探討具有基因突變之晚期非小細胞肺癌病患再次接受病理切片現況–以台灣某醫學中心為例

Abstract

研究背景：2018年台灣癌症發生率及死亡率首位皆是肺癌。目前肺癌病患最常使用的標靶治療為表皮生長因子接受器-酪胺酸酶抑制劑(EGFR-TKIs)。病患為了確認肺癌是否產生抗藥性，需要接受再次病理切片(re-biopsy)，但臨床上並非每位病患都願意接受。 研究目的：藉由此研究了解病患在接受再次病理切片前或切片之後可能會產生何種併發症及相關護理問題，提供照護此類病患面對接受再次病理切片決定時之參考。 研究方法：利用橫斷式(cross-sectional study)、回溯性(retrospective study)，收集台 北某醫學中心西元2012至2017年癌症登記資料庫中確診為非小細胞肺癌 (NSCLC) 病患，而回顧其病歷資料。 研究結果：此研究對象共71人，有68人（95.8%，N=71）完成檢測，其中34人（50.0%，N=68）帶有EGFR-Thr790Met 突變，有服用第三代標靶藥物osimertinib者共16人（47.1%，N=34）。27人(38.0%，N=71)有併發症現象產生，以肺炎(10人，14.1%)最多。有關護理問題部分，接受切片前(68人，95.8%)及切片後(70人，98.6%)，皆有相關護理需求。接受再次病理切片前的前三名護理問題分別為潛在危險性感染與焦慮皆為46人次(64.8%)、潛在危險性跌倒22人次(31.0%)；接受再次病理切片後的前三名護理問題為焦慮49人次(69.0%)、潛在危險性感染46人次(64.8%)、潛在危險性跌倒30人次(42.3%)。 研究結論與應用：共71人住院接受re-biopsy，16人服用第三代標靶藥物osimertinib。Re-biopsy後併發症以肺炎(14.1)最多；切片前與切片後之常見護理問題皆為潛在危險性感染與焦慮、潛在危險性跌倒。 本研究可提供醫護人員及晚期非小細胞肺癌病患，在病情產生變化時考量是否接受re-biopsy，或是檢測出抗藥性基因突變時是否選擇第三代標靶藥物，多一項重要衛教參考資料。

Background: Lung cancer is the major incidence and mortality of cancer types in Taiwan, in 2018. Epidermal growth factor receptor tyrosine kinase inhibitor (EGFR‑TKI) is most commonly used to treat lung cancer. In order for patients to identify secondary mutations that are resistant to the first treatment, it is important to check whether the lung cancer has produced new mutations. However, not every patient is willing to undergo re-biopsy clinically. Re-biopsy is essential to check whether the lung cancer has produced drug resistance mutations. Purpose: Re-biopsy is essential to check whether the lung cancer has developed EGFR-TKIs resistant mutations. However, no research has been conducted on the complications and nursing health problems of patients with EGFR-TKIs resistant mutation-positive non-small cell lung cancer (NSCLC) pretreated with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs). Method: This is a retrospective, case-control, and cross-sectional, Taiwanese study. We reviewed medical records of patients with non-small cell lung cancer (NSCLC) pretreated with EGFR-TKIs who treated between January 2012 and Aug 2017 at the medical center in Taipei. Result: Of 71 patients, 68 (95.8%, N = 71) were successful re-biopsy, of which 34 (50.0%, N = 68) developed EGFR-Thr790Met mutation, and 16 (47.1%, N = 34) treated by the third-generation target therapy (osimertinib), 27 (38.0%, N = 71) had re-biopsy-related complications, and the most common was pneumonia in 10 (14.1%). There are nursing health problems that before and after the re-biopsy were the risk for infection and anxiety, and the risk for falls (22, 31.0%); the top three nursing health problems after re-biopsy were the risk for anxiety (49, 69.0%), the risk for infection (46, 64.80%) and falls (30, 42.3%). Discussion and application: Seventy-one patients received re-biopsy, and 16 of them treated by osimertinib using the third-generation EGFR-TKI. The incidence of pneumonia in complications was increased. These are important information that can contribute towards the quality of medical and nursing care provided to lung cancer patients receiving re-biopsy.