接受口服標靶藥物胃腸道基質瘤患者之照護需求及相關因素探討

Care Needs and the Related Factors in Gastrointestinal Stromal Tumor Patients Undergoing Oral Targeted Therapy

游鎧璘(Kai-Lin You)

指導教授 ： 賴裕和

國立臺灣大學/醫學院/護理學研究所/碩士(2018年)

https://doi.org/10.6342/NTU201803142

摘要

近年因標靶藥物酪氨酸激酶抑制劑的發明，胃腸道基質瘤病患的存活期大有提升，但長時間或終生服用標靶藥物卻也可能產生問題和需求，目前相關的研究仍有限，故本研究目的在探討接受口服標靶基立克 (Glivec) 治療之胃腸道基質瘤病患的照護需求現況，及其與身體及心理困擾和重要之人口學特質之相關性。
本研究為橫斷式設計，於北部某一所醫學中心的外科門診區進行連續取樣，採用結構式問卷訪談，問卷包含：支持性照護需求調查簡表、症狀嚴重度量表、醫院焦慮憂鬱量表、Karnofsky身體功能狀態量表和疾病基本資料表，收集之資料以敘述性統計、斯皮爾曼相關係數檢定、無母數統計和羅吉斯迴歸進行分析。
本研究符案病人共83位，研究結果顯示口服基立克之胃腸道基質瘤病人整體身體功能良好，症狀平均為輕度至中度嚴重，其中嚴重度最高的前五項為皮膚顏色改變、疲倦、眼眶水腫、睡眠問題和肌肉痙攣; 五大層面之支持性照護需求程度，由高至低為：(1) 健康系統與資訊、(2) 心理、(3) 病人照護及支持、(4) 生理及日常生活、(5) 性需求層面，平均值依序為27.2 (19.3)、18.4 (18.2)、16.4 (16.3)、15.9 (19.0) 和7.7 (20.1)。病人之平均症狀嚴重度、焦慮及憂鬱程度與五大層面照護需求呈現顯著低度至中度相關，進一步以羅吉斯迴歸分析，發現整體支持性照護需求主要的相關因素為憂鬱程度和皮膚顏色改變。
整體而言，使用口服標靶基立克治療之胃腸道基質瘤病人的整體支持性照護需求雖然較其他癌別低，但仍有部分的病人呈現出中高程度照護需求、焦慮和憂鬱的問題，建議未來應於門診篩檢，針對這些病人，發展進一步的介入措施，改善不足之照護需求，以增進病人的生活品質。

關鍵字

胃腸道基質瘤 ； 基立克 ； 照護需求 ； 症狀 ； 焦慮 ； 憂鬱

並列摘要

Background The advent of oral targeted tyrosine-kinase inhibitor (TKI) therapy, such as Imatinib (Glivec), has made a promising survival for patients with Gastrointestinal Stromal Tumor (GIST). However, patients might suffer from side effects of Imatinib and have supportive care needs. Limited studies have approached this problem. The purposes of this study are to (1) examine levels of supportive care needs; and (2) the relationships between supportive care needs and physical and psychological distress, and selected demographic characteristics in GIST patients taking Imatinib.
Method This is a cross-sectional study using consecutive sampling to recruit GIST patients receiving Imatinib therapy in surgical outpatient clinics at a medical center in northern Taiwan. GIST patients were assessed by Supportive Care Needs Survey-Short Form 34 (SCNS-SF34), Symptom Severity Scale (SSS), Hospital Anxiety and Depression Scale (HADS), Karnofsky Performance Status Index (KPS), and background information form.
Results A total of 83 patients were recruited in the study. In general, patients reported to have mild to moderate symptoms. The top five symptoms as the descending order of severity were: skin discoloration, fatigue, periorbital edema, sleep problems, and muscle cramp. Patients had low level of unmet supportive care needs. The supportive care need domains as their ranking order were (1) health system and information needs, (2) psychological needs, (3)patient care and support needs, (4) physical and daily living needs, and (5) sexuality needs with mean scores as 27.2 (19.3), 18.4 (18.2), 16.4 (16.3), 15.9 (19.0), and 7.7 (20.1), respectively. Patients with higher symptoms severity, anxiety, and depression revealed higher care needs with generally moderate correlations. Further analysis by logistic regression, we found that depression and skin coloration were those two robust variables related to patients’ overall supportive care needs.
Conclusion Although the overall supportive care needs of GIST patients treated with Imatinib are lower than those of other cancer types, some GIST patients are still enduring moderate to high level of unmet care needs, anxiety, and depression. Therefore, we suggest that we should do the screening in outpatient clinics and develop further interventions in order to meet these patients’ unmet care needs.

並列關鍵字

Gastrointestinal Stromal Tumor ； Imatinib ； Glivec ； Care Needs ； Symptom ； Anxiety ； Depression

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