Olanzapine於控制晚期癌症病人非因放化療引起之噁心與嘔吐成效－系統性文獻回顧

Effect of Olanzapine to Control Nausea and Vomiting in Advanced Cancer Patients Without Concurrent Chemotherapy or Radiation Therapy: A Systematic Review

10.6537/TJHPC.202103_25(2).04

杜小昕(Sio-Ian Tou)；黃家榆(Chia-Yu Huang)

olanzapine ； 晚期癌症 ； 嘔吐 ； 噁心 ； 系統性文獻回顧 ； olanzapine ； advanced cancer ； nausea ； vomiting ； systematic review

安寧療護雜誌

25卷2期（2021 / 03 / 01）

143 - 160

繁體中文

研究目的：探討olanzapine介入運用在晚期癌症病患非因放化療引起之控制嘔吐與噁心的成效。材料與方法：以系統性文獻回顧，搜尋2020年08月以前在PubMed、Cochrane Library與Web of Science資料庫之相關文獻。文章主要納入條件為研究族群為接受安寧緩和照護之成年晚期癌症病人、接受olanzapine為控制噁心或嘔吐的藥物、無併行的化學治療與放射治療等。結果：共搜尋到542篇英文文獻，有9篇符合本文收案條件：病例（系列）報告5篇、回溯性研究3篇、隨機分派實驗有1篇，以口服olanzapine為主、劑量為2.5－10毫克／天、最常見副作用為嗜睡。結論：本文所納入的文獻多是將olanzapine當作傳統止吐劑無效後的替代療法，病人使用口服劑型時需保有一定的吞咽能力。如錐體外症候群的副作用尚無文獻提及，但須考量高血糖的風險。雖然大多數文獻所採用的研究方式在實證醫學的等級並不高、各文獻所採用評估療效與副作用的方式皆不一，因此目前難以證明olanzapine介入運用在晚期癌症病患非因放化療引起之控制嘔吐與噁心的成效。在未來進行此類主題時，應採隨機分派實驗架構，並輔以客觀評估療效工具，方能更真實呈現olanzapine的效果。

Purpose: The aim of this study is to disclose the effect of olanzapine to control nausea and vomiting in advanced cancer patients without concurrent chemotherapy or radiation therapy. Methods: A systemic review was performed through collecting studies published before August 2020 in databases of PubMed、Cochrane Library and Web of Science. Studies presented adult patient with terminal advanced cancer accepted hospice or palliative care and had prescription with olanzapine to control nausea and vomiting which were not induced by concurrent chemotherapy or radiation therapy were included. Results: A total 542 studies were identified and 9 studies matched our criteria: 5 case reports (series), 3 retrospective studies and 1 randomized controlled trial. The most common prescription was olanzapine 2.5-10 mg/day by oral intake. Drowsiness was the most common complication. Conclusion: Olanzapine was used as alternative treatment in most included studies. Patient usually used 5-10 mg oral form daily with adequate swallow function. Drowsiness and dizziness were the most common side effects from olanzapine, but extrapyramidal syndrome has not been found. The high level blood glucose development is still a potential risk. The high level evidence to support the role of olanzapine to control nausea and vomiting in patients with terminal care was limited and the tools for evaluating results and complication were variable. The role of olanzapine to control nausea and vomiting in advanced cancer patient is still unclear. Future randomized controlled trials with objective evaluation tools would be helpful to disclose the real effect of olanzapine.

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