冷療照護於女性乳癌患者接受紫杉醇類化學治療導致手部周邊神經病變之成效

研究背景：女性罹患乳癌盛行率極高，多數患者會接受化學藥物治療合併手術治療或放射線治療，然而，在化療藥物中，有許多的藥物副作用會引起患者身體上的不適，例如：噁心、嘔吐等，這些副作用可藉由施打化療藥物前給予預防性的藥物來緩解或預防，但是另外一項周邊神經病變的副作用，常常會導致感覺異常，進而影響正常生理功能，且此症狀可能持續好一段時間，也因此影響患者日常生活。研究目的：本研究目的為了解患者在施打化療藥物時給予冷凍手套是否能有效緩解化療藥物引起的手部周邊神經病變，並了解其生活品質概況。研究方法：本研究採類實驗性研究設計，以中部某一醫學中心的乳癌病人為選樣對象，研究對象為施打太平洋紫杉醇藥物之乳癌病人，以冷療作為介入措施，於患者每次施打化療藥物時配戴冷凍手套於慣用手，設此為實驗組，而另一側未配戴冷凍手套則為對照組。評估工具包含基本資料與歐洲癌症病患生活品質量表(European Organization for Research and Treatment of Cancer quality of life questionnaire - chemotherapy-induced peripheral neuropathy 20, EORTC QLQ-CIPN20)，資料收集共四次(分別為打藥前及第一次打藥後第四週、第八週、第十二週及第十六週)。本研究使用重複測量(Repeated measurement)及成對樣本T檢定(Paired samples t-test)來進行資料分析。結果：本研究共收納22位女性乳癌患者，完成研究者共21位，另一位因疾病進展因素更改化療藥物，因此未完成本研究。本研究以重複測量分析實驗組與對照組整體手部周邊神經病變，除了第一次測量為基準對照值外，第二次測量(p = .028)、第三次測量(p = .001)、第四次測量(p = .035)及第五次測量(p = .002)皆有顯著差異，代表冷凍手套之介入對於緩解化療引起之周邊神經病變有顯著效果。特別是手指或手有針刺感、手指或手感覺麻木、手指或手有劇烈或灼熱的疼痛、用手指操作細小物件有困難、及手部無力而難以打開罐子或瓶子等項目皆有顯著效果。然而，樣本周邊神經病變的手抽筋、分辨熱水及冷水有困難、及握筆有困難導致寫字有困難等項目皆無顯著效果呈現。結論：整體來說，冷療能夠緩解化療引起之手部周邊神經病變，尤其是在針刺感、麻木感、灼痛感、操作細小物件以及開啟罐子或瓶子方面，故期望透過本研究將冷療推廣於臨床應用，以促進患者治療完整性及維持日常生活，並降低因副作用帶來之情緒困擾。

Background: The incidence of breast cancer is high in women. Most patients would receive chemotherapy with surgery or radiotherapy; however, there are many side effects of chemotherapy, such as nausea and vomiting, which can be relieved or prevented by medicine before chemotherapy. However, there is a side effect, that is, chemotherapy-induced peripheral neuropathy (CIPN), which can cause paresthesia and have an impact on physical function and daily life for months.Objective: The purpose of this study was to examine the effectiveness of frozen gloves in CIPN of the hands.Methods: This was a quasi-experimental study design. Frozen glove was provided for dominant hand of breast cancer patients while receiving paclitaxel treat, and as the experimental group. In addition, another hand as a control group. The questionnaire was used before chemotherapy and at the fourth, eighth, twelfth, and sixteenth weeks to understand the effectiveness of frozen gloves. The measurement instruments included the demography and European Organization for Research and Treatment of Cancer quality of life questionnaire-chemotherapy-induced peripheral neuropathy 20 (EORTC QLQ-CIPN20). The generalized estimating equation and paired samples t-test were used to test the research hypotheses.Results: Twenty-two female breast cancer patients who met the criteria of the study were recruited. There were 21 participants who completed five questionnaires, and one dropped out due to the disease progress. Repeated measurements were used to analyze the difference in overall peripheral neuropathy between the experimental and control groups. Except for the first measurement as a baseline, the incidence of peripheral neuropathy of the following measures were significantly lower in the experimental group. The frozen gloves worked effectively, particularly in “tingling,” “numbness,” “shooting or burning pain,” “manipulating small objects,” and “opening a jar or bottle because of weakness.” However, the frozen gloves were ineffective in “cramps,” “distinguishing between hot and cold water,” and “holding a pen.”Conclusion: In summary, cryotherapy can reduce CIPN in the hands, especially in tingling, numbness, shooting or burning pain, manipulating small objects, and opening a jar or bottle due to weakness. Moreover, cryotherapy can be promoted in the future among cancer patients for completion of chemotherapy and for maintenance of activities of daily living, as well as to reduce the emotional disturbance stemming from side effects.