接受標靶治療的肺癌病患治療副作用與自我處置之初探

Side Effects and Self-management among Patients Treated with EGFR-TKIs: A Preliminary Study

陳芷葳(Jhih-Wei Chen) ； 張皓媛(Hao-Yuan Chang) ； 賴裕和(Yeur-Hur Lai) ； 施金元(Jin-Yuan Shih) ； 廖唯昱(Wei-Yu Liao)

《腫瘤護理雜誌》 19卷2期 (2019/12) Pp. 5-22

https://doi.org/10.6880/TJON.201912_19(2).01

摘要

背景：EGFR-TKIs是具EGFR基因突變的肺腺癌患者的第一線首選治療。臨床護理人員須謹慎監測並教導病人與照顧者服用標靶藥品的副作用與處理原則。目的：進行EGFR-TKIs口服標靶治療之副作用與病患的處置行為初探，並依據初探結果提出臨床照護的相關建議與後續研究方向。方法：採橫斷式研究設計，共納入22位晚期肺腺癌患者，受訪者填寫基本屬性問卷、中文版癌症治療功能性評估之肺癌症狀指標量表、標靶副作用處置行為問卷，疾病相關資料表由研究者參考病歷填寫。結果：標靶藥物常見副作用為皮膚症狀（皮疹86%、搔癢84%、甲溝炎64%），其次是腸胃道症狀（腹瀉68%、腹痛46%）。73%病患對副作用感到困擾。副作用平均出現頻率越高，病患對治療副作用越感到困擾。執行率最高（91%）的處置措施，如每天至少一次全身擦拭保濕護膚品、使用溫水沐浴與選擇舒適寬鬆衣著。由醫護人員提供的疾病與治療相關訊息幫助程度得分最高，情感導向為主的支持團體得分較低。結論：接受EGFR-TKIs治療的肺癌患者在副作用處置上，以日常活動與容易執行的自我照護項目執行率較高。建議臨床醫護人員應在治療後，再次評估副作用對於病患生活的困擾，並加強給予個別性的副作用處置指導。尚須更大樣本支持以上論述，但本研究可初步提供臨床人員做為照護上的參考。

關鍵字

肺癌 ； 標靶治療 ； 表皮生長因子接受器酪胺酸酶抑制劑 ； 副作用 ； 自我處置

並列摘要

Background: Oral epidermal growth factor tyrosine kinase inhibitors (EGFR-TKIs) are the first priority in therapy for lung adenocarcinoma patients with EGFR mutations. Health care specialists should carefully monitor and educate patients and caregivers regarding side effects and self-management of targeted therapy. Purpose: To explore how patients treated with EGFR-TKIs manage the side effects of targeted therapy and to propose suggestions for clinical care and future research directions accordingly. Methods: We adopted cross-sectional design and recruited 22 participants diagnosed with advanced lung adenocarcinoma. Participants completed self-administrated questionnaires, including demographic information, Functional Assessment of Cancer Therapy-Functional Lung Symptom Index-17 (Chinese Version) and questionnaire for self-management of targeted therapy-related adverse effects. Disease-related forms were collected from medical records. Results: Most frequent side effects of targeted therapy include dermatological symptoms (acneiform/papulopustular eruption 86%, pruritus 84% and paronychia 64%) and gastrointestinal symptoms (diarrhea 68% and abdominal pain 46%). 73% patients were disturbed by side effects. Higher frequency of side effects was associated with higher distress levels in patients with side effects. Managements of highest frequency (91%) include regular use of emollient, warm showers, avoidance of hot baths, and comfortable loose clothing. Information provided by healthcare providers was ranked most helpful while emotionally-oriented peer-support groups were ranked lower in helpfulness. Conclusion: Most frequent side effects of targeted therapy include dermatological symptoms (acneiform/ papulopustular eruption 86%, pruritus 84% and paronychia 64%) and gastrointestinal symptoms (diarrhea 68% and abdominal pain 46%). 73% patients were disturbed by side effects. Higher frequency of side effects was associated with higher distress levels in patients with side effects. Managements of highest frequency (91%) include regular use of emollient, warm showers, avoidance of hot baths, and comfortable loose clothing. Information provided by healthcare providers was ranked most helpful, while emotionally-oriented peer-support groups were ranked less helpful.

並列關鍵字

self-management ； side effects ； target therapy ； EGFR-TKIs ； lung cancer

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