癌症病人化療後認知功能障礙之照護

Nursing Care for Cancer Patients with Cognitive Impairment Following Chemotherapy

10.6880/TJON.201812_18(2).01

李麗紅(Li-Hung Lee)；陳于群(Yu-Chun Chen)；楊政議(Cheng-I Yang)

癌症 ； 化療腦 ； 化學治療 ； 認知功能障礙 ； 照護 ； Cancer ； Chemo Brain ； Chemotherapy ； Cognitive Dysfunction ； Care

腫瘤護理雜誌

18卷2期（2018 / 12 / 01）

5 - 11

繁體中文

隨著醫療照護技術不斷進步，癌症病患的存活率日益增加，然而面對疾病復發的不確定性及治療副作用所產生的身心不適，以及對生活各層面所造成的影響，常帶給病人及其家屬極大的壓力。過去醫護人員對於癌症所產生的副作用，傾向於關注各項治療所造成的噁心、嘔吐、虛弱以及免疫力降低等生理症狀。事實上，癌症治療特別是化學治療，也可能導致病人認知功能損傷，但病人、家屬甚至醫護人員常容易忽略此副作用，而延誤醫療照護的介入時間，對病人日常生活及工作都造成影響。本文主要目的在彙整相關文獻，檢視化學治療導致認知功能障礙之現象，藉由瞭解導因與機轉以及對病人身心狀況及生活各層面可能造成的影響，使護理人員在照護因化學治療產生認知障礙的病人時，能適時提供良好的護理照護與衛教，企能增加護理人員對於癌症照護的相關知識，提供病患更完整的癌症照護。

Medical advances have improved the cancer survival rate. Nonetheless, the uncertainty of disease recurrence, the physical and mental stress, and treatment side effects bring excessive pressure to patients and their family. Healthcare providers place their focus of concerns on the side effects of cancer treatment, especially physiological symptoms such as nausea, vomiting, weakness, and decreased immunity; while in fact, cancer treatment, especially chemotherapy, may also cause cognitive impairment, which is often overlooked by the patient, family, and even healthcare professionals and can lead to late intervention and negative impact on patient’s daily life and work performance. Through literature review, the purpose of this article is to examine and share the chemotherapy-related cognitive dysfunction in cancer patients, the causes and mechanisms, the impact on patient’s physical and mental conditions and daily life, so that the nursing staff can better intervene to manage this side effect. This article hopes to enrich the nurses’ knowledge in this aspect of cancer care to provide patients with better medical services.

1. Armstrong, K.(2016).Chemobrain: Physiological predisposing factors.Academy of Medical-Sur- gical Nursing,25(4),215-218+223.
2. Boykoff, N.,Moieni, M.,Subramanian, S. K.(2009).Confronting chemobrain: An in-depth look at survivors reports of impact on work, social networks, and health care response.Journal of Cancer Survivorship,3(4),223-232.
3. Cheung, Y. T.,Shwe, M.,Tan, Y. P.,Fan, G.,Ng, R.,Chan, A.(2012).Cognitive changes in multiethnic Asian breast cancer patients a focus group study.Annals of Oncology,23(10),2547-2552.
4. Dietrich, J.,Monje, M.,Wefel, J.,Meyers, C.(2008).Clinical patterns and biological correlates of cognitive dysfunction associated with cancer therapy.The Oncologist,13(12),1285-1295.
5. Evens, K.,Eschiti, V. S.(2009).Cognitive effects of cancer treatment: chemo brain explained.Clinical Journal of Oncology Nursing,13(6),661-666.
6. Hines, S.,Ramis, M. A.,Pike, S.,Chang, A. M.(2014).The effectiveness of psychosocial interventions for cognitive dysfunction in cancer patients who have received chemotherapy: A systematic review.Worldviews on Evidence-Based Nursing,11(3),187-193.
7. McDougall, G. J.,Oliver, J. S.,Scogin, F.(2014).Memory and cancer: A review of the literature.Archives of Psychiatric Nursing,28(3),180-186.
8. Raffa, R. B.(2011).A proposed mechanism for chemotherapy-related cognitive impairment ( chemo-fog ).Journal of Clinical Pharmacy and Therapeutics,36(3),257-259.
9. Raffa, R. B.(2010).Is a picture worth a thousand (forgotten) words?: Neuroimaging. evidence for the cognitive deficits in chemo-fog / che- mo-brain.Journal of Clinical Pharmacy and Therapeutics,35(1),1-9.
10. Schagen, S. B.,Boogerd, W.,Muller, M. J.,Huinink, W. T. B.,Moonen, L.,Meinhardt, W.,Van Dam, F. S.(2008).Cognitive complaints and cognitive impairment following BEP chemotherapy in patients with testicular cancer.Acta Oncologica,47(1),63-70.
11. Staat, K.,Segatore, M.(2005).The phenomenon of chemo brain.Clinical Journal of Oncology Nursing,9(6),713-721.
12. World Health Organization (2018). Cancer. Retrieved from http://www.who.int/news-room/ fact-sheets/detail/cancer
13. Xiao, F.,Song, X.,Chen, Q.,Dai, Y.,Xu, R.,Qiu, C.,Guo, Q.(2016).Effectiveness of psychological interventions on depression in patients after breast cancer surgery: A meta-analysis of randomized controlled trials.Clinical Breast Cancer,17(3),171-179.
14. 陳仁亮,張金堅(2014)。癌症化學治療與認知功能異常。台灣醫學，57(7)，16-18。
15. 衛生福利部(2018).106年國人死因統計結果, 取自 https://www.mohw.gov.tw/cp-3795-41794-1.html [Ministry of Health and Welfare (2018). 106 Cause-of-Death Statistics. Retrieved from https://www.mohw.gov.tw/cp-3795-41794-1. html]
16. 衛生福利部國民健康署(2017). 104年癌症登記年報 ．https://www.hpa.gov.tw/Pages/ Detail.aspx?nodeid=269&pid=8084 [Health Promotion Administration, Ministry of Health and Welfare (2017). 104 Cancer Report. Re- trieved from https://www.hpa.gov.tw/Pages/ Detail.aspx?nodeid=269&pid%=8084]
17. 鄭逸如, Y. R.,曾嫦嫦, C. C.,張琦郁, C. Y.,楊于婷, Y. T.,黃揚文, Y. W.,李素貞, S. J.,黃柏蒼, B. C.(2018).心理腫瘤照護的實務與解析：生命交會中的療癒契機.台北=Taipei:五南=Wunan.

1. 楊卉穎,孫秀卿(2020)。癌症相關輕微認知功能障礙之評估與處置。源遠護理，14(1)，5-15。