接受標靶治療的肺癌病患身體心像改變之臨床照護

Clinical Care of Lung Cancer Patients with Body Image Changes after Targeted Therapy

肺癌病患在存活期較短與疾病惡化快速的極大衝擊下，標靶治療擁有方便簡單、存活期延長、較化學治療副作用少的多項優點，儼然成為晚期病患最期待的治療方式。然而，目前適用於肺癌病患口服標靶治療的艾瑞沙Gefitinib（Iressa®）與得舒緩Erlotinib（Tarceva®），其易導致全身皮膚痤瘡樣疹、乾燥等皮膚毒性副作用，為最困擾病患的問題之一，不僅嚴重影響其身體心像，產生負向情緒反應，進而影響社交與生活，若減少或停止用藥以減輕副作用，又會擔憂存活問題，此種矛盾情緒造成病患內心極大痛苦，因而無法擁有良好之生活品質。因此，本文將針對此族群病患介紹肺癌標靶藥物產生皮膚毒性症狀與引發身體心像改變之相關知識，並建議使用相關評估工具，依其身體心像改變之生理、心理與社會問題，提供皮膚毒性症狀照護、情緒支持及因應策略之運用，以協助病患重建正向自我概念，並期望未來在臨床上能突破當前護理照護之時間與空間限制外，亦能給予醫護人員更多相關的專業訓練，以提昇醫護人員對接受肺癌病患標靶治療身體心像改變問題的關注，並運用純熟的照護知識與技巧，進而提升臨床護理品質。

Lung cancer has a relatively short survival prognosis and advanced disease progression. Therefore, targeted therapy has become one of the most frequent treatments of this disease. Targeted therapy has several features that effectively extend the survival period; is easy to apply and use; and has fewer side effects than chemotherapy. Therefore, this therapy approach has become the preferred choice of patients with advanced lung cancer. However, current targeted therapies like Iressa® and Tarceva® produce side effects such as skin dryness and acneiform eruption that may bother patients. These side effects may further cause patient concern over negative changes in their body image, and these concerns may influence their work and social lives. Additionally, some patients treated with targeted therapy worry about their chances of survival if they reduce or stop the medication to avoid the side effects. Consequently, patients may struggle with both physical and psychological impacts, and may have problems sustaining a good quality of life. This article focuses on delivering relevant information to patients receiving targeted therapy who suffer from dermatological toxicity and damage to their body image. We demonstrate an assessment tool and information to help patients cope with physical and psychosocial issues through daily skin care routines, mental/psychological supports, and cognitive behavior therapy. These measures may help patients rebuild a positive self-concept. We plan to develop further associated training to provide professionals/care providers with the appropriate knowledge and skills to care for cancer patients in a resource-limited environment so that they may improve the quality of nursing care for patients with body image changes.