治療過程にある高齢がん患者の“がんと共に生きる”ことに対する受け止め

Acceptance of "Living with Cancer" among Older Patients during Cancer Treatment

要旨

　本研究の目的は，治療過程にある高齢がん患者が“がんと共に生きる”ことをどのように受け止めているのかを明らかにすることである．入院して手術療法もしくは化学療法や放射線療法を受けている高齢がん患者24名を対象に半構成的な面接法を用いてデータを収集し，Krippendorffの内容分析を参考に分析した．その結果，治療過程にある高齢がん患者が“がんと共に生きる”ことに対する受け止めとして，【がんに抵抗しないで成り行きに任せる】，【最後まで人生を全うしたい】，【虚弱な自分を実感】，【耐えがたく不安で辛い】の4つの大カテゴリーで構成されていた．治療過程にある高齢がん患者は，高齢者が持つ長年の生活史を糧として，がんという脅威に対して自分にとって負担がないように受容し，生の限界を感じるからこそ生きることへの重みを感じながら“がんと共に生きて”いた．もう一方で，がんと加齢にともなう衰退の要素による二重の苦悩を持ち合わせながら，“がんと共に生きて”いた．以上から，高齢がん患者の持つ過去の経験は人生を反芻するうえで重要な材料であり，がんという脅威を乗り越える契機につながることが示唆された．看護師が生活者として生きてきた高齢がん患者が持つ生活史に視点を向けることは，高齢がん患者が“がんと共に生きる”ことを受け止めていくうえで重要な情報になると考えられた．

Abstract

　The purpose of this study was to clarify ways in which older people, in the course of cancer treatment, accept and coped with "living with cancer". Data were collected, using semi-structured interviews, from 24 hospitalized older patients undergoing surgery, chemotherapy or radiotherapy. Collected data were analyzed with reference to Krippendorff's content analysis method. The results showed that acceptance of "living with cancer" among older patients in the process of treatment could be divided into four main categories: 'letting cancer take its course without resistance', 'still wanting to complete one's life', 'realizing one's own fragility' and 'being overwhelmed with anxiety and bitterness'. Older people could draw on their long life experience to accept the threat of cancer without being overwhelmed by it, reinterpreting their sense of being at the limit of life to a sense of realizing the importance of life, as they "lived with cancer". At the same time, older patients in the course of treatment "lived with cancer", by receiving a double blow with the combination of decline due to cancer and decline due to ageing. The past experiences of older patients with cancer were thus important resources for reflecting on life and it seems that this may be linked to an opportunity for overcoming the threat of cancer. For nurses, focusing on the life history of older cancer patients may be an important way of obtaining information that can help older cancer patients "live with cancer".