接受標靶藥物治療之慢性骨髓性白血病患者症狀嚴重度與照護需求及相關因素探討

Abstract

慢性骨髓性白血病是少數癌症中，透過口服標靶藥物治療即有九成疾病控制率的癌症，隨著標靶藥物的研發與進步，大多數的患者皆在門診進行疾病的追蹤與治療，患者的病況相對穩定。然而，過去針對標靶藥物相關的學術研究多半探討藥物副作用，鮮少聚焦在接受標靶藥物後的症狀嚴重度與照護需求。因此，本研究目的為:（1）探討患者因藥物引起的身體症狀嚴重度及身體活動狀況、（2）探討標靶藥物服藥種類、服藥時間與症狀嚴重度之相關性、（3）探討患者的照護需求、 (4) 探討患者整體及五大項分類需求之預測因子。 本研究採橫斷式設計，於台灣北部某醫學中心血液科門診對正接受口服標靶藥物治療之慢性骨髓性白血病患者進行收案，共有102位患者參與研究。研究工具使用結構式問卷包含:基本資料表、症狀嚴重度量表（SSS）及支持性照護需求調查（SCNS-SF34）。 本研究結果為:（1）患者經標靶藥物治療後呈現輕度的症狀嚴重度，症狀嚴重度前五項為皮膚顏色改變、體重變化、疲倦、肌肉痙孿、頭髮變白；有87.2%患者身體活動功能不受影響。（2）服用Imatinib（GlivecR）治療與症狀嚴重度有顯著差異，但症狀嚴重度與服藥時間長度（p=0.23）無顯著相關。（3）患者的照護需求預測因子為:目前症狀嚴重度、治療反應、個人月收入狀況、ECOG生活品質狀態、有無與治療相關衛教管道及服藥困擾等。（4）患者的整體照護需求以「心理層面」最高，整體照護需求六項預測變項共可解釋45%的變異量。以上研究結果可提供接受標靶藥物治療之慢性骨髓性白血病患者於治療後的症狀處理及醫療人員提供照護之參考，以期協助患者調適長期服藥治療對生活的影響。

With the development and progress in oral targeted therapy, CML has ninety percent disease control rate, and most of the CML patients treated in OPD were relatively stable. However, the information of patients’ symptoms severity and care needs after target therapy was still shortage. The purposes of this study are to: (1) examine the symptoms severity and physical activity status of the CML patients receiving target therapy, (2) examin the relationship between types of targeted therapy and treatment period to the patients’ symptoms severity, (3) examine CML patients’ care needs and the predictor of care needs, and (4) explore the overall and individual care needs. This study was cross-sectional and recruited CML patients after target therapy from a medical center in northern Taiwan, and a total of 102 subjects were recruited. Patients were assessed with several structured questionnaires, including Background Information Form (BIF), Symptom Severity Scale (SSS), and Short-Form item-34 Supportive Care Needs Survey (SCNS-SF34). The results showed that (1) in general, patients experienced mild symptom severity, and the top five symptoms as their severity ranked order are: skin color change, weight changes, fatigue, muscle spasms and white of hair color. Beside, 87.2 % of patients have good physical activity function. (2) Patients treated with Imatinib (GlivecR) have significant differences between symptom severities, but symptom severities has no relationship with medication time（p=0.23）. (3) Care needs predictor are as follows: personal income status (monthly), treatment response, symptom severity, ECOG quality of life status, medication perplexity and having health education or not. (4) Generally, patients reported to have high care needs in psychological care needs and the six predictive variables can explaine 45% variance of overall care needs. The results of this study can provide the care reference for CML patients and health care providers, and further to help patients coping with long-term effects of life.