オキサリプラチンによる末梢神経障害をもつ進行再発大腸がん患者の体験

Experiences of Advanced and Recurrent Colorectal Cancer Patients with Oxaliplatin-induced Peripheral Neuropathy

要旨

　本研究の目的は，オキサリプラチンによる末梢神経障害をもつ進行再発大腸がん患者の体験を明らかにすることである．対象者は進行再発大腸がんでオキサリプラチンによる外来化学療法を受け，末梢神経障害が出現している患者8名であり，インタビューガイドを用いた半構成的面接法を行った．データを逐語録にし，対象者の末梢神経障害の体験に関する部分を最小単位に抽出してコード化し，意味内容の類似性と差異に着目して分類しカテゴリー化した．その結果，治療前には想像できないオキサリプラチン特有の過剰な知覚の具体的症状が明らかになり，また，【自ら体験して初めてわかったしびれの感覚】【しびれを我慢してでも生きたい】【当たり前だった自分の生活ができなくなる脅威】【ぎりぎりまで「自分で自分のことができること」を死守】【しびれを抱えつつ安全な生活を確保するための努力】の5つのカテゴリーが抽出された．

　末梢神経障害を通常の生活ができなくなる新たな脅威として認識しながらも，「生きたい」という強い意志を持ち，自ら安全性や自律性の確保を末梢神経障害の許容の限界と決め，懸命に治療を継続している患者の体験が明らかとなった．また，これらの体験は，進行再発大腸がんでも延命が期待できる一次治療段階にいる患者の特徴として捉えることができ，患者が主体的に生活の中で末梢神経障害を調整できるよう援助することの重要性が示唆された．

Abstract

　In the present study, we sought to clarify the experience of advanced and recurrent colorectal cancer patients with oxaliplatin.induced peripheral neuropathy. Eight advanced and recurrent colorectal cancer patients who experienced peripheral neuropathy presumably caused by oxaliplatin were enrolled in this study. We conducted a semi.structured interview based on our interview guideline. The interviews were transcribed, coded and categorized; the smallest unit comprised a separate part on symptoms and experiences of specific peripheral neuropathy, classified by focusing on similarities and differences in semantic content.

　As a result, hypersensitive symptoms peculiar to oxaliplatin were determined and also five categories were identified in the patients' experiences of peripheral neuropathy: "Sense of numbness understood only after it has been experienced", "The will to live patiently with numbness", "Menace of hindrances in daily life", "Desiring to do things on one's own to the extent permitted by numbness", and "Efforts to ensure a safe life with numbness".

　These findings demonstrated the fact that the patients recognized peripheral neuropathy as a new menace to threaten life, and they received the treatment desperately with a strong will to live, and they decided to secure safety and autonomy within the limitations imposed by the numbness. These experiences can be regarded as characteristic of colorectal cancer patients in the primary treatment stage who can expect prolonged survival even with advanced and recurrent cancer, and the importance of our support for the patients to proactively manage peripheral neuropathy in life was suggested.