接受不同代標靶藥物之晚期肺癌病人於皮膚不良事件、自我照顧能力與情緒狀態之探討

Skin Adverse Events, Ability of Self-Care and Psychological Status in Patients with Lung Cancer Receiving Different Generation Targeted Therapies

游竹君(Chu-Chun Yu)

指導教授 ： 李芸湘

國立臺灣大學/醫學院/護理學研究所/碩士(2020年)

https://doi.org/10.6342/NTU202000722

摘要

標靶治療為晚期肺癌病人重要的抗癌治療之一，表皮生長因子受體酪胺酸激酶抑制劑（EGFR-TKI）常見之副作用為皮膚不良事件，隨著標靶藥物不斷推陳出新，不同代EGFR-TKI引起之皮膚不良事件發生比例、自我照顧能力與情緒狀態差異的相關研究，仍十分缺乏，故本研究主要目的為探討晚期肺癌病人接受不同代標靶藥物於皮膚不良事件、自我照顧能力及情緒狀態的現況及差異。
本研究為橫斷式描述性相關研究設計，以立意取樣方式，於北部某醫學中心皮膚科及腫瘤治療藥物疹特別門診進行收案，共收案135位，使用結構式問卷包括：基本資料量表、客觀指標之美國國家癌症研究所（NCI）公佈的不良事件常用術語標準（CTCAE v4.03）及主觀指標之患者報告的結果版本（PRO-CTCAE ITEMS Version 1.0）、醫院焦慮憂鬱量表（HADS）與情緒溫度計（DT）、自我照顧能力及自我照顧策略量表收集資料，以描述性及推論性統計進行資料分析。
研究結果顯示：（1）99.3 %病患出現皮膚不良事件，發生率前三名依序為搔癢、乾燥及痤瘡樣疹，嚴重度多落在grade I至grade II之間；（2）整體情緒困擾（DT）平均分數為3.3分；31.1 %病患有重度焦慮、憂鬱傾向；（3）皮膚不良事件之自我照顧能力平均分數為6.9分，而最常使用之自我照顧策略為：使用醫生開立的藥物、藥妝店買得乳液及手邊現成皮膚科的藥物；（4）皮膚不良事件之搔癢、乾燥、痤瘡樣疹、手足症候群、脫髮與DT呈現正相關；皮膚自我照顧能力與DT呈現負相關性；（5）第三代EGFR-TKI病患之痤瘡樣疹發生率於客觀評量（CTCAE）結果顯著比第一代少，主觀評量（PRO-CTCAE）嚴重度則比第一、二代好；（6）接受第三代EGFR-TKI病患之DT顯著比第一代表現輕微。
本研究所探討使用標靶治療之肺癌病患皮膚不良事件、自我照顧能力與策略，以及情緒狀態，有助於臨床人員更進一步了解不同代標靶藥物於皮膚不良事件與情緒狀態之差異，可提供學術及臨床照護上具體參考依據。

關鍵字

肺癌 ； 標靶治療 ； 皮膚不良事件 ； 自我照顧 ； 情緒狀態

並列摘要

Background
Targeted therapy is now a predominant treatment method for advanced lung cancer. The side effect of EGFR inhibitors is one of the manifestations of skin adverse events. As new targeted therapy programs for lung cancer have been developed, diverse generation of target medicine has induced the similar adverse events of skin toxicity. However, the reported incidents were lack of comparison and investigation, especially skin reactions. The purpose of this report is to understand diverse skin adverse reactions on advanced lung cancer patient with experience of targeted therapy, and to discuss their self-care ability and psychological distress. Therefore, this article has also examined the differences of skin adverse events, the level of patient self -care ability, and the level of psychological state in selected lung cancer patients treated by various targeted therapy medicine.

Method
This article is presented as a descriptive correlation research which was designed as cross-sectional design and purposive sampling of 135 patients. Structured questionnaires including patient details and objective data are collected through CTCAE v4.03 from NCI. Subjectively, PRO-CTCAE ITEMS Version 1.0, Hospital Anxiety and Depression Scale, Distress Thermometer (DT), Self-Care Ability Scale, and Effective Self-Care Strategies Scale are all involved as data collection in dermatology and oncology outpatient medical center at a Taiwan hospital in north. Consequently, inferential and descriptive statistics conclude the data analysis by Fisher’s Exact Test, Kruskal-Wallis test and Spearman Correlation.

Results
　　The results showed (1) 99.3% of patients had dermatologic toxicities. The top three incidences of these skin adverse events were pruritus, dry skin and papulopustular eruption. The severity of these symptoms is between grade I to grade II. (2) Tools: DT score was 3.3 (±2.5)；31.1% of patients had severe anxiety and depression. (3) The self-care ability of skin adverse reactions score was 6.9. The most common self-care approaches to skin adverse events were first using prescription drugs by Dermatologists, applying topical cream over the counter comes after, and using pre-purchased dermatology medicine at the end. (4) Subject skin adverse events, including pruritus, dry skin, papulopustular eruption, hand-foot syndrome and hair loss have positive correlation to distress thermometer score. The ability of skin self-care has negative correlation to distress thermometer score. (5) The incidence rate of papulopustular eruption in the third generation of EGFR-TKI patient was significantly lesser than the first generation use as CTCAE examined. The severity of this sympton in the third generation drug was lesser than other two generations as Pro-CTCAE presented. (6) The DT score of the third generation of EGFR-TKI patient showed less stressed but differed significantly than the first generation.

Conclusion
Findings above have already summarized the reported skin adverse events in advanced lung cancer patients regarding the ability and strategy of self-care and the subjective opinions of psychological status. To investigate more relations between three different targeted drugs and patient skin care physically and mentally, the longitudinal studies would be necessary as references in nursing care to benefit patient care and medical research.

並列關鍵字

lung cancer ； targeted therapy ； skin adverse event ； self-care ； psychological state

參考文獻

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