低溫療法應用於乳癌病人因紫杉烷類化療藥物引起的周邊神經病變之處置成效──系統性文獻回顧

The Effectiveness of Cryotherapy to Manage Taxane-Induced Peripheral Neuropathy in Patients With Breast Cancer: A Systematic Review

背景：紫杉烷類藥物是乳癌化學治療中常用的藥物，但其常引發周邊神經病變（chemotherapy-induced peripheral neuropathy, CIPN）。過去研究指出低溫療法可預防或減緩CIPN，然對於低溫療法執行措施內容尚缺乏整合性文獻以評價其臨床成效。
目的：本研究旨在探討低溫療法用於預防或減輕紫杉烷類化療藥物引起周邊神經病變之效益。
方法：以系統性文獻回顧法，資料蒐集包含來自於PubMed、Embase、Cochrane、CINAHL、MEDLINE和Airiti Library等電子資料庫，以PICO（patient/problem, intervention, comparison, outcome）建立關鍵字，限定2023年12月以前出版之中、英文文獻，族群界定於年齡大於18歲且接受紫杉烷類藥物輔助性化療的女性乳癌病人。符合篩選標準並排除重複文獻後，以Jadad Quality Scale評讀隨機對照試驗研究文章，非隨機對照試驗研究文章則以methodological index for non-randomized studies（MINORS）進行評析。
結果：收納共11篇研究進入分析，其中有五篇隨機試驗研究共納入198位病人，和六篇非隨機對照試驗研究共1,930位病人。五篇隨機對照試驗（randomized controlled trial）之Jadad Quality Scale得分都大於3分，六篇非隨機對照試驗之MINORS得分也都達到理想得分20分以上，顯示文獻品質佳。有五篇研究指出低溫療法可預防CIPN，另五篇研究指出可減輕嚴重度，但有一篇研究指出並無明顯效果。
結論／實務應用：根據本系統性文獻回顧發現，低溫療法可能是一相對簡單、安全的方法以改善病人CIPN的症狀；在臨床上可建議乳癌病人在接受紫杉烷類化療藥物時，於治療前15分鐘、治療中、直到治療後15分鐘使用冰手套／冰腳套來進行低溫療法。然而，因所收納的研究所使用之測量問卷和結果變項異質性較大無法進行統合分析，故根據系統性文獻分析歸納的結果，仍然缺乏足夠實證的支持，建議未來需要有更多研究以證實其成效。

Background: Taxanes are essential chemotherapy agents for breast cancer treatment. However, patients frequently experience chemotherapy-induced peripheral neuropathy (CIPN) during their course of treatment. Cryotherapy is a non-pharmacological approach that has been explored for its potential effects on preventing or improving CIPN. However, although several studies have reported on the effects of cryotherapy, no comprehensive review has been conducted to confirm its benefits.
Purpose: This study was designed to investigate the potential benefits of cryotherapy in terms of alleviating CIPN in patients with breast cancer undergoing taxane-containing chemotherapy.
Methods: This systematic review was conducted using databases including PubMed, Embase, Cochrane, CINAHL, Medline, and Airiti Library, focusing on female patients over 18 years old with breast cancer treated using taxane-containing regimen. Key words searched were based on the PICO (patient/problem, intervention, comparison, outcome) framework, and cover articles in the literature published up to December 2023. In this study, the Jadad Quality Scale was employed to evaluate the randomized controlled trials (RCTs), while methodological index for non-randomized studies was utilized for non-RCTs.
Results: The 11 studies used in this analysis included five RCTs comprising 198 patients and six non-RCTs comprising 1,930 patients. Five of the studies reported cryotherapy may help prevent CIPN, five reported cryotherapy may alleviate CIPN symptoms, and one study reported no significant prevention or alleviation effect.
Conclusion/ Implications for Practice: Cryotherapy shows promise as a practical and safe method the prevention / alleviation of CIPN symptoms during chemotherapy treatment. However, the related evidence is inadequate, indicating a need for more rigorous studies to establish stronger evidence.