探討晚期非小細胞肺癌接受標靶治療不同階段的患者皮膚毒性嚴重度差異

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晚期非小細胞肺癌患者需要接受表皮生長因子接受器-酪胺酸激?抑制劑類的標靶藥物治療，治療期間90-100%的患者會出現皮膚毒性。標靶治療引起之皮膚毒性在服藥1週左右就會出現，有些症狀是持續服藥半年後陸續發生。皮膚毒性反應無法避免但可控制，為了在適當時機對患者提出合宜之衛教，本文研究目的是要瞭解非小細胞肺癌患者接受標靶治療1個月內及1個月以上常見之皮膚毒性種類，並比較嚴重度之差異。本研究為探索性研究，採橫斷式研究設計，收案場所為北部某醫學中心之胸腔內科、腫瘤科門診及病房，以方便取樣選取符合收案條件之患者。自2015年7月至2016年3月有效樣本共149位，無論接受標靶治療1個月內或1個月以上，患者過半皆出現皮膚乾燥、皮膚搔癢、丘疹膿?、口腔黏膜炎等皮膚毒性症狀，而甲溝炎則是在治療1至3個月期間過半人數出現。接受標靶治療1個月內及1個月以上的患者，出現甲溝炎人數有顯著差異（χ2 =4.478，p< .05）。接受標靶藥物治療初期，醫療人員需提供患者全面性的皮膚與口腔照護衛生教育，服藥1個月之後，更需加強指（趾）甲照護。在適當時機對患者與其家屬強調照護重點，不僅可以強化衛教成效，更能提升患者皮膚照護自我管理能力與生活品質。

Patients with advanced non-small cell lung cancer need long-term treatment for targeted therapy. About 90–100% of the patients receiving EGFR-tyrosine kinase inhibitor will experience skin toxicities after one week of targeted therapy. Patients also experience other side effects sequentially half a year after treatment. These skin reactions are inevitable but controllable. Therefore, providing effective education in appropriate time is critical. The purpose of this study was to explore several common skin toxicities among patients receiving targeted therapy for less than and more than one month and compare the difference in severity. This study is an exploratory and cross-sectional design. Convenient sampling was used to recruit patients from thoracic and oncology ward and outpatient department of a medical center in northern Taiwan. One hundred and forty-nine patients were included in this study from July 2015 to March 2016. Results showed that more than 50% patients both receiving targeted therapy for less than and more than one month have experiences of dry skin, pruritus, rash acneiform, and/or oral mucositis. Half of the patients experienced paronychia within 1 to 3 months after treatment. There is a significant difference in the incidence of paronychia between patients receiving treatment for less than and more than one month (χ2 =4.478, p< .05). Health care provider need to provide a comprehensive education of skin and oral care to the patients in the initial stage of targeted therapy. Finger and toe care are especially emphasized one month after treatment. By emphasizing timely care to patients and their family members, this study promotes the value of education and patient’s skin care ability and quality of life.