化学療法を受けている膵がん患者の健康関連QOLの特徴と栄養指標・食の苦悩の実態との関連

Relationship between Characteristics of Health-Related Quality of Life and Nutritional Indicators and Eating-Related Distress in Pancreatic Cancer Patients Undergoing Chemotherapy

要　旨

　目的：膵がん患者の66〜84％は中等度以上の体重減少を呈する．そのため，患者は食に対する悩みをかかえ，QOL に影響を及ぼすことが推察される．本研究の目的は，膵がん化学療法中の患者の健康関連QOL の特徴を明らかにし，栄養指標・食の苦悩との関連を検討することである．

　方法：化学療法中の膵がん患者のうち，同意の得られた33名を対象に自記式質問紙および診療録による調査を行った．項目は基本属性，診療関連情報，Functional Assessmentof Cancer Therapy-Hepatobiliary（FACT-Hep），栄養指標，食の苦悩とした．分析はFACT-Hep の平均値を基準に高群と低群に分類し，ほかの変数との関連を統計的に比較した．

　結果：FACT-Hep の平均は117.1 ± 23.7 であり，対象者の72.7〜78.9％が軽度以上の栄養障害を有していた．FACT-Hep の高低群の比較では，栄養指標に有意差はみられず，食の苦悩では「食べないといけないとわかっているが食べられない」（p＝0.033），「食事を用意してくれた家族の思いに応えられない」（p＝0.009）の割合がFACT-Hep 低群で有意に高いことが示された.

結論：膵がん患者のQOL 向上にはFACT-Hep 評価による症状マネジメント，食の苦悩を緩和する取り組みの必要性が示唆された．

　Background: Patients with pancreatic cancer show moderate to severe weight loss in 66-84% of cases. This suggests that, pancreatic cancer patients experience eating-related distress, which is presumed to affect their quality of life (QOL). Therefore, the purpose of this study was to characterize the health-related QOL in patients undergoing pancreatic cancer chemotherapy and to examine its relationship with nutritional indicesand eating-related distress.

　Methods: A self-administered questionnaire and medical record survey were conducted with 33 pancreatic cancer patients undergoing chemotherapy after obtaining their informed consent. The survey items included basic information, medical-related information,Functional Assessment of Cancer Therapy-Hepatobiliary(FACT-Hep), a disease-specific QOL Assessment Scale for Patients with Hepatobiliary and Pancreatic Cancer, and nutritional indices. Analysis was based on the mean value of FACT-Hep, which was classifiedinto high and low groups, and statistical group comparisons were made with respect to the association with other variables.

　Results: The mean FACT-Hep was 117.1±23.7, and 72.7-78.9% of subjects had more than mild nutritional disorders. Comparison of the low and high FACT-Hep groups showed no significant differences in nutritional

indices. The low FACT-Hep group showed significantly higher rates of feeling “Although I know that I have to eat enough, I cannot do it.” (p=0.033) and “I am burdened by the meals that my family serves me” (p=0.009) in the eating-related distress items.

　Conclusions: Our results suggest that symptom management based on FACT-Hep assessment and efforts to alleviate eating-related distress are necessary to improve the quality of life of pancreatic cancer patients.