比較不同疾病特質的晚期肺癌病人生心理困擾之差異

近年來，表皮生長因子受體酪胺酸酶抑制劑 (Epidermal growth factor receptor tyrosine kinase inhibitor, EGFR-TKI) 的發展使得EGFR突變呈陽性(mutation - positive)的晚期肺腺癌病人與EGFR突變呈陰性(wild type)的病人相比，有較長的存活期。然而，不同的EGFR變異型態是否影響病人接受治療後的身體症狀及心理困擾（憂鬱、不確定感)，目前國內外皆未有相關的研究。為使臨床醫護人員能於病人初診斷期即識別其在照護需求上的不同，並提早給予介入措施，本研究主要目的為探討晚期肺腺癌病人接受治療後第一個月之憂鬱、不確定感、身體症狀嚴重程度；以及控制症狀嚴重度的影響後，比較不同的EGFR變異型態心理困擾（憂鬱、不確定感)之差異。本研究採用橫斷式研究法(cross-sectional design)，以接受治療後第一個月之新診斷晚期肺腺癌病人為研究對象，以連續取樣方法於台灣北部某醫學中心腫瘤醫學部門診，使用結構式問卷 (基本資料表、歐洲癌症研究與治療組織生活品質量表及肺癌模組量表、醫院焦慮憂鬱中文翻譯量表及Mishel疾病不確定感量表-社區版) 進行身體症狀及心理困擾資料收集，再透過病歷查詢收集癌症分期、EGFR突變型態及治療方式等資料；最後，以描述性統計以及推論性統計 (t檢定、皮爾森積差相關係數及階層多元迴歸) 進行資料分析。總共收案84人，病人平均年齡為58.8歲，男、女性比例各占47.6%及52.4%，EGFR wild type病人占總病人數57.1%；而EGFR mutation - positive的病人則占42.9%。統計分析結果發現 (1) EGFR wild type的晚期肺腺癌病人之憂鬱程度，顯著的高於EGFR mutation - positive者 (t=3.2, p<.01)；(2)不同EGFR變異型態的晚期肺腺癌病人其不確定感程度皆為中度(EGFR wild type: 57.9±10.9; EGFR mutation - positive: 55.2 ±13.3) ，但兩者間未達統計上顯著之差異 (t=1.0, p=.31) ； (3) 整體而言，疲倦及睡眠障礙為晚期肺腺癌病人嚴重度最高的症狀，且EGFR wild type的晚期肺腺癌病人症狀嚴重度較高 (EORTC QLQ-C3O：t=2.72, p=.01；QLQ-LC13：t=2.73, p=.01) ；最後 (4) 控制症狀嚴重度後，不同EGFR變異型態的病人其憂鬱及不確定感程度皆未達統計上顯著差異。 EGFR wild type的晚期肺腺癌病人的身體症狀嚴重度及憂鬱程度都較EGFR mutation-positive者高，但不論病人是何種EGFR變異型態，症狀嚴重度對憂鬱、不確定感等心理困擾帶來的影響是不容忽視的，未來臨床護理人員除了應具備癌症基因型態與其相關治療的知識外，對於因腫瘤及不同治療所帶來之症狀及副作用，許多與腫瘤及治療相關之副作用，更需妥善的介入與處理，以降低治療後之憂鬱、不確定感等心理困擾所帶來的影響，進而提升整體臨床照護品質。

關鍵字

晚期肺癌； EGFR突變型態；症狀嚴重度；憂鬱；不確定感

並列摘要

Currently, the rapid development of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) leads the promising survival times for lung cancer patients with EGFR mutation. However, limited information has known about patients’ distress in the treatment process. The purposes of this study were to (1) explore the levels of symptom severity and psychological distress (depression and uncertainty), and (2) examine the differences in levels of psychological distress between patients with various types of EGFR mutation after controlling for symptom severity in newly diagnosed advanced lung cancer patients at the first month after receiving anti-cancer treatment. This is a cross-sectional study with consecutive sampling to recruit newly diagnosed advanced lung cancer patients at the first month after receiving treatment. Patients were recruited and assessed at outpatient department of a medical center in northern Taiwan. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, (EORTC QLQ-C3O), -Lung Cancer 13(EORTC QLQ-LC13), Hospital Anxiety and Depression Scale (HADS), and Mishel's Uncertainty in Illness Scale-Community, (MUIS-C) were applied to assess both physical symptoms and psychological distress. Disease related characteristics were also defined and assessed. Descriptive statistics, correlation analysis and hierarchical multiple regression were used to analyze data. A total of 84 patients were recruited in the study. The mean age of patients was 58.8 years. 47.6% of patients were male; and 52.4% were female. Over half of patients were EGFR wild type (57.1%); and 42.9% were EGFR mutation-positive. The findings showed that (1) the level of depression in patients with EGFR wild type was higher than patients with EGFR mutation-positive (t=3.2, p<.01)；(2) level of uncertainty between patients with different EGFR mutation types were all in moderate levels (EGFR wild type: 57.9±10.9; EGFR mutation - positive: 55.2 ±13.3) but not reaching significant (t=1.0, p=.31); (3) in general, fatigue and sleep disturbance were two most severe symptoms in our patients. EGFR wild type patients had higher level of symptom severity in comparison with the EGFR mutation-positive patients (EORTC QLQ-C3O：t=2.72, p=.01；QLQ-LC13：t=2.73, p=.01); (4) after controlling for symptom severity, however, there were no difference in depression and uncertainty between patients with or without EGFR mutation. This study provides the preliminary findings about lung cancer patients’ symptoms severity and psychological distress while having different genomic mutation types. Both groups of patients suffer from psychological distress and patients with wild-types reported severer symptoms. Longitudinal follow-up and providing appropriate interventions to these patients should be conducted for improving patients’ quality of life.

並列關鍵字

Advanced lung carcer ； EGFR mutation ； Symptom severity ； Depression ； Uncertainty

參考文獻

簡淑娟、黃珊、韓彤珍、郭美玲、余芳娥(2005)•乳癌患者之不確定感及其相關因素之探討•腫瘤護理雜誌，5(2)，1-13。

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比較不同疾病特質的晚期肺癌病人生心理困擾之差異

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