- 學位論文
晚期肺腺癌病患接受標靶治療之副作用、因應行為與希望狀態之探討
Side Effects, Coping Behaviors and Hope among Advanced Lung Adenocarcinoma Patients with Targeted Therapy
摘要
背景：近年來，肺癌已竄升為危害全球人類健康的頭號殺手。以非小細胞肺癌約佔所有肺癌人數的85%以上，以肺腺癌居多。診斷時多數為晚期需長期接受全身性治療。由於精準醫療迅速的發展，對於有表皮生長因子受體酪胺酸酶基因突變(EGFR mutation)的患者則以表皮生長因子接受器酪胺酸酶抑制劑(EGFR-TKIs)為首選治療。EGFR-TKIs在腸胃道與皮膚毒性是最常見之副作用。 目的：本研究為探討晚期肺腺癌患者之標靶治療副作用、因應行為與希望狀態相關性，並確認與希望狀態之預測因子。 方法：採相關性、描述性之橫斷式研究設計，於2018年8月1日至2020年9月9日，以台灣北部某醫學中心之胸腔內科門診、腫瘤科門診與胸腔內科病房之晚期肺腺癌患者為收案對象，採便利取樣，有效問卷共175份，以結構式問卷進行資料收集包括個人基本屬性資料表、疾病與治療相關資料表、中文版癌症治療功能性評估之肺癌症狀指標量表(National Comprehensive Cancer Network-Functional Assessment of Cancer Therapy- Lung Symptom Index-17 items, Chinese version 2.0, NFLSI-17 Chinese version)、短版癌症因應行為量表(Cancer Behavior Inventory-Brief Version, CBI-B)、標靶副作用自我處置問卷、中文版赫氏希望指標(The Herth Hope Index Chinese version, HHI)。以IBM SPSS Statistics 25.0版分析資料。統計方法包含描述性統計、獨立T檢定(independent- test)、單因子變異數分析(one way ANOVA)、皮爾森積差相關(Pearson’s product-moment correlation)及多元迴歸分析(Multiple regression)等統計方式進行資料處理。 結果：本研究有幾項重要發現：(1)標靶治療副作用以腹瀉(68%)對希望狀態有負相關(t = -2.13, p = 0.035)，以皮膚方面的副作用發生率最高(皮疹97%、皮膚搔癢82%、甲溝炎76%)；(2)在皮膚毒性的因應行為上，有95%患者會確實執行衛教措施且反應效果佳；但是有腹瀉患者中僅有一半患者有遵循醫囑使用止瀉劑與調整飲食，與冷涼相關的自我照護措施執行率低；(3)在因應行為總得分平均值為89.1±15.58分，標準化得分為82.5%；(4)希望狀態總得分平均值為33±4.67分，標準化得分為82.5%；(5)希望狀態的預測因子包含癌症復發(β = -1.48, p = .041)、腹瀉(β = -1.66, p = .025)、一般功能與安適狀態(β = 1.18, p = <.001)、維持獨立與保持積極態度(β = 0.18, p = .036)、因應與壓力調適(β = 0.19, p = .003)與情感管理(β = 0.22, p = .011)，整體迴歸模式解釋變異量達51.3%。 結論：整體而言，在接受標靶治療期間，患者的希望狀態與是否為肺癌復發、腹瀉狀況及對因應行為的執行信心有關。在治療初期時，應對標靶治療副作用的衛教與加強執行自我照護的信心整合處理，並在不同時間依據患者需要提供其建議，能幫助標靶治療患者的希望狀態提升。藉由本研究結果提供醫護人員與病患、家屬有效的資訊，俾利提升肺癌患者之希望狀態，並作為後續研究之參考。
並列摘要
Background. Lung cancer is leading major cause of cancer deaths worldwide. Non-small cell lung cancer accounts for approximately 85% of all lung cancer. Adenocarcinoma is the most common subtype of non-small cell lung cancer. Most patients are advanced stage at the time of diagnosis and require long-term systemic treatment. In the era of precision medicine, Epidermal growth factor tyrosine kinase inhibitors (EGFR-TKIs) is the first line treatment for patients with genetic mutations. The common adverse effects of EGFR-TKIs is gastrointestinal and dermatologic toxicities. Purpose. The proposed of this study focused on (1) the associated between the coping behavior toward the drug adverse effects and hope in patients with advanced lung adenocarcinoma receiving targeted therapy; (2) identify the hope of predictive factors. Methods. A correlational and descriptive cross-sectional designed approach was used. The data was collected structural questionnaire via convenience sampling from outpatient pulmonary medicine and oncology department and pulmonary medicine wards.at a medical center in northern Taiwan. There are 175 valid questionnaires. The structure questionnaires were as follows (1) demographic information, (2) the illness and therapeutic questionnaire, (3) National Comprehensive Cancer Network-Functional Assessment of Cancer Therapy - Lung Symptom Index-17 items, Chinese version (NFLSI-17 Chinese version), (4) cancer-related coping behavior as measured with Cancer Behavior Inventory-Brief version (CBI-B), (5) the scale for coping with targeted therapy related adverse effects, and (6)the Herth Hope Index Chinese version (HHI). The data were analyzed by IBM SPSS Statistics 25.0 using descriptive statistics including Student t -test, one-way ANOVA, Pearson’s product-moment correlation and multiple regression test as appropriate. Results. Several important findings are listed below: (1) Diarrhea (68%) was negatively associated with hope status (t = -2.13, p = 0.035). Dermatologic toxicities are the most frequently adverse effects (i.e., rash 97%, followed by pruritus in 82% and paronychia in 76%). (2) Among participants with dermatologic toxicities, 95% reported that they implement health education and reported good effects. However, only half of participants with diarrhea have followed the instructions to use laxatives and adjust their diet, and the utilization rate of self-care measures associated with cold is relatively low. (3) The mean score of the coping behavior was 89.1±15.58 (standardized score: 89.1/108 = 82.5%). (4) The mean score of the hope was 33±4.67 (standardized score: 33/40 = 82.5%). (5) Hope status was associated with cancer recurrence (β = -1.48, p = .041), diarrhea (β = -1.66, p = .025), general function/well-being (β = 1.18, p = <.001), maintaining independence and positive attitude (β = 0.18, p = .036), coping and stress management (β = 0.19, p = .003), managing affect (β = 0.22, p = .011). The total variance explained by the regression model was 51.3%. Conclusion. In sum, during the period of targeted therapy, patient’s hope state would be associated with the recurrence of lung cancer, diarrhea, and the confidence in coping behavior. Health professionals should integrate health education of adverse effects and confidence in coping behavior according to individual needs, thus enhancing patient’s hope status. This study provides information to clinical health professionals, patients, and families to improve the hope status for lung cancer patients treated with EGFR-TKIs, and also provides directions to future studies.
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