背景：化療誘發周邊神經病變（Chemotherapy-induced peripheral neuropathy, CIPN）是指化療藥物引發周邊神經功能的損傷及病理變化，會造成病人有四肢末梢刺痛、麻木、疼痛或肌肉無力等症狀。據研究顯示約70%使用具神經毒性化療藥物的病人會發生周邊神經病變的副作用，且因使用藥物及個人體質的不同，每個病人所發生神經病變的症狀差異極大。有些病患使用藥物完全不會有周邊神經病變的症狀或僅有四肢末梢輕微感覺異常，但有些病患卻會嚴重到感覺遲鈍，肌肉無力影響日常生活。對於這多樣化且具個別性差異的症狀增加臨床醫護人員在症狀評估及照護上的困難，因此對於CIPN 症狀群之預測與對生活品質影響更顯重要。
目的：本研究主要目的為探討CIPN 病人症狀群集在化學治療期間的變化，以及人口學及健康醫療變項在各病人症狀群集間差異。次要的研究目的為探討人口學、健康醫療變項對不同化學治療階段CIPN 症狀及治療結束後生活品質的預測力。
研究方法：本研究為縱貫性的次級資料分析，資料來源為「To Study The Individual Variants of Chemotherapy-Induced Neurotoxicity （Colorectal, Ovarian, and Endometrial Cancer）」研究資料庫。統計分析首先使用群集分析（Cluster analysis）的方式，將三個不同時間點（化療前T0，化療中T1 及化療結束後T2）的病人群集，接著使用ANOVA 及卡方檢定分析各個症狀子群集在人口學及健康醫療變項的差異。再來使用趨勢分析探討在CIPN 症狀是否會隨著時間而有所變化，最後使用逐步迴歸分析探討人口學、健康醫療變項對不同化學治療階段CIPN 症狀對治療結束後生活品質的預測力。
結果：研究收案人數為化療前115 人，化療中104 人及化療結束後96 人，在三階段(化療前、化療中及化療後)皆有完整資料的個案人數為89 人。CIPN 病人症狀群會隨著時間而變化，在T0 可依CIPN 症狀將病人分為運動神經較高群（n = 23）、所有症狀皆低群（n=77）及感覺神經較高群（n=15）三群；T1 及T2 可分為感覺神經較高群（T1: n=27; T2: n=39）、所有症狀皆低群（T1: n=70; T2:n=38），及所有症狀皆高群（T1: n=7; T2: n=19）三群。在T0 高血壓在個症狀子群集間有顯著差異，在感覺神經症狀教高群所佔高血壓比例約50 %較所有症狀皆低群（25%）顯著高出許多。在T1 各症狀子群集間則是在年齡有顯著差異，所有症狀皆高的群集平均年齡較所有症狀皆低群及年輕10 歲。在T2 高血壓在所有症狀皆高群約佔50%，較有症狀皆低群
（27%）高出許多。在趨勢分析方面，CIPN 症狀會隨著時間而有所變化，在T0 CIPN20的平均分數為16.94 分，T1 為19.26 分及T2 為28.56 分，隨時間及治療次數的增加，CIPN 的症狀會越來越嚴重（P=0）。有關T1 階段CIPN 症狀的預測因子，化療藥物種類可預測化療中）CIPN 的症狀嚴重程度（adjusted R2=0.079）。T2 階段CIPN 症狀的預測因子，化療藥物種類及性別可以預測化療結束（T2）CIPN 的症狀嚴重程度（adjusted R2=0.124），接受Paclitaxel 治療的病人其CIPN 症狀會較接受Oxaliplatin的病人多，使用Oxaliplatin 或女性的病人會較使用Paclitaxel 或男性的病人有較多的CIPN 症狀。在生活品質預測力方面，年齡、化療藥物種類及化療結束後（T2）CIPN症狀可預測化療結束後（T2）生活品質的高低（adjusted R2=0.349），年紀越大生活品質越差，使用Paclitaxel 的病人相較於使用Oxaliplatin 的病人會有較差的生活品質，T2 CIPN 症狀多的病人也會有比較差的生活品質。
結論：病人在不同化學治療階段會呈現不同CIPN 的症狀，臨床醫護人員應因特別注意高危險群病人（高血壓、年紀輕、女性及接受Oxaliplatin 治療）症狀的表現，定期評估病人的神經功能，隨時掌握病人CIPN 症狀的表現情形，給予個別化的照護或適
時的轉介神經科。在化療結束後，年紀大、使用Paclitaxel 及CIPN 症狀多的病人會有較差的生活品質，臨床醫護人員應長期持續追蹤此類病人，加強評估病人CIPN 症狀及生活品質的狀態。

Chemotherapy-induced peripheral neuropathy is one of side effects caused by Chemotherapy. Patients complain tingling, burning pain, numbness or muscle weakness on their extremities. Those symptoms not only make patients uncomfortable, but also make some trouble on their daily life. This study aims to investigate chemotherapy-induced
neurotoxicity symptom clusters at different period during chemotherapy treatment and to find out high risk factors and predictors of CIPN in cancer patients receiving Taxanes and
Oxaliplatin chemotherapy. It was a secondary data analysis study, recruiting 115 patients at T0 (before chemotherapy), 104 patients at T1 (after first time chemotherapy), and 96
patients at T2 (end of chemotherapy). The number of patients who have complete data at three time points is 89. Symptoms will be worsen as the time pass by (P=0). Patients were classified into three subgroups through cluster analyses at three period during chemotherapy. Diagnosis of hypertension (T0&T2) and age (T1) were significantly different among three
subgroups. Type of chemotherapy can predict grade of CIPN at T1 (adjusted R2=0.079). Type of chemotherapy and gender can predict grade of CIPN at T2 (adjusted R2=0.124). Age, type of chemotherapy and CIPN grade at T2 can predict QOL at T2 (adjusted R2=0.349). Patients will present different symptoms of CIPN at different period of chemotherapy. Clinical staff should pay attention on the high-risk patients (high blood
pressure, young age, female and using Oxaliplatin treatment), regularly assess the patient's neurological functions, quality of life and give those patients individual care.

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