治療期膵がん患者の家族が認知する患者の症状・療養支援状況および患者の治療状況と家族のQOLとの関連

Relationship to Family Quality of Life：the Family Perceptions of Symptoms, the Medical Treatment Support Situation, and the Patients Treatment Situation in Pancreatic Cancer Patients Undergoing Treatment

要旨

　本研究の目的は，（1）治療期膵がん患者の家族のQOL，（2）家族が認知する患者の症状，療養支援状況，患者の治療状況と家族のQOLの関連を明らかにすることである．

　膵がん患者の家族67名を対象に，基本属性，治療状況，家族の療養支援状況，家族が認知する患者の症状，健康関連QOL（SF-36v2尺度）について自記式質問紙および診療録調査を実施した．その結果，QOLの中央値が60歳で調整した国民標準値と比較して「日常役割機能（精神）」が有意に低かった（p＜0.05）．また，家族が認知する患者の症状合計得点が高い者ほど，「活力」「日常役割機能（精神）」「心の健康」が有意に低かった（r_S＝−0.29〜−0.39；p＜0.01〜0.05）．療養支援状況におけるQOLの比較では，患者の症状を理由とした食事に関する負担がある者ほど（p＜0.01〜0.05），また，経済的負担がある者ほどQOLが有意に低かった（p＜0.05）．重回帰分析の結果，膵がん患者の家族のQOLに影響する要因は，食事の準備や食卓を囲むことの負担の有無，家族が認知する患者の症状得点（体重減少，不安，痛み），手術経験の有無，病期，内服薬管理状況，患者と病気についての話し合い状況，医師による症状出現時の対応に関する説明の有無だった．治療期膵がん患者の家族に対する患者の症状マネジメントに関する教育および情緒的支援の必要性が示唆された．

　This study sought to determine the quality of life (QOL) of family members of pancreatic cancer patients undergoing treatment, and to clarify relationships between family QOL, and their perceptions of the patient's symptoms and treatment status as well as the family's medical treatment support situation.

　A self-administered questionnaire was distributed to 67 family members of outpatients. The questionnaire contained items on characteristics of the family and patient, the family's medical treatment support situation, the patient's symptoms as perceived by the family, and health-related QOL (SF-36v2). The patient's treatment status was surveyed from medical records. A runs test, Mann-Whitney U test and Spearman's rank correlation coefficient were used to assess the distribution of the family QOL. Multiple regression analysis was performed.

The role emotional subscale of the family's QOL was significantly lower than the national median coordinated at 60 years of age (p＜0.05). And the patient's total symptom score as perceived by family members was related to the worsening of their QOL (rs=−0.29〜−0.39; p＜0.01〜0.05).

Moreover, in terms of correlation between QOL and the medical treatment support situation, there were significant differences between QOL and whether family members perceived a “dietary burden due to the patient's symptoms” (p＜0.01〜0.05), and whether family members perceived an “ economic burden” (p＜0.05). The results of multiple regression analysis showed that factors affecting QOL of family members depended on whether they felt burdened by preparing meals and eating together, weight loss, anxiety and pain scores, the patient's surgical history, oral medicine management, the treatment stage, communication about the disease and treatment from the doctor.

　The findings suggested that education and emotional support for managing patient symptoms are essential when providing support for family members of pancreatic cancer patients.