補助化学療法中の初発乳がん患者の倦怠感への取り組み

Coping with Fatigue in Patients with Primary Breast Cancer Undergoing Adjuvant Chemotherapy

要　旨

　本研究の目的は，補助化学療法中の初発乳がん患者の倦怠感に対する取り組みを明らかにすることである．補助化学療法を受けている22名の初発乳がん患者を対象に，半構造化面接を行い，質的帰納的に分析した．

　その結果，倦怠感への取り組みとして，【やるべきことを選り分け今を乗り切る】【体調を見極めながら活動量を調整する】【動くペースを意識して消耗しない方法を見出す】【自分なりの方法で活動を拡げ新たな活力を得る】【回復に合わせた活動ができないことを自覚する】【いつもどおりの生活を維持するために必要な支援を受ける】【思うようにならない状況を1 人でかかえ込む】の7カテゴリーが得られた．患者は，倦怠感の変動性に応じて，単にエネルギー消費を抑えるだけではなく，身体に意識を向けてその日の体調を指標に活動の量や質に注意を払い行動していた．また，自分に合った方法を模索しながら活動を拡げていた．

　患者の倦怠感に対する対処能力を高めるためには，生活の支障に応じた活動調整の方法や，患者に合わせた活動の指標を示す看護支援の重要性が示唆された．

　This study aimed to determine the ways of coping with fatigue in patients with primary breast cancer undergoing adjuvant chemotherapy. We conducted semi-structured interviews with 22 patients diagnosed with primary breast cancer who were undergoing neoadjuvant or adjuvant chemotherapy and analyzed the data qualitatively and descriptively.

　The following seven categories were extracted as ways of coping with fatigue: “select what needs to be done and get through the current situation,”“adjust the amount of activities while assessing one's physical condition,”“be aware of the pace at which one moves and finding ways to avoid exhaustion,”“expand activities in one's own way and gain new vitality,”“be aware of not being able to do activities to match one’s own recovery,” “get the help one needs to maintain life as usual,” and “endure situations that are not the way one wants them to be alone.” In response to the variability of fatigue, patients did not simply reduce their energy expenditure but were also aware of their bodies; they acted with attention to the quantity and quality of their activities, using their physical condition for the day as an indicator. They also expanded their activities and sought those that would suit them.

　The results suggest that nursing is important for improving patients’ ability to cope with fatigue by providing methods to adapt activities to life obstacles and indicators of activities tailored to patients.