有助於改善病人的生活品質，甚或能延長病人的生命。本文闡述：末期肺癌患者的評估以決定安寧療護介入的時機；以混合處置模式兼顧積極的疾病治療與緩和的安寧療護；瞭解醫病溝通的障礙與改善溝通的方法；末期肺癌患者的種種症狀及可能之處置方式，讓末期肺癌病人的最後階段得以善終。

關鍵字

肺癌(Lung cancer) ； 緩和醫療(Palliative care) ； 症狀處置(Symptom management) ； 照護目標(Goals of care)

並列摘要

Lung cancer is the most common cancer globally and is the leading cause of cancer death in both men and women in Taiwan. Patients with advanced lung cancer suffer from progressive dyspnea, pain cough, stridor, hemoptysis, fatigue, anxiety and depression, etc. The significant symptom burden can adversely affect patients' quality of life, adding more to the constellation of physical, emotional, psychosocial and existential suffering. Aiming at symptom amelioration and patient comfort, palliative care helps to effective and timely assessment and management of symptoms in an interdisciplinary manner via open communication and dynamic goal setting. We suggest to introduce palliative care earlier to advanced lung cancer patients for better symptom control and life quality. Comprehensive interdisciplinary team-based palliative care should be an integral part of routine care for patients with advanced lung cancer.