乳がん患者の化学療法誘発性末梢神経障害と身体活動および生活の質の関連

Association of chemotherapy-induced peripheral neuropathy, physical activity and health-related quality of life among breast cancer patients

要旨

　本研究の目的は，タキサン系薬剤を用いた乳がん患者の化学療法誘発性末梢神経障害（CIPN）と，身体活動および生活の質（HRQOL）の関連を明らかにすることである．タキサン系薬剤を用いた乳がん患者43名に対し，基本情報，疾患・治療関連情報，CIPN（Ntx subscale），HRQOL（FACT-G），身体活動（IPAQ-SF），抑うつ・不安（K6）について自記式質問紙および診療録で調査した．分析の結果，CIPNはHRQOL（r＝0.55，p＜0.001），HRQOLの身体面（r＝0.72，p＜0.001），精神面（r＝0.41，p＜0.01），機能面（r＝0.47，p＜0.01）と有意な正の相関がみられた．CIPNと身体活動，身体活動とHRQOLの相関は有意ではなかった．CIPNの症状が強い19名において，身体活動は7名（36.8％）がinactive，12名（63.2％）がactiveであった．CIPNは乳がん患者の生活に影響する症状であり，症状があっても自己管理を行い，症状に耐えて個々の役割や環境に応じて身体活動を行っている者がいることが考えられた．看護師は，CIPNによる日常生活と身体活動への影響について具体的に確認し，活動する背景について受け止めを聞き，支援することが重要である．そして，CIPNをかかえて安全に身体活動を行う方法を個別に検討することが必要である．

　The purpose of this study was to gain insights into the relationship between chemotherapy-induced peripheral neuropathy (CIPN), physical activity, and health-related quality of life (HRQOL) in breast cancer patients who received taxane-based chemotherapy. We conducted a cross-sectional, observational study on 43 breast cancer patients who underwent taxane-based chemotherapy. Information on demographics, CIPN (Ntx subscale), HRQOL (FACT-G), physical activity (IPAQ-SF), and psychological distress (K6) was collected through self-administered questionnaires. Data of clinical characteristics were extracted from the patients' medical records. Correlation analysis revealed a significant positive correlation between CIPN and HRQOL (r = 0.55, p < 0.001), physical well-being (r = 0.72, p < 0.001), emotional well-being (r = 0.41, p < 0.01), and functional well-being (r = 0.47, p < 0.01) but not physical activity. There was no significant correlation between physical activity and HRQOL. Among the 19 patients with severe symptoms of CIPN, an analysis of physical activity showed that 7 (36.8%) were inactive and 12 (63.2%) were active. Hence, CIPN significantly affects the HRQOL of breast cancer patients. Additionally, some patients perform physical activity according to their individual roles and environment by managing and enduring the symptoms of CIPN. Nurses should recognize the impact of CIPN on patients' everyday lives, adequately assess the CIPN symptoms, evaluate the influence of CIPN on patients' physical activity levels, and counsel patients accordingly. Additionally it is necessary to consider patients individually how to perform physical activity safely, especially when experiencing CIPN.