薬物療法を受ける造血器腫瘍患者の口腔トラブルの実態とそのマネジメント

Actual Condition and Symptom Management of Oral Complications in Patients with Hematologic Malignancies Receiving Chemotherapy

要旨

目的：本研究の目的は，薬物療法を受ける造血器腫瘍患者の口腔トラブルの実態と，患者が症状をどのようにマネジメントしている明らかにすることである．

方法：対象は，造血器腫瘍により薬物治療を受けている患者であった．方法は，症状マネジメントモデルを概念枠組みとした半構成的面接を行い，口腔トラブルの症状体験やマネジメントを収集した．また，口腔内の状態，QOL，自己効力感，セルフケア能力の評価を行った．薬物療法1コースの1週目から4週目までの変化を分析した．

結果：対象者14名全員がなんらかの口腔トラブルを体験し，そのうち11名が口腔内乾燥や唾液の減少，5名が口腔粘膜炎を認めた．多くの対象者が一時的に口腔内の状態の悪化がみられたが，改善がみられなかった対象者は14名中2名と少数であった．遷延する高度の血球減少や身体状況の悪化，セルフケア能力が低い対象者にOAG（Oral Assessment Guide）スコアの悪化がみられ，医療者の介入の必要性が高かった．

　対象者が取り組んでいる口腔トラブルへの対処方法は，過去の口腔トラブルの体験から獲得した方略や，口腔ケアの習慣が強く影響しており，口腔内に違和感が現れたら含嗽を追加するなど，血球や身体の変化に応じた適切な対処を実践していた．しかし，QOLは全体的に低く，一部の対象者に自己効力感の低下がみられ，取り組んでいる効果が実感できていないことが分かった．

Actual condition and symptom management of oral complications in patients with hematologic malignancies receiving chemotherapy

Purpose: The purpose of this study was to clarify the actual condition of oral complications in patients with hematologic malignancies receiving chemotherapy and how the patient manages the symptoms.

Method: The subjects were patients receiving chemotherapy for hematologic malignancies. Semi-structured interviews were conducted with a symptom management model as a conceptual framework, and data was collected on symptomatic experiences and the management of oral complications. We also evaluated oral health condition, quality of life, self-efficacy, and self-care ability. Changes from the 1st week to the 4th week of one course of chemotherapy were analyzed.

Results: All 14 subjects experienced some oral complications, with 11 of them experiencing dry mouth and saliva reduction, while 5 had oral mucositis. Many subjects temporarily experienced worsening conditions of their oral cavity, and 2 out of 14 subjects experienced no improvement. Deterioration of OAG scores were observed in subjects with prolonged blood cell depletion, signs of deterioration of physical condition and low self-care ability, and with a high need for medical intervention by medical personnel. The subjects' method of coping with oral complications was strongly influenced by strategies acquired from past experiences of oral problems and their oral care practices, and patients practiced appropriate measures in response to changes in blood cells and the body, such as increasing the amount of mouth rinse when they felt a sense of abnormality in the oral cavity. However, QOL was low overall, as some subjects showed a decline in self-efficacy, and it was found that patients did not feel successful in improving their condition of their oral cavity.