癌症末期患者群集性症狀診治的新進展

Therapeutic Update on Symptom Clusters in Advanced Cancer Patients

症狀控制是癌末病患照顧的第一步。癌末病患的症狀傾向同時多發性、嚴重度較高。以往針對單一症狀之處置往往造成多重用藥、藥物副作用增加等現象，有時為了治療單一症狀反而引起另一種症狀。近年來對於癌末病患症狀的研究，已經從以往的單一症狀逐步轉變為群集性症狀的研究。常見的群集性症狀包括能量耗損、進食不佳、自主神經失調、呼吸消化障礙、疼痛。研究發現存活期、身體功能狀態、骨轉移、肋膜積水和腹水與癌末群集性症狀型態有關連。雖然相關機轉尚未完全明瞭，臨床上癌末群集性症狀的觀念可以應用在症狀評估與處置。癌末病患承受整體痛，症狀評估應包含心理社會靈性的問題。症狀處置也必須將心理靈性支持納入其中。由於群集性症狀的觀念仍在起步階段，我們還需要更多相關的研究，方能提供癌末病患更完善的整體性照護。

Symptom management is the initial and basic care of advanced cancer patients. Characteristics of the symptoms in advanced cancer patients include multiplicity and concurrence of moderate to severe symptoms. Previous strategies, which tried to control symptoms separately, raise some concerns, including polypharmacy and increased side effects. Recent research on symptom management for advanced cancer patients has shifted from treating individual symptoms to focusing on symptom clusters. Common symptom clusters in advanced cancer patients include loss of energy, poor intake, autonomic dysfunction, aerodigestive impairment and pain. A study revealed a close relationship between survival, functional performance, bone metastasis, pleural effusion and ascites and symptom clustering patterns in advanced cancer patients. Although the underlying mechanism is not clear, the concepts of symptom clustering can be utilized for effective symptom assessment and management. Since total suffering is the quintessential characteristic of advanced cancer patients, symptom assessment should include psychological and spiritual aspects. Symptom management could include psychological support and spiritualcare. To improve the quality of palliative care, it is worthy of further study for symptom clustering in advanced cancer patients.