冷療照護介入對癌症病人接受化學治療皮膚毒性反應之成效——系統性文獻回顧

The Effectiveness of Cooling Packaging Care in Relieving Chemotherapy-Induced Skin Toxicity Reactions in Cancer Patients Receiving Chemotherapy: A Systematic Review

背景 抗癌化學治療會引起皮膚毒性反應，冷療照護種類對於化學治療皮膚毒性反應成效不一。目的 探討冷療照護介入，對於癌症病人接受化學治療引起皮膚毒性反應之成效。 方法 以系統性文獻回顧法，使用「chermotherapy cutaneous toxicity」、「 chemotherapy skin reaction 」、 「chemotherapy skin toxicity」、「化學治療皮膚毒性」、「化學治療皮膚毒性反應」；「frozen glove」、 「frozen sock」、「冷療」、「冰手套」、「冰襪」、「局部冰敷」；「usual care」、「常規照護」；「 severity」、 「comfort」、「 satisfaction」、「嚴重度」、「舒適度」、「滿意度」等關鍵字搜尋資料庫，選取文獻符合篩 選標準並排除重複文獻，共得五篇。 結果 本系統性文獻回顧納入五篇隨機分派之實驗性研究，共222位有單獨或合併接受docetaxel（紫杉醇）及單獨接受PLD（pegylated liposomal doxorubicin）化學治療癌症病人。結果發現使用冷療介於 -10℃- -30℃，皮膚毒性反應發生率有下降。但受限於研究樣本數小，且冷療介入方案不同、溫度、 時間、頻率、持續時間有所不同，需更多研究進行探討。 結論及臨床應用 整合文獻結果，使用docetaxel or PLD的前15分鐘、輸液期間1小時及結束後15分鐘，使用 -25℃- -30℃的Elasto-Gel冷凍襪或冷凍手套，可改善使皮膚毒性反應發生的頻率和嚴重程度。局部冷療為非藥物處置，其成本低及無副作用，可供未來臨床使用之參考。

Background: Anti-cancer chemotherapy may cause skin-toxicity reactions. Different types of cooling packages affect chemotherapy-induced skin toxicity reactions differently. Purpose: To evaluate the effects of cooling packing care on chemotherapy-induced skin toxicity reactions in cancer patients receiving chemotherapy. Methods: A systematic review approach was used. Searches were conducted in databases including Cochrane Library, Embase, MEDLINE, PubMed and Airiti Library using the keywords “chemotherapy cutaneous toxicity”, “chemotherapy skin reaction”, “chemotherapy skin toxicity”, “frozen glove”, “frozen sock”, “cooling packaging care”, “ice gloves”, “ice socks”, “usual care”, “severity”, “comfort”, “satisfaction”, “severity”, and “comfort”. The search focused on articles published before December 2016. Based on the inclusion and exclusion criteria, 5 articles involving relevant randomized controlled trials were extracted for review. Results: Elasto-Gel ice gloves or ice socks that were chilled to -25℃– -30℃ and used for 15 mins during initial chemotherapy, for one hour during chemotherapy infusion, and for 15 mins after chemotherapy were shown to improve the frequency and severity of chemotherapy-induced skin toxicity reactions. Several studies were limited by small sample sizes and different types of cooling packing programs, temperature, timing, and frequency. Thus, further research is recommended to verify the effects of cooling packing care. Conclusions / Implications for Practice: Cancer patients who were treated with docetaxel or PLD and who used ice gloves or ice socks that were chilled to -25℃– -30℃ for 15 mins during initial chemotherapy, for one hour during chemotherapy infusion, and for 15 mins after chemotherapy improved significantly in terms of the frequency and severity of their chemotherapy-induced skin toxicity reactions. Local cooling packing care is a non-pharmacotherapy approach that is low cost and free of side effects. This review is intended to provide a reference for clinical care.