初回がん薬物療法を受ける進行期非小細胞肺がん患者のQOLの推移

Quality of Life in Patients with Advanced Stage Non-Small Cell Lung Cancer Undergoing Cancer Drug Therapy (First-line)

要　旨

　本研究の目的は，初回がん薬物療法を受ける進行期非小細胞肺がん患者のQOLについて縦断的に調査し，QOLの推移や変化を明らかにすることであった．また，治療を継続できた患者と治療途中で死亡に至った患者のベースラインのQOLを比較した．分析対象者はA病院で2021年6月〜2023年3月の間に診断を受けた22名で，初回治療の3カ月間，治療開始前を含む4時点でQOLを測定した．QOLには自記式質問紙 European Organization for Research and Treatment of Cancer Quality of Life Questionnaire（QLQ-C30）を使用した．初回治療4回を完了できたのは10名で，2回目にC30の［健康度］や［趣味や仕事などの遂行］に改善があるものの，4回目では低下を認めた．完了10名と病状進行のため治療変更した8名を継続群とし，未継続群4名との2群でベースラインのC30を比較したところ，未継続群は［運動機能］［趣味や仕事などの遂行］が低く，有意差を認めた．EORTC QOL Group の参照値と比べても，未継続群の［健康度］や［趣味や仕事などの遂行］は参照値の標準偏差を超えて低かった．これらの結果は，治療3回目に看護支援を強化する必要性や治療前のQOLから臨床経過を予測した支援の必要性を示唆するものであった．

　This was a longitudinal assessment of the quality of life of patients with advanced-stage non-small cell lung cancer undergoing cancer drug therapy and aimed to identify trends and shifts in quality of life over time. We compared baseline quality of life between patients who were able to continue treatment and those who did not. The participants were 22 patients diagnosed between June 2021 and March 2023 at Hospital A. Quality of life was measured at four points during the first-line treatment for three months, including before the start of the treatment, using the self-administered European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Ten patients completed four courses of first-line treatment. Although the global health score [GHS] and role functioning [RF] (as measured by the C30 scales) improved by the second course, these gains declined by the fourth course. We compared the baseline C30 scores between the two groups: the continuous group, including ten patients who completed the treatment and eight patients who had to change treatments due to disease progression, and the non-continuous group of four patients who did not complete the treatment. The non-continuous group showed significantly lower physical functioning [PF] and RF. GHS and RF scores were lower than the standard deviations of the reference values in the EORTC QLQ. These findings underscore the need for enhanced nursing support during the third course and the importance of personalized support that anticipates clinical trajectories based on pretreatment quality-of-life assessments.