がん化学療法による慢性末梢神経障害を抱える患者のQOLに及ぼす要因の分析

Analysis of Factors Affecting the Quality of Life of Patients with Chronic Peripheral Neuropathy Induced by Cancer Chemotherapy

要旨

　【目的】がん化学療法による慢性末梢神経障害を抱える患者のQOLに及ぼす要因を明らかにし，今後の看護支援を検討する．

　【方法】短期入院・外来通院にてがん化学療法を施行している末梢神経障害を有する患者を対象に，一般背景，治療基盤要因，心理・社会・末梢神経障害の認知要因およびQOL測定尺度（FACT-G）を用いて質問紙調査を行った．データ分析は，統計ソフトIBM SPSS（Ver.23.0），IBM SPSS Amos（Ver.23.0）を使用した．

　【結果】患者174名に調査用紙を配布し，有効回答163名を分析した．QOL得点は平均70.2（SD＝13.23）点であった．単変量解析の結果，QOLに影響する要因は末梢神経章症状（CTCAE）と心理・社会・末梢神経障害の認知要因の8項目であった．また重回帰分析の結果，QOLに影響する要因は治療による気がかり，ソーシャルサポート（家族内，家族外），FACT-GOG-Ntxの4項目であった．さらに共分散構造分析の結果，QOLと治療による気がかり，ソーシャルサポート（家族外），FACT-GOG-Ntxなどの9因子に有意な関連傾向が示された．

　【考察】がん化学療法による慢性末梢神経障害を抱える患者のQOLに及ぼす影響要因が明らかとなった．看護師は慢性末梢神経障害の程度を的確に把握し，症状緩和法や対処方法について説明し，患者がセルフモニタリングを継続できるように支援する必要がある．そして治療による気がかりの内容を的確に把握し，それらの解決に向けた看護支援を行うことで患者のQOLを維持・向上できると示唆された．

　Objective: To identify factors potentially affecting quality of life (QOL) of patients with chronic peripheral neuropathy induced by cancer chemotherapy. Furthermore, to discuss the nursing support needed for patients in the future.

　Methods: A questionnaire survey was conducted for patients with chronic peripheral neuropathy receiving cancer chemotherapy under short-term hospitalization or on an outpatient basis. The survey included general background characteristics of the patients, basic factors related to therapies, cognitive factors related to psychological / social / peripheral neuropathy, and QOL measurement scales (Functional Assessment of Cancer Therapy - General [FACT-G]). Data analyses were performed using the IBM SPSS (Ver.23.0) and IBM SPSS Amos (Ver.23.0) statistical analysis packages.

　Results: The survey form was distributed to 174 patients, and valid responses obtained from 163 patients were included in the analysis. The mean QOL score was 70.2 (standard deviation, 13.23). As a result of univariate analysis, factors affecting QOL consisted of 8 items, peripheral cognitive symptoms (CTCAE) and cognitive factors of psychological / social / peripheral neuropathy. Multiple regression analysis revealed that factors affecting QOL of the patients included concerns about therapies, social support (intra- or extra-familial），and 4 items from the Functional Assessment of Cancer Therapy / Gynecologic Oncology Group - Neurotoxicity (FACT/GOGNtx). Furthermore, the results of covariance structure analysis demonstrated that QOL tended to be significantly associated with 9 factors, including concerns associated with therapies, social support (extra-familial), and items of the FACT-GOG-Ntx.

　Discussion: Factors affecting QOL of patients with chronic peripheral neuropathy induced by cancer chemotherapy have been clarified. Nurses are required to accurately assess the severity of chronic peripheral neuropathy, explain methods to obtain symptom relief and/or coping strategies, and support patients in continuing selfmonitoring. In addition, these results suggested that accurate assessments of the concerns associated with therapies and providing nursing support towards obtaining solutions for such concerns can help in maintaining/improving QOL of patients.