内分泌療法を受ける閉経前乳がん患者の困難と治療を継続する体験

Difficulties Among Premenopausal Breast Cancer Patients Undergoing Endocrine Therapy and Their Experiences of Treatment Continuation

要旨

　本研究の目的は，内分泌療法を受ける閉経前乳がん患者の困難と対処，内分泌療法中の支えを明らかにすることである．外来通院をする内分泌療法を受ける閉経前乳がん患者14名を対象に半構造化面接を実施し，その内容を質的帰納的に分析した．

　内分泌療法を受ける閉経前乳がん患者の困難として【内分泌療法による多様な苦痛をもたらす身体症状】【自身をコントロールできない苦しみ】【妻・娘・母の役割を遂行できずやるせない】など6カテゴリが導き出された．困難への対処として【自分の状況を前向きに意味づけ受け入れようと考える】【喪失・変化・つらさに耐えようとする】など4カテゴリが導き出された．内分泌療法中の支えとして【自分に関心を寄せてくれる人の存在を感じる】【内分泌療法によって生き抜きたいという思い】【内分泌療法を継続できるという確信】の3カテゴリが導き出された．支えてくれる存在，生き抜きたい思い，および治療継続できる確信を支えに，困難が生じるたびごとに工夫をこらし対処し続けることが，閉経前乳がん患者の治療継続を支えていた．10年という長期間にわたる乳がん内分泌療法継続を支えるために，短時間で患者の状況を的確にアセスメントし，患者の治療継続できるという自己効力感を高め，患者が表出しづらい困難に積極的に関わる看護援助が必要である．

　The objective of this study is to clarify the difficulties and coping strategies of premenopausal breast cancer patients undergoing endocrine therapy as well as their support during treatment. Semi-structured interviews were conducted with 14 outpatient premenopausal breast cancer patients who were undergoing endocrine therapy, and the results were qualitatively and inductively analyzed.

　Six categories were derived as difficulties faced by premenopausal breast cancer patients who were undergoing endocrine therapy, including: physical symptoms that cause various types of pain resulting from endocrine therapy, suffering from an inability to control oneself, and an inability to fulfill the role of wife/daughter/mother. Four categories were derived as coping strategies for those difficulties, including: trying to positively apply meaning to and accept one's situation and trying to endure loss, change, and suffering. Three categories were derived as support during endocrine therapy: feeling the presence of someone who has an interest in them, the desire to survive endocrine therapy, and the confidence that endocrine therapy can be continued]. Premenopausal breast cancer patients were able to continue treatment by devising ways to cope with difficulties whenever they emerged. Through their supporters, the patients developed the desire to survive and the confidence that endocrine therapy can be continued. It was shown that employing endocrine therapy for breast cancer over a long period of 10 years requires accurately assessing the patient's condition in a short period of time, increasing the patient's sense of self-efficacy for continuing treatment, and providing nursing assistance that actively engages with the patient's difficulties that are hard to express.