提昇非小細胞肺癌病人手術後接受輔助性治療率之專案

The Project of Elevating The Rate of Receiving Adjuvant Chemotherapy in Patients with Non-Small Cell Lung Cancer

早期非小細胞肺癌手術後，執行輔助性治療可提高存活率，而本院2012年非小細胞肺癌第I~IIIA期行手術治療有50人，接受術後輔助性治療僅20人(40%)，經現況分析發現主要原因為：肺癌術後輔助性治療指引欠缺完整、缺乏肺癌術後輔助性治療之討論機制、病人未接受肺癌術後輔助性治療護理指導及欠缺單張。本專案目的藉由修訂術後標準輔助性治療指引及訂定照護流程：包括多專科團隊提案討論與發揮個案管理師的角色功能、執行肺癌術後輔助治療之護理指導。2013年1月至8月經專案改善實施後，統計本院非小細胞肺癌病人接受手術治療有23人，術後輔助性治療達17人，術後輔助性治療率由原40%提昇為74%，顯示本專案的施行，確實能提昇非小細胞肺癌病人手術後輔助性治療之執行率，藉以提高照護品質及病人之存活率。

Adjuvant chemotherapy has been proven to improve the survival rate in patients with early stage non-small cell lung cancer. We reviewed the patients with stage I-IIIA non-small cell lung cancer in 2012. There were a total of 50 patients with stage I-IIIA patients who had received the operation. Among them, only 20 (40%) had received adjuvant chemotherapy. The major reasons for patients not receiving adjuvant chemotherapy were: unclear guidelines regarding adjuvant chemotherapy, poor communications among physicians, lack of an education program regarding adjuvant chemotherapy for patients, lack of educational sheets regarding adjuvant chemotherapy for patients. To improve patients with early (I-IIIA) stage non-small cell lung cancer receiving adjuvant chemotherapy, we amended the guidance of the adjuvant therapy after operation, established the caring protocols, such as proposal conferences by cancer collaboration teams, elaborated the roles and functions of care-managers, and provided nursing care for adjuvant therapy post-operation. After these interventions, 17 of 23 (74%) patients with early (I-IIIA) stage patients who received operation between January 2013 and August 2013 received adjuvant chemotherapy. The cooperation among professional team members provides patients with best treatment modalities that could improve overall survival rate.