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항암치료 후 발생한 식욕부진, 오심에 대하여 독활지황탕 투여 후 삶의 질 개선 증례 보고 1례

A Cancer Patient Suffering from Chemotherapy-Induced Anorexia and Nausea Treated by Herbal Medicine (Dokhwaljihwang-tang-gamibang) Resulted in Improved Quality of Life: A Case Report

Abstract

Despite a considerable improvement in antiemetic chemotherapy and the use of antiemetic prophylaxis for decades, there are still numerous cancer patients suffering from anorexia and nausea after chemotherapy, which forces them to postpone or refuse treatment. This case report is about a 66-year-old female patient diagnosed with malignant lymphoma of the small intestine who underwent right hemicolectomy. After the tumor and the colon adjacent to it were surgically removed, the patient continued to undergo chemotherapy. Chemotherapy-induced anorexia and nausea appeared but were well treated with administration of Dokhwaljihwang-tang-gamibang. During the treatment, no adverse effect related to this Korean medicine was reported. The outcome was evaluated by the functional assessment of anorexia/cachexia therapy (FAACT); the total score increased from 85 to 130 within 12 days, and the symptoms were alleviated. This improvement might suggest the feasibility of Dokhwaljihwang-tang-gamibang to help cancer patients suffering from chemotherapy-induced anorexia and nausea.

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핵심어 질문 논문에서 추출한 답변
5HT3RA 제제
양방치료인 5HT3RA 제제의 단점은 무엇인가?
투여되는 경로가 제한적이거나, 심혈관질환, 소화기 장애 등의 부작용을 초래하며, 급성기에만 유효한 한계가 있다

따라서 항암치료 중 나타나는 식욕부진, 오심 및 구토의 예방 및 관리가 매우 중요하나, 현재까 지 발표된 항암화학요법의 후유증에 대한 양방치료엔 한계가 있다 6. 현재 보고된 항암치료 후유증 에 대한 양방치료로 5HT3RA 제제가 있는데, 투여되는 경로가 제한적이거나, 심혈관질환, 소화기 장애 등의 부작용을 초래하며, 급성기에만 유효한 한계가 있다 7. 이 밖에 일부 식욕촉진제는 암환자의 식욕부진 완화목적으로 우선적으로 사용되나, 부신기능억제를 유발할 수 있다 6.

항암화학요법
항암화학요법 중 발생하는 CINV는 암환자에게 어떤 결과를 초래하는가?
일상 기능 및 삶의 질을 떨어뜨려 부정적인 결과를 초래하는데, 육체적 피로감, 정서적 우울함, 항암치료에 대한 스트레스로 치료에 대한 순응도 저하, 죽음에 대한 공포 및 불안 심화가 있다

항암화학요법은 수명연장과 증상 경감을 위한 주요한 암 치료법 중 하나이지만, 오심과 구토가 가 장 흔한 부작용으로, chemotherapy-induced nausea and vomiting(CINV)이라 지칭하며, CINV는 항암 치료를 받는 암환자의 70-80%에서 나타난다22. CINV 는 일상 기능 및 삶의 질을 떨어뜨려 부정적인 결과를 초래하는데, 육체적 피로감, 정서적 우울함, 항암치료에 대한 스트레스로 치료에 대한 순응도 저하, 죽음에 대한 공포 및 불안 심화가 있다4. 항구토제를 사용함으로써 오심과 구토를 다소 경감시킬 순 있지만, 설사, 두통, 아미노전이효소 상승과 같은 다른 부작용을 일으킨다 22.

항암화학요법
항암화학요법 중 가장 흔하게 나타는 부작용은 무엇인가?
오심과 구토

암환자들은 암 질병 자체로 인한 증상뿐만 아니라, 수술, 방사선요법 및 항암화학요법 등의 치료 과정 중 수반되는 부작용에 대항하여 견뎌야 한다 1. 항암화학요법 중 가장 흔하게 나타나는 부작용으로 오심과 구토가 있는데, 암 환자의 약 45-65%에서 오심을, 15-25%에서 구토를 경험하며 2, 3, 이렇게 항암치료로 유발된 오심과 구토는 삶의 질을 현저히 떨어뜨린다 4. 또한 암 환자의 15-40%에서 식욕 부진, 영양실조, 근육량 감소가 연쇄적으로 일어나는데, 이 경우 예후가 나쁘며 조기에 사망할 수 있다5.

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참고문헌 (36)

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