熱敷護理方案介入大腸癌與胃癌病人化學治療期間周邊神經病變與生活品質之成效

研究背景：胃癌與大腸癌病人於臨床上使用Oxaliplatin及5-FU作為化療藥物，以提高反應率及延長整體存活期，但也面臨不良反應如Oxaliplatin最著名的副作用-化學治療引起周邊神經病變（chemotherapy-induced peripheral neuropathy, CIPN），此副作用嚴重時需減少化療劑量及停止治療，影響癌症控制、存活及生活品質，目前CIPN尚無早期介入相關研究，本研究將針對此議題進行研究。研究目的：探討熱敷護理方案早期介入對大腸癌、胃癌病人接受Oxaliplatin造成周邊神經病變與生活品質之成效。研究方法：本研究採隨機分配之類實驗性研究設計，自2020年7月1日至2021年8月31日，以台北市某醫學中心腫瘤門診診斷為大腸癌或胃癌術後且初次以Oxaliplatin作為化療藥物之病人作為收案對象。實驗組：使用恆熱熱療法於手掌及腳掌；控制組：採臨床化療常規照護。兩組於治療前（T0, 基準值）、與治療後第2（T1）、4（T2）、6（T3）、8（T4）、10（T5）及12（T6）週進行周邊神經病變程度之EORTC QLQ-CIPN20測量，以及於治療後第4（T2）、8（T4）及12（T6）進行周邊神經病變程度之NCI-CTCAE V5.0及生活品質EORTC-QLQ-C30的測量，最後以廣義推估模式（GEE）分析確認兩組成效之差異。研究結果：熱敷護理方案介入的CIPN嚴重度於EORTC QLQ-CIPN20量表中感覺神經分辨熱水及冷水困難具有顯著改善（p=0.04）；在運動神經精細動作上握筆寫字（p=0.05）和手打開罐子的力氣（p= 0.01）也具有顯著的改善，於生活品質（EORTC-QLQ-C30）沒有顯著差異，但整體健康/生活品質、整體功能及症狀問題等次量表熱敷組都比控制組狀況佳的趨勢。結論：熱敷護理方案介入能改善周邊感覺神經的溫度感覺及運動神經的精細動作;建議將熱敷護理方案納入接受oxaliplatin治療之大腸癌及胃癌病人常規的護理措施內容，以改善其周邊神經病變之不適症狀，進而提升生活品質。

關鍵字

大腸癌；胃癌；化學治療；熱敷；周邊神經病變；生活品質

並列摘要

Background: The combination of oxaliplatin and 5-FU is frequently used clinically in patients with gastric and colon cancers. Such combination improves response rates and extends overall survival but exposes patients to many adverse effects. The most well-known side effect of oxaliplatin is chemotherapy-induced peripheral neuropathy (CIPN), which not only affects patients' quality of life but in severe cases may require a reduction in chemotherapy dose, or discontinuation of therapy, affecting cancer control and survival. There are no early intervention studies on CIPN, and this study will focus on this issue. Purpose: To investigate the effectiveness of early intervention with a hot compress regimen on peripheral neuropathy and quality of life in patients with gastric and colon cancers receiving oxaliplatin. Method: This study was designed as a randomly quasi-experimental study. Patients diagnosed with gastric or colon cancer from July 1, 2020 to August 31, 2021 at an outpatient oncology clinic at a medical center in Taipei and complete surgery and were going to receive oxaliplatin chemotherapy. In the experimental group, hot compresses were applied to the palms of the hands and feet while in the control group, general clinical chemotherapy care was provided. In both groups, pre-treatment as baseline testing (T0) and post-treatment week 2 (T1), 4 (T2), 6 (T3), 8 (T4), 10 (T5), 12 (T6) for follow-up to measure peripheral neuropathy indicators using the EORTC QLQ-CIPN20. In the meawhile, post-treatment 4 (T2), 8 (T4), 12 (T6) for follow-up to measure peripheral neuropathy indicators using the NCI-CTCAE V 5.0 and patients’ quality of life using the EORTC-QLQ-C30. The differences between the two groups were confirmed by generalized estimating equation (GEE) analysis. Results: The EORTC QLQ-CIPN20 scale showed a significant improvement in the difficulty of sensory distinction between hot and cold water (p=0.04). In terms of fine motor system movements, there was also a significant improvement in pencil grip for writing and hand strength for opening jars (p=0.05). There were no statistically significant differences in quality of life, but the hot compress group tended to do better than the control group on the overall health/quality of life, the overall functioning, and the symptom problems subscales. Conclusion: Intervention with the hot compress protocol improved peripheral sensory function and fine motor movements. It is recommended that hot compresses be incorporated into the daily care of patients with gastric and colon cancer treated with oxaliplatin to reduce the discomfort of peripheral neuropathy and improve the quality of oncologic care.