中藥外敷是否能改善頭頸癌病人放射性皮膚炎的嚴重程度Can external application of Chinese medicine improve the severity of radiation dermatitis in patients with head and neck cancer

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2020-07-16 已刊登
新刊登 綜 整 預防/治療/介入類型

作  者

李宜柔 林美惠*

實證知識類別

B 類:實證健康照護應用

PICO

治療/預防性問題

治療/介入措施

腫瘤醫學 Oncology

科別

  • 護理及健康管理 Nursing and Health Management
  • 腸胃護理 Gastroenterology Nursing
  • 腫瘤護理 Oncology Nursing

中文關鍵詞

頭頸癌病人 中藥 放射線皮膚炎

英文關鍵詞

Patients with head and neck cancer receive radiation therapy radiation dermatitis Chinese herbal medicine

機構名稱

長庚醫療財團法人基隆長庚紀念醫院

申請單位

血腫科病房

中文摘要

形成臨床提問:
放射性皮膚炎是頭頸癌病人接受放射線治療時最常見的副作用,皮膚發炎反應可能會令病人感到不舒服甚至痛苦,並會有感染的風險,且可能會對病人的生活品質產生負面影響,目前在預防和管理上尚無標準,且缺乏實證證據,因此,如何預防頭頸癌病人接受放射線治療引起知放射皮膚炎顯得重要。臨床問題為:中藥是否能預防頭頸癌病人接受放射線治療引起的放射性皮膚炎?
文獻搜尋的方法與分析:
依據實證護理步驟,設定「PICO」關鍵字搜尋,並使用MESH檢索同義字於PubMed、Clinical Key、Embase、Cochrane Library、及華藝線上圖書館,限制十年內中英文文獻,符合檢索限制及PICO的文章有2篇隨機對照試驗研究。本文使用英國Better Value Healthcare機構所研發的Critical Appraisal Skill Program (CASP) RCT checklist中文版進行有效性、重要性/影響力、臨床可應用等三方面的評讀。
文獻的品質評讀:
列入評讀之文章依照以Oxford CEBM 2011 Levels of Evidence將文章做分級,評析文章一篇屬於Level 2,一篇因有3項評讀結果不明確,故判定為Level 3。以個案特性來看,研究對象皆為頭頸癌接受放射線治療病人(>18歲),介入措施採用含蘆薈產品作為皮膚照護。測量方法採用NCI CTCAE( National Cancer Institute Common Terminology Criteria for Adverse Events) 或RTOG( the Radiation Therapy Oncology Group)評估放射性皮膚炎的嚴重程度。兩篇研究在統計學上具有顯著意義(p < .04; p < .012)。
證據之臨床應用:
運用實證知識轉譯之7步驟進行改善,推行同時進行結果分析。研究期間自2019年08月20至2019年12月31日,應用於3位頭頸癌有接受放射線治療病人,由主治醫師向病人解釋後取得病人同意後會診中醫科醫師開立如意金黃膏布使用。
成效評值:
本次臨床實證護理應用於3位頭頸癌有接受放射線治療之病人,評值方式採用RTOG(Radiation Therapy Oncology Group)評估放射性皮膚炎的嚴重程度,於治療結束後放射線治療劑量均為66Gy,RTOG級均維持在1級,疼痛分數2分。
結論與建議:
經由實證文獻搜尋結果,雖顯示放射線皮膚炎在頭頸癌病人接受放射線治療過程時是無法避免的毒性反應,為避免病人因放射性皮膚炎導致療程被迫中斷,依照此次實證結果顯示中藥外敷對於減緩放射線皮膚炎,可能更優於對照組,臨床試用在三位病人上其結果與文獻相類似,確實有延緩放射線皮膚炎發生的時間及嚴重度,不過,仍需要更多大型臨床試驗證明其確實的治療及預防效果。

英文摘要

Ask an answerable question (PICO):
Radiation dermatitis is a common side effect of radiotherapy, which most frequently used therapeutic modalities in Head and neck Cancer. However, patients who suffer from radiation dermatitis may also have substantial discomfort and pain, even lead to local or systemic infections, which could affect the quality of life. To date the literature contains no consensus or universal standard for preventing and management of radiotherapy skin toxicities. Therefore, preventing radiation-induced dermatitis is important issue for patients treated with radiotherapy for Head and Neck Cancer. The clinical problem is Prophylaxis of Radiation-Induced Dermatitis in Patients with Head and Neck Cancer by using Herbal Creams.
The Method and Analysis of Literature Review:
PICO keyword search was set according to the empirical nursing steps, and synonyms were retrieved by MESH in the PubMed Clinical Key Cochrane Library and Huayi online Library. Limit the Chinese and English literature within ten years, which meets the search restrictions and PICO’s the article has 2 randomized controlled trials. This article uses the Chinese version of the Critical Appraisal Skill Program (CASP) RCT checklist developed by Better Value Healthcare in the UK to evaluate the effectiveness, importance/influence, and clinical applicability.
Critical Appraisal:
Included in the review of reading articles according to Oxford CEBM 2011 Levels of Evidence to make articles classification, analyzes the article belongs to Level 2, read an article with the three evaluation results are not clear, so the judge for Level 3. According to the characteristics of the cases, all the subjects were head and neck cancer patients who received radiation treatment (>18 years old), and the intervention measures used aloe-containing products as skin care. The measurement method used NCI CTCAE (National Cancer Institute Common Terminology Criteria for Adverse Events) or RTOG (the Radiation Therapy Oncology Group) to assess the severity of radiation dermatitis. The two studies were statistically significant (p <.04; p <.012).
Clinical Application of Evidence:
Using 7 steps to improve the empirical knowledge of translation, at the same time to analyze the results. Study period since August 20, 2019 to December 31, 2019, applied in 3 patients with head and neck cancer with radiation therapy, the doctor explained to the patient after obtaining permission from the patient consultation regions physicians use Ruyi-Jinhuang Gao.
Evaluation of Effectiveness:
The clinical evidence-based nursing applied in three patients with Radiation Therapy of head and neck cancer, The evaluation method used RTOG (Radiation Therapy Oncology Group) to assess the severity of radiation dermatitis. After the treatment, the radiation therapy dose was 66Gy, RTOG grade All maintained at level 1, with a pain score of 2 points.
Conclusions and Recommendations:
Through empirical literature search results, show that radioactive dermatitis in head and neck cancer patients receiving radiation treatment process is unable to avoid toxic reaction, in order to avoid the patient treatment caused by radioactive dermatitis was forced to interrupt, according to the empirical results show that the traditional Chinese medicine external treatment to reduce radioactive dermatitis, may be more better than the control group, the clinical trial in three cases the result is similar with the literature, do have to delay the time and the severity of radioactive dermatitis occurs, however, still need more large clinical trials to prove its effect of treatment and prevention.