Yu Chu-Chun, Chu Chia-Yu, Lai Yeur-Hur, Hung Chia-Tai, Chan Jui-Chun, Chen Yen-Ju, Hsu Hui-Te, Lee Yun-Hsiang
Author Affiliations: Department of Nursing, National Taiwan University Hospital (Mrs Yu, and Drs Lai and Lee); Department of Dermatology, National Taiwan University Hospital, National Taiwan University College of Medicine (Dr Chu); School of Nursing, College of Medicine, National Taiwan University (Drs Lai and Lee); and Department of Nursing, National Taiwan University Cancer Center (Dr Lai), Taipei; Department of Nursing, Mackay Medical College (Dr Hung and Ms Chan), New Taipei City; Department of Nursing, Da-Yeh University (Dr Chen), Changhua; and Department of Dermatology, Far Eastern Memorial Hospital (Dr Hsu), New Taipei City, Taiwan.
Cancer Nurs. 2023;46(6):488-495. doi: 10.1097/NCC.0000000000001147. Epub 2022 Dec 1.
Most advanced non-small-cell lung cancer (NSCLC) patients received targeted therapies of epidermal growth factor receptor tyrosine kinase inhibitors. However, few studies reported the relationships between adverse events (AEs) and psychological distress.
The aims of this study were to (1) examine the differences in the incidence of AEs, fear of progression (FoP), anxiety, and depression among 3 generations of epidermal growth factor receptor tyrosine kinase inhibitors (first, gefitinib and erlotinib; second, afatinib; third, osimertinib) and (2) examine the difference in levels of FoP, anxiety, and depression between the presence and absence of AEs in NSCLC patients.
This study used a cross-sectional study design. Patients with NSCLC (N = 120) were recruited from a medical center in northern Taiwan. Adverse events, FoP, anxiety, and depression were assessed by questionnaires.
The incidence rates of photosensitivity, mouth and throat sores, and diarrhea were significantly high in the gefitinib, erlotinib, and afatinib groups, respectively. A lesser proportion of patients experienced AEs in the osimertinib group, compared with those in the gefitinib and erlotinib, and afatinib groups. The incidence rates of FoP, anxiety, and depression were 13.8% to 26.0%, 24.1% to 40.4%, and 17.6% to 40.0%, respectively. Patients with photosensitivity, paronychia, and alopecia had significantly higher levels of FoP, anxiety, and depression.
This study confirmed the priorities of care among 3 generations of epidermal growth factor receptor tyrosine kinase inhibitors in NSCLC patients, using both the Common Terminology Criteria for Adverse Events (CTCAE 4.03) and PRO-CTCAE 1.0. Photosensitivity, paronychia, and alopecia were associated with higher levels of FoP, anxiety, and depression. Therefore, these AEs require further management.
Our study suggests a follow-up to address AEs and psychological distress.
大多数晚期非小细胞肺癌（NSCLC）患者接受了表皮生长因子受体酪氨酸激酶抑制剂的靶向治疗。然而，很少有研究报道不良事件（AE）与心理困扰之间的关系。
本研究的目的是：（1）检查三代表皮生长因子受体酪氨酸激酶抑制剂（第一代，吉非替尼和厄洛替尼；第二代，阿法替尼；第三代，奥希替尼）之间不良事件、疾病进展恐惧（FoP）、焦虑和抑郁发生率的差异；（2）检查NSCLC患者中存在和不存在不良事件时FoP、焦虑和抑郁水平的差异。
本研究采用横断面研究设计。从台湾北部的一个医疗中心招募了120例NSCLC患者。通过问卷评估不良事件、FoP、焦虑和抑郁情况。
吉非替尼、厄洛替尼和阿法替尼组的光敏反应（皮疹）、口腔和咽喉溃疡以及腹泻的发生率分别显著较高。与吉非替尼、厄洛替尼和阿法替尼组相比，奥希替尼组经历不良事件的患者比例较低。FoP、焦虑和抑郁的发生率分别为13.8%至26.0%、24.1%至40.4%和17.6%至40.0%。有光敏反应、甲沟炎和脱发的患者的FoP、焦虑和抑郁水平显著更高。
本研究使用不良事件通用术语标准（CTCAE 4.03）和PRO-CTCAE 1.0确定了NSCLC患者三代表皮生长因子受体酪氨酸激酶抑制剂的优先护理事项。光敏反应、甲沟炎和脱发与更高水平的FoP、焦虑和抑郁相关。因此，这些不良事件需要进一步管理。
我们的研究建议对不良事件和心理困扰进行随访。
