接受不同代標靶藥物之晚期肺癌病人於皮膚不良事件、自我照顧能力與情緒狀態之探討

游竹君

doi:10.6342/NTU202000722

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接受不同代标靶药物之晚期肺癌病人於皮肤不良事件、自我照顾能力与情绪状态之探讨

Skin Adverse Events, Ability of Self-Care and Psychological Status in Patients with Lung Cancer Receiving Different Generation Targeted Therapies

游竹君 , 硕士　　导师：李芸湘　　

繁体中文 DOI： 10.6342/NTU202000722

肺癌；标靶治疗；皮肤不良事件；自我照顾；情绪状态； lung cancer ； targeted therapy ； skin adverse event ； self-care ； psychological state

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摘要 │ 参考文献 (187) │ 国际计量

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Background
Targeted therapy is now a predominant treatment method for advanced lung cancer. The side effect of EGFR inhibitors is one of the manifestations of skin adverse events. As new targeted therapy programs for lung cancer have been developed, diverse generation of target medicine has induced the similar adverse events of skin toxicity. However, the reported incidents were lack of comparison and investigation, especially skin reactions. The purpose of this report is to understand diverse skin adverse reactions on advanced lung cancer patient with experience of targeted therapy, and to discuss their self-care ability and psychological distress. Therefore, this article has also examined the differences of skin adverse events, the level of patient self -care ability, and the level of psychological state in selected lung cancer patients treated by various targeted therapy medicine.

Method
This article is presented as a descriptive correlation research which was designed as cross-sectional design and purposive sampling of 135 patients. Structured questionnaires including patient details and objective data are collected through CTCAE v4.03 from NCI. Subjectively, PRO-CTCAE ITEMS Version 1.0, Hospital Anxiety and Depression Scale, Distress Thermometer (DT), Self-Care Ability Scale, and Effective Self-Care Strategies Scale are all involved as data collection in dermatology and oncology outpatient medical center at a Taiwan hospital in north. Consequently, inferential and descriptive statistics conclude the data analysis by Fisher’s Exact Test, Kruskal-Wallis test and Spearman Correlation.

Results
　　The results showed (1) 99.3% of patients had dermatologic toxicities. The top three incidences of these skin adverse events were pruritus, dry skin and papulopustular eruption. The severity of these symptoms is between grade I to grade II. (2) Tools: DT score was 3.3 (±2.5)；31.1% of patients had severe anxiety and depression. (3) The self-care ability of skin adverse reactions score was 6.9. The most common self-care approaches to skin adverse events were first using prescription drugs by Dermatologists, applying topical cream over the counter comes after, and using pre-purchased dermatology medicine at the end. (4) Subject skin adverse events, including pruritus, dry skin, papulopustular eruption, hand-foot syndrome and hair loss have positive correlation to distress thermometer score. The ability of skin self-care has negative correlation to distress thermometer score. (5) The incidence rate of papulopustular eruption in the third generation of EGFR-TKI patient was significantly lesser than the first generation use as CTCAE examined. The severity of this sympton in the third generation drug was lesser than other two generations as Pro-CTCAE presented. (6) The DT score of the third generation of EGFR-TKI patient showed less stressed but differed significantly than the first generation.

Conclusion
Findings above have already summarized the reported skin adverse events in advanced lung cancer patients regarding the ability and strategy of self-care and the subjective opinions of psychological status. To investigate more relations between three different targeted drugs and patient skin care physically and mentally, the longitudinal studies would be necessary as references in nursing care to benefit patient care and medical research.

参考文献 ( 187 ) 〈TOP〉

Agero, A. L., Dusza, S. W., Benvenuto-Andrade, C., Busam, K. J., Myskowski, P., & Halpern, A. C. (2006). Dermatologic side effects associated with the epidermal growth factor receptor inhibitors. Journal of the American Academy of Dermatology, 55(4), 657-670. doi:10.1016/j.jaad.2005.10.010
连结：
Almonacid, C. I., Ramos, A. J., & Rodriguez-Borrego, M. A. (2016). Level of anxiety versus self-care in the preoperative and postoperative periods of total laryngectomy patients. Revista Latino-Americana de Enfermagem, 24, e2707, doi:10.1590/1518-8345.0743.2707
连结：
Annunziata, M. C., Ferrillo, M., Cinelli, E., Panariello, L., Rocco, D., & Fabbrocini, G. (2019). Retrospective Analysis of Skin Toxicity in Patients under Anti-EGFR Tyrosine Kinase Inhibitors: Our Experience in Lung Cancer. Open Access Macedonian Journal of Medical Sciences, 7(6), 973-977. doi:10.3889/oamjms.2019.170
连结：
Aprile, G., Pisa, F. E., Follador, A., Foltran, L., De Pauli, F., Mazzer, M., . . . Fasola, G. (2013). Unplanned presentations of cancer outpatients: a retrospective cohort study. Supportive Care in Cancer, 21(2), 397-404. doi:10.1007/s00520-012-1524-6
连结：
Arrieta, O., Angulo, L. P., Nunez-Valencia, C., Dorantes-Gallareta, Y., Macedo, E. O., Martinez-Lopez, D., . . . Onate-Ocana, L. F. (2013). Association of depression and anxiety on quality of life, treatment adherence, and prognosis in patients with advanced non-small cell lung cancer. Annals of Surgical Oncology, 20(6), 1941–1948. doi:10.1245/s10434-012-2793-5
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使用DOI作为永久连结

引用含有DOI的文献

DOI可强化引用精确性、增强学术圈连结，并给予使用者跨平台的良好使用经验，目前在全世界已有超过五千万个对象申请DOI。 如想对DOI的使用与概念有进一步了解，请参考 （ ） 。

DOI可强化引用精确性、增强学术圈连结，并给予使用者跨平台的良好使用经验，目前在全世界已有超过五千万个对象申请DOI。如想对DOI的使用与概念有进一步了解，请参考（）。