術後補助化学療法を受けながら就労する胃がん患者の就労継続における阻害要因と促進要因

Inhibitors and Facilitators for the Continuation of Employment in Gastric Cancer Patients Who Work While Receiving Postoperative Adjuvant Chemotherapy

要　旨

　本研究の目的は，術後補助化学療法を受けながら就労する胃がん患者の就労継続における阻害要因と促進要因を明らかにすることである．術後化学療法を受けながら就労する胃がん患者8名に半構造化面接を行い，質的帰納的に分析を行った．就労継続の阻害要因として，【胃切除による生活の変化】，【術後補助化学療法の副作用による苦痛】，【治療による社会生活への適応の難しさ】，【治療による就労継続への懸念】【就労継続に必要な情報不足】の5カテゴリが抽出された．就労継続の促進要因として，【治療と就労の両立を目指すセルフケア行動】，【治療と就労が両立できる制度や体制】，【就労意欲を支える周囲の協力】，【仕事への原動力】の4カテゴリが抽出された．

　就労継続の阻害要因として，胃切除や術後補助化学療法による副作用は日常の食事や排泄に直接的に影響を及ぼし，体力低下や不安を招いていた．いつ改善するのかわからない食欲不振など，予測や自己コントロールが難しい症状により，就労意欲は低下しQWL に影響していた可能性がある．就労継続の促進要因として，術後補助化学療法は初めての体験でも，自分なりの対処や調整の積み重ねを通して，調整力や対処能力が養われていた．同僚の理解や協力，職場環境の充実は就労意欲を高めることにつながっていた．

　The purpose of this study was to identify facilitators and inhibitors of continued employment among gastric cancer patients who are working while receiving adjuvant chemotherapy. Semi-structured interviews were conducted with eight gastric cancer patients who were working while receiving postoperative chemotherapy, and were analyzed qualitatively and inductively. Five categories of disincentives to continue working were identified: “changes in life due to gastrectomy”, “distress due to side effects of adjuvant chemotherapy”, “difficulty adjusting to social life due to treatment”, “concerns about continuing to work due to treatment”, and “lack of information necessary to continue working”. Four categories were identified as factors that promote continuation of employment: “self-care behavior aimed at balancing treatment and employment”, “systems and structures that enable balancing treatment and employment”, “surroundings that support motivation to work”, and “motivation to work”.

　As disincentives to continue working, side effects from gastrectomy and postoperative adjuvant chemotherapy　directly affected daily eating and defecation, resulting in physical weakness and anxiety. Due to symptoms　that were difficult to predict or control, such as loss of appetite without a clear timeline for improvement, the patient’s willingness to work may have decreased and affected QWL. As a factor promoting continued employment, even though postoperative adjuvant chemotherapy was new to the patient, they had developed their coordination and coping skills through their own coping and adjustment process. The understanding and cooperation of coworkers and the work environment were conducive to increased motivation to work.