放射線治療之皮膚炎預防及照護指引

Clinical Practice Guideline on Radiation Dermatitis in Cancer Patients

張黎露(Li-Lu Chang) ； 周繡玲(Hsiu-Ling Chou) ； 邱文姿(Wen-Tzu Chiu) ； 謝嘉芬(Chia-Fen Hsieh) ； 李佳諭(Chia-Yu Lee) ； 洪敏瑛(Ming-Ying Hong) ； 江孟冠(Meng-Guang Chiang) ； 謝忱希(Chen-Hsi Hsieh) ； 蔡玉真(Stella Yu-Chen Tsai)

《腫瘤護理雜誌》 15卷增訂刊 (2015/12) Pp. 81-98

https://doi.org/10.3966/168395442015121503006

摘要

放射線治療皮膚炎（radiation dermatitis）是癌症病人接受放射線治療後常見的副作用之一。嚴重之放射線皮膚炎會迫使放射治療中斷，降低腫瘤治療的反應率與局部控制率，進而可能導致癌症復發，且會造成嚴重感染導致死亡。本指引發展的目的是從腫瘤護理人員的專業觀點，提供癌症病人接受放射線治療時，皮膚炎之預防及有效的照護方式。搜尋近十年國內外照護指引及文獻，藉由實證基礎之評核、系統性文獻查證與評讀等嚴謹的過程，加以歸納整合，並經過國內專家的共識，根據護理人員熟悉的護理過程方式書寫內容，清楚列出對於照護內容的建議等級，並解釋各項建議的內容，成為一份容易閱讀和查詢的照護指引，並提高臨床的實用性。本指引概念構圖分為：1)評估；2)確認問題；3)處置與照護，包括皮膚的預防照護、皮膚炎處置照護之準則；4)持續照護。期望藉此能培養腫瘤護理人員敏銳的觀察病人在放射治療前、中、後期之全程的皮膚照護，並能提供整體性的評估、確認病人皮膚的問題，進而提供具實證的照護處置及後續護理措施，促進病人之生活品質與提升護理人員的照護品質。

關鍵字

癌症 ； 放射線治療 ； 放射線皮膚炎 ； 指引

並列摘要

Radiation dermatitis is a common side effect when cancer patients receiving radiation therapy. Complications caused by severe radiation dermatitis can lead to treatment interruption. Prevention and management of radiation dermatitis is important to ensure patient's quality of life and treatment outcome. This guideline is developed based on comprehensive systematic review of literature, appraisal of evidences and summary of recommendations for practice by expert committee. This guideline is written as a format of four-step nursing process: 1) Assessment; 2) Identification of problem; 3) Intervention: prevention and care; 4) Evaluation: evaluation and management of complications. This guideline is intended to assist the oncology nurses in their clinical decision-making for providing optimal quality of individualized patient care.

並列關鍵字

cancer ； radiotherapy ； radiodermatitis ； radiation dermatitis ； guideline

參考文獻

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McQuestion M . Evidence-based skin care management in radiation therapy: Clinical update. Semin Oncol Nurs. 2011 May;27(2):e1-17. doi: 10.1016/j.soncn.2011.02.009.

Schnur JB, Love B, Scheckner BL, et al. A systematic review of patient-rated measures of radiodermatitis in breast cancer radiotherapy. Am J Clin Oncol. 2011 Oct;34(5):529-536. doi: 10.1097/COC.0b013e3181e84b36.

Yazbeck VY, Villaruz L, Haley M, et al. Management of normal tissue toxicity associated with chemoradiation (primary skin, esophagus, and lung). Cancer J. 2013 May-Jun;19(3):231-237. doi: 10.1097/PPO.0b013e31829453fb.

Partl R, Richtig E, Kapp KS. Calling attention to radiation recall reactions: Simultaneous occurrence of a recall dermatitis after CMF application in two separate sites irradiated 10 years apart. Acta Oncol. 2012 Jul;51(6):809-811. doi: 10.3109/0284186X.2011.639799. Epub 2011 Dec 19.