経口抗がん薬治療を受ける高齢者のストレス・コーピング

How Older Adult Patients Receiving Oral Anticancer Drug Therapy Cope with Stress

要　旨

　目的：経口抗がん薬治療を受ける高齢者のストレス・コーピングを明らかにすることである．

　方法：外来通院にて経口抗がん薬治療を受ける高齢者12名を対象にした．診療録調査と半構造化面接調査にてデータを収集し，質的帰納的に分析した．

　結果：【がん罹患が頭から離れない】とがん罹患を強く意識し，〖自分の人生を歩み続ける〗ことを励みに，〖経口抗がん薬を確実に飲む〗と治療に取り組んでいた．生活のなかで〖がん罹患を忘れる時間をもつ〗ことを大切にしていた．一方で，【経口抗がん薬治療を続ける意味を迷う】というストレスをかかえており，〖医療者に任せる〗ことで治療の継続につながっていた．【副作用と付き合っていかなくてはならない】と受け止め，生活しながら無理なく服薬管理や副作用対策に取り組めるよう〖新たな習慣にする〗方法を習得し，〖この体調なら生活できる〗とコントロール感覚を得ていた．また，【子ども・兄弟に負担をかけたくない】【収入が変化するなかでの医療費負担が大きい】と家族や経済面への負担を心配し，〖自分自身で治療に取り組む〗と対策を講じていた．

　結論：経口抗がん薬を確実に服用するなかで，経口抗がん薬治療を続ける意味に迷いが生じていた．経口抗がん薬治療に対する懸念や日常生活の活動範囲・社会的役割への心配に対する看護が重要である．生活のなかでの楽しみや社会的役割の継続を支え，今までの生活習慣を活かしたセルフケア支援が示唆された．

　Objective: To clarify the stress coping methods of older adult patients undergoing oral anticancer drug therapy.

　Methods: Twelve older adult patients undergoing outpatient oral anticancer drug therapy were included in the study. Data were collected by a medical record survey and semi-structured interview and were analyzed qualitatively and inductively.

　Results: The patients were “strongly conscious of having cancer”, saying that they could not get rid of it, and they were committed to treatment by “consistently taking oral anticancer drugs”, encouraging themselves to “continue with their lives”. Patients prioritized having “time to forget about their cancer status” in their daily lives. At the same time, patients were “having doubts about the meaning of continuing oral anticancer drug treatment” and continued treatment by “trusting the medical staff with their treatment”. Patients “accepted that they had to live with the side effects”, learned how to “incorporate them as a new habit” so that they could work with them in their daily lives without difficulty, and gained a sense of control that they could “live with this physical condition”. Patients also worried about the economic burden on their families, saying, “I don't want to burden my children and siblings” and “I have to bear the burden of medical expenses while my income changes” and took measures to avoid burdening their family, saying, “I will work on the treatment myself”.

　Conclusion: While consistently taking oral anticancer drugs, patients experienced doubts about the meaning of continuing oral anticancer drug therapy. It is important to provide nursing care with regard to concerns about oral anticancer drug therapy and the range of activities and social roles possible in patients' daily lives. It is suggested that self-care support that helps with the continuation of enjoyment and social roles in daily life and utilizes information from patients' past lifestyles should be provided.