探討非何杰金氏淋巴癌存活者之化療相關周邊神經病變的症狀困擾與因應策略

Abstract

化學治療(R)-CHOP為非何杰金氏淋巴癌主要治療處方，但其中化學藥物Vincristine相關周邊神經病變是造成病人生活極大困擾的長期副作用。然而，化療相關周邊神經病變仍缺乏具體有效的預防與治療策略，臨床上，多數患者會自行發展出個人因應策略克服症狀造成的生活困擾，但在因應策略選擇與其有效性為何目前仍尚無相關研究，因此，本研究將針對此部分進行深入探討。 本研究為橫斷式之描述性相關性研究，於中部某醫學中心血液腫瘤科門診、門診化療室及病房，以立意取樣針對123位非何杰金氏淋巴癌的患者進行收案。研究工具包含：歐洲癌症治療與研究組織生活品質核心問卷-周邊神經病變、特定於VIPN相關因應策略有效性量表，並使用整體神經病變（臨床版）進行化療相關周邊神經病變的評估，最後以描述性及推論性統計進行分析。 研究結果顯示 (1)以歐洲癌症治療與研究組織生活品質核心問卷-周邊神經病變進行症狀嚴重度評估，共102位患者自覺有症狀，其中以手麻木、腳抽筋和腳麻木最嚴重，而施測者以整體神經病變（臨床版）向每位患者進行測試，共61位患者出現神經受損症狀，尤其以肌腱反射最為明顯 (2)化療相關周邊神經病變的自我評估與理學檢查嚴重度，皆與年齡呈現顯著正相關 (3)具Vincristine相關周邊神經病變的患者於症狀因應的整體有效性平均為5.17分，心理因應的整體有效性平均為6.15分，而心理因應有效性和自我評估症狀嚴重度呈現顯著負相關，尤其與感覺神經症狀呈現顯著低度負相關，症狀因應有效性則未見顯著差異。 結論：臨床評估建議仍以病人自我評估的化療相關周邊神經病變症狀為主，讓病人定期自我檢視症狀的變化，以回歸病人為中心的照護，必要時，再配合整體神經病變（臨床版）評估，以提供最適當的時機轉介病人進一步復健科神經學相關檢測，並可提供本研究之VIPN的因應策略做為臨床照護之建議。

Background: Vincristine-induced peripheral neuropathy(VIPN) is the most common long-term side effect of chemotherapy in patients with non-Hodgkin's Lymphoma (NHL).However, there is still no specific effective intervention to prevent or treat it. In clinical settings, most of patients will develop their own coping strategies to overcome the distress of VIPN for reducing the impact of life. At the same time, there is still few studies focused on coping strategies and its effectiveness which specific to the VIPN symptom in these patients. Thus, this study will address these issues. Methods: This is a description and correlation study, using a cross-sectional study design. Total 123 patients with NHL will be recruited from outpatient department, outpatient chemotherapy room and ward in a medical center in central Taiwan. Data will be collected by the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire -CIPN20 (EORTC-QLQ-CIPN20),Specific to the VIPN-related Coping Strategy Effectiveness Scale(VIPN-COPE). The Total Neuropathy Score- clinical (TNSc) will be used for objective assessment of VIPN. For statistical analysis, the differences between the severity of VIPN and clinical related variables will be analyzed by Mann-Whitney U test and Kruskal–Wallis test, and the correlation between variables will be analyzed by Spearman's rank-order correlation. Results: The finding included that (1)102 patients had self-reported VIPN symptoms by EORTC-QLQ-CIPN20 questionare, and 61 patients were reported VIPN by TNSc test. The common symptoms included fingers/toes numbness, reduced deep tendon reflex, and leg cramps. (2) The severity of self-reported and physical examination of VIPN is significantly positively correlated with age.(3) It was more effective to use psychological coping than symptom coping in patients with VIPN. And effectiveness of psychological coping was significantly negatively correlation with self-reported severity of VIPN, especially with sensory neurological symptoms. Conclusion: The self-reported VIPN severity would be better to help clinicians understand the patient’s distressing symptoms, and physical examination could early diagnose whether the patients had potential VIPN symptoms. As there were no effective treatments or prevention strategies for VIPN, how to cope with symptoms had become very important. The coping strategied in this study could be used as a reference for clinical care.