晚期肺癌病人接受首次免疫療法前衰弱狀況之初探

A Preliminary Study to Investigate Frailty in Advanced Lung Cancer Patients Before Receiving Immunotherapy

背景：大多數晚期肺癌病人在接受免疫療法前，往往都先歷經過其他的治療。相較於接受第一線治療之晚期肺癌病人，這些病人更易出現易受傷害的傾向及衰弱的狀況。目的：本研究在探討晚期肺癌病人接受首次免疫療法前之衰弱狀況。方法：收集將接受免疫療法52位晚期肺癌病人以Fried標準判定其衰弱狀況。使用工具包括：病人基本資料、巴氏量表、美國流行病學研究中心憂鬱量表、國際身體活動量表及手握力與4.6公尺行走速度。結果：發現衰弱者占17.3%，衰弱分組會受到共病症（p = .023）、身體質量指數（p = .004）、日常體能狀態（p ＜ .001）、日常生活活動功能（p ＜ .001）及生理檢驗數值白蛋白（p = .042）、C反應蛋白（p = .048）的影響。結論／實務應用：本研究晚期肺癌病人以體重減輕與低身體活動量為衰弱的主要症狀。因此，醫療人員在病人接受免疫療法前，應評估病人的營養與身體活動功能狀況。盼藉由此研究可提供臨床照護人員思考如何在接受免疫療法之前，提供病人衰弱相關照護。

Background: Most advanced lung cancer patients have already received many types of treatment before starting immunotherapy. Compared with advanced lung cancer patients under first-line treatment, those receiving immunotherapy are vulnerable to many health problems and increased frailty. Purpose: This study was designed to investigate frailty in advanced lung cancer patients before starting immunotherapy. Methods: A total of 52 pre-immunotherapy patients completed the survey. Frailty status was determined using the Fried standard and survey questionnaires included the Barthel Index, Center for Epidemiologic Studies Depression Scale, the Chinese version of scales of international physical activities questionnaire (short version). In addition, the handgrip and 4.6-meter walk speed of the participants were measured. Result: The ratio of frailty was 17.3%, with comorbidities ( p = .023), body mass index ( p = .004), Eastern Cooperative Oncology Group Status (p ＜ .001), activities of daily living status (p ＜ .001), albumin (p = .042), and C-reactive protein (p = .048) all associated with frailty. Conclusions/Implications for Practice: In this study, weight loss and low physical activity were the main symptoms of frailty in patients with advanced lung cancer. Therefore, healthcare workers should assess the nutrition and physical activity status of patients before initiating immunotherapy. We suggest that clinical care workers provide frailty care to patients before administering immunotherapy.