接受標靶治療之肺癌病患的副作用及其與皮膚相關生活品質探討

Abstract

標靶治療是治療肺癌的治療方式之一，其中表皮生長因子抑制劑的副作用是出現皮膚變化，皮膚變化可能會衝擊個案的生，因此本研究之目的為探討非小細胞肺癌病患接受標靶治療後，皮膚變化對生活品質、身體心像的影響及了解病人採用的因應行為。研究設計為描述相關性研究，採用橫斷式研究設計（cross-sectional design），以立意取樣（purposive sampling）使用結構式問卷進行資料收集，包括：「症狀嚴重度評估」、「皮膚疾患生活品質量表」、「身體心像量表」、「因應行為量表」，收案場所於台北某醫學中心之腫瘤科門診或胸腔科門診接受治療及追蹤之個案收案，於97年6月至97年12月共收案94人，檢力82％。結果顯示有91.5%出現皮膚變化，70.2%為多處皮膚變化，12.8%為單一部位，部位以頭部佔最多；副作用發生率前三名為皮疹、搔癢及乾燥。副作用嚴重度多落在grade I至grade II 之間，嚴重度排序為搔癢、乾燥、皮疹。皮膚症狀以「癢」對於個案的日常生活造成很大影響。個案常使用的方法為：使用醫生開的藥；使用藥妝店買得乳液；在指甲周圍出現紅腫時馬上使用消毒液或藥膏擦拭，減緩紅腫惡化。標靶治療個案的乾燥、發紅、搔癢、皮疹、潰瘍和皮膚變化之生活品質中，症狀干擾及情緒干擾次量表有正相關，日常生活功能狀態和憂鬱有顯著正相關。Tarceva 和 Iressa個案的副作用嚴重度嚴重，在皮膚變紅及皮疹上有顯著差異，同時在皮膚變化之生活品質之情緒構面及症狀構面有顯著差異。依據服藥期長短顯示，小於等於3個月比大於3個月對於身體滿意度較差。因此長期性的追蹤有其必要性，本研究有助於臨床人員更進一步了解服用標靶治療皮膚副作用嚴重度，可提供學術及臨床照護上具體參考依據。

Targeted therapy is one of treatment for tumor. The side effect of EGFR inhibitors is the manifestation of skin toxicities and may influence patients’ quality of life. Limited studies have explored these problems. The purposes of this study were to examine (1) patients’ experiences related to dermatologic toxicities; and its impact on quality of life and body image; and (2) patients’ strategies used to cope with side effects related to targeted therapy. A cross-sectional study with purposive sampling was used. Data were collected by (1) Symptom Severity Scale（NCI CTC v3.0---dermatology/skin; (2) skin related quality of life（Skindex-29）, Hospital Anxiety and Depression Scale (HADS), Body image scale （BIS）and Coping strategies scale. A total of 94 lung cancer patients were recruited from a medical center in Taipei. The results showed that 91.5% of patients had dermotologic toxicities and 70.2% of patients had multi-locational skin change. Incidences of these side effects as their descending order were (1) skin rash, (2) pruritus, and (3) dry skin. The severity of these symptoms as their ranking order was (1) pruritus, (2) dry skin, and (3) skin rash. The most frequently used coping strategies were (1) using prescription by doctor, (2) using the lotion, (3) using antiseptic before nail change. Pruritus was the most significant side effect to affect patients’ life. There were significant correlations among NIC CTC v3---dermatology/skin skindex-29. ECOGE PS and depression. Tarceva is significantly presented more severe side effects than Iressa. To whom received EGFR-TKI less than three months had more negative body image about themselves. Longitudinal studies would be necessary to further examine the changes of dermotologic toxicity and quality of life, and body image change in lung cancer patients.