外来がん化学療法における携帯型ディスポーザブル注入ポンプを使用する大腸がん患者のニードと関連要因

Related Factors and Needs of Outpatient Colorectal Cancer Patients Using Portable Disposable Injection Pumps for Chemotherapy

要旨

　本研究の目的は，外来がん化学療法における携帯型ディスポーザブル注入ポンプを使用する大腸がん患者のニードと関連要因を明らかにすることである．外来化学療法を行う大腸がん患者668名を対象に，郵送質問紙調査を実施した．298名から回答が得られ，すべてを分析対象とした．分析は単純集計，χ²検定，ロジスティック回帰分析を用いた．記述式項目は，記述内容をカテゴリー化した．

　治療は日常生活上特に清潔行動，仕事に支障があり，その原因は副作用とポンプの物理的な影響であった．ポンプ装着生活に6割が心配を抱え，心配に関連する要因は「年齢が低い」「家事を主には行わない」であった．多くは，管や針部の保護などを心配していた．自宅で注入終了処置を行うのは7割，その内，困っているのは約3割でテープがはがしにくい，針扱いが怖いなどを感じていた．注入中の不具合経験者は4割で，その半数以上にテープ固定部皮膚症状の経験があった．不具合経験に関連する要因は，「女性」「罹患年数が長い」「ポート位置胸部」であった．自由記述から得られたニードは，【苦痛の少ない針刺入とテープ固定改善の要望】【ポンプ装着方法改善の要望】【ポートトラブルとポートに関する不安】などであった．

　治療前に治療や生活について情報提供・指導することが重要であり，治療に慣れた患者においても，皮膚トラブルや不具合，生活面の問題などがみられるため，継続的支援や相談窓口が必要であることが示唆された．

　The purpose of this study is to clarify the needs and related factors of outpatient colorectal cancer patients using portable disposable injection pumps for chemotherapy. The authors implemented a postal questionnaire survey of 668 patients with colon cancer who were undergoing outpatient chemotherapy. Responses were received from 298 subjects, all of which were suitable for analysis. Analysis was comprised of simple calculations, chisquare testing and logistic regression analysis. The written questions were subjected to categorization of the details provided.

　Such chemotherapy treatment interferes with the activities of daily life, particularly in the areas of hygiene and work, with side effects and the physical impact of the pump being contributing factors. In all, 60% of respondents were concerned about living with their pump attached, and the factors related to the concerns included “young age” and “Not the person doing most of the housework.” In many cases, respondents were concerned about protecting the tubes and needles from damage, etc. A total of 70% completed their injections at home, with approximately 30% of these finding difficulties such as the tape being difficult to remove, that they were afraid of handling the needles, etc. Altogether, 40% of respondents had experienced some sort of problem during injection, with more than half of these reporting skin symptoms in the area where the tape was fixed. Factors involved in experiencing problems included “Female,” “Having the disease for a long time,” and “port location : chest.” The needs ascertained from the free responses included “Would like needle insertion that hurts less and improved tape fixing,” “Would like an improved method of attaching pump,” and “Problems with and concerns about the port,” etc.

　It is important to ensure the provision of information and guidance regarding treatment and lifestyles prior to the initiation of treatment. Even patients used to treatment may have skin trouble or other problems, or experience lifestyle issues. For these reasons, it appears that ongoing support and access to advice are required.