進行食道がんのために化学放射線療法を受けた初老男性患者のがんを生き抜くプロセス─食道がんを超えて生きる知恵を生み出す

The Cancer Survivorship Process of Elderly Male Patients with Advanced Esophageal Cancer Undergoing Chemoradiotherapy : Gaining Wisdom for Living beyond Cancer

要旨

　目的は，進行食道がんのために化学放射線療法を受けた初老の男性食道がん患者が，いかにして食道がんを生き抜いていくか，そのプロセスを明らかにすることである．対象は，進行食道がんのために化学放射線療法を受けた60〜70歳代の男性食道がん患者11名で，半構成的面接にてデータを収集し，修正版グラウンデッド・セオリー・アプローチの手法を用いて分析した．

　結果，食道がんの脅威の中を生きるだけではなく，食道がんを超えて生きる知恵を生み出すプロセスが示された．対象者らは，食道がんを告げられ，【食道がんの脅威の中を生きる】という衝撃の中を，自分の［からだと対話する］ことによって【食道がんを生き抜くために自分が動き出し】ていた．このことが【食道がんの脅威の中を生きる】ことを脱して，【食道がんを超えて自分の人生を生きる】ことへと，プロセス全体を大きく転換させていた．そして対象者らは，古い価値観やこだわりを捨て［新しいペースをつくり出］し，がんになった人生であっても，自分の人生を生き抜いてきた証として人生の意味を見いだした．そして［自分自身に誇りをも］ち，【がんを超えて自分の人生を生き】ようと変化していた．

　食道がんという疾患や侵襲の強い治療に伴う障害を改善し，対処するだけに留まらず，がんサバイバーシップの観点に立つがん看護実践に向けて，がんを超えて生きる力を支えていくこと，特に自分のからだと対話しながら，自分で動き出すという転換点に焦点を当てた看護を探究することが看護実践への示唆となった．

Abstract

　The aim of this study was to explore the life process of elderly male patients who wished to survive advanced esophageal cancer by undergoing chemoradiotherapy(CRT). Semistructured and in-depth interviews were conducted with 11 elderly males who were advanced esophageal cancer patients. The data were analyzed using the Modified-Grounded Theory Approach.

　The interview results elucidated not just living with the threat of esophageal cancer, but also the process of gaining wisdom for living beyond esophageal cancer. When the participants were informed about their esophageal cancer, they felt that "living with the threat of esophageal cancer" was as if they were close to death. By "communicating with their bodies", participants living with the threat of esophageal cancer understood that they had to "start making an attempt to survive esophageal cancer". By thinking of "living one's life beyond esophageal cancer" instead of "living with the threat of esophageal cancer", they significantly improved their perception of the overall life process. The subjects disregarded traditional values and hang-ups to "create a new pace of life" and discovered the meaning of life through cancer survival despite the hardships. Consequently, they "took pride in themselves" and changed their perception by "living their life beyond esophageal cancer".

　Nursing care is very important for managing and improving behavioral changes caused by cancer and intense invasive treatments such as CRT. However, nursing from the perspective of cancer survival seeks to increase the patient's strength to survive cancer, especially focusing on the turning point in the patient's behavior. Moreover, nursing care helps patients to communicate with their own bodies and start moving forward by themselves.