Methods: This pilot study is a two-group pretest-posttest longitudinal study. Data were collected at pre-targeted therapy, 1 and 3months after the targeted therapy prospectively. Convenience sampling was used to recruited patients from thoracic and oncology ward / outpatient department of a medical center in northern Taiwan. Eighty-five patients were randomly assigned with 40 patients in the experimental group and 45 patients in the control group from Nov 2017 to July 2018. The control group received routine care of targeted therapy. The experimental group received a skin care self-management program besides routine care of targeted therapy. The skin care self-management program for this study, that aimed to improve the patients’ ability of skin care, is developed based on Self-Efficacy Theory and Causal Model of Behavior Change.
Results: There were no difference between groups in demographic data, treatment-related characteristics, skin care self-efficacy, and status of anxiety and depression at pretest. The score of depression was significantly lower in the experimental group than it was in the control group at one month (p <.05) after pretest. The score of skin care self-efficacy was significantly higher in the experimental group than it was in the control group at one month (p < .001) and three months (p < .001) after pretest. The score of skin care self-efficacy was significantly higher in the experimental group than it was in the control group at one month (p < .001) and three months (p < .001) after pretest. The status of social function was significantly better in the experimental group than it was in the control group at one month (p < .05) and three months (p < .05) after pretest. After the intervention, significant improvements were found in the experimental group in quality of life (p < .05). There were no difference between groups in severity of skin toxicity and avoiding dose-reduce or discontinued of EGFR-tyrosine kinase inhibitor after pretest.
Conclusion: Early identification of skin toxicity during targeted therapy is useful to conceptualize the impact of skin toxicity on a health trajectory, as this provides a comprehensive means to link a patient’s past, present, and projected future health condition and places the patient’s health within a specific context.
The skin care self-management program is developed based on Self-Efficacy Theory and Causal Model of Behavior Change, the contents include knowledge about target therapy, skin cleansing (scalp, face, body), skin hydration and photo protection, fingers and toes protection, oral care, diarrhea managing, relaxation technique, breathing control methods and maintaining a healthy lifestyle. . We suggest healthcare professionals to apply this program to advanced non-small cell lung cancer patients with skin toxicity during targeted therapy.
Most of our participants lived with their families (92.5% in experimental group and 95.6% in control group). The family kinship system in Taiwan is different from that of Western families. Families play a key role in motivating patients to attend healthcare programs. A patient-centred program of disease self-management should not only be focused on patients’ health problems and psychological distress, but also on educating family members about the benefits of self-management.