根治的治療の適応外となりがん薬物療法を受ける進行性肝胆膵がん患者の治療・療養過程における体験

Experiences of Advanced Hepatobiliary Pancreatic Cancer Patients Receiving Chemotherapy when Cure is Unlikely

要旨

　本研究の目的は，根治的治療の適応外となりがん薬物療法を受ける進行性肝胆膵がん患者の治療・療養過程における体験を明らかにし，看護支援の示唆を得ることである．首都圏大学病院の腫瘍内科に通院する原発性肝胆膵がん患者で，根治的治療の適応外と診断されがん薬物療法を受けている18名を対象に面接調査を実施し，グラウンデッド・セオリー・アプローチを用いて分析した．

　分析の結果，31カテゴリから5コアカテゴリのただならぬ事態に巻き込まれる，病名のみに留まらない多重告知を受ける，傷つきながら治療の場を探す，化学療法という足元の小さな光を頼りに歩き続ける，生死の境に在ることを痛感するが生成され，患者が苛酷ながん告知を受けることや，確定診断や納得のできる治療法を探すなかで医療者の支援を求めないこと，治療効果の起伏が出現した際に深い苦悩をいだくことが示された．また，治療・療養過程は，時間の経過にともない‘がんが発覚するまでの時期'‘診断・告知が行われる時期'‘治療法を模索する時期'‘受療する時期'‘治療に変化が生じる時期'に分けられ，それぞれ5コアカテゴリと対応していた．

　看護支援として，患者が的確な診断を受け，速やかに治療に移行できる体制づくりが必要である．また，微細な変化を含む良くない兆候が出現し始めた際に，患者の思いを傾聴し治療継続のための支援を行うとともに，突然の治療終了とならないよう積極的な関与が求められる．

　This study aimed to clarify advanced hepatobiliary pancreatic cancer patients' experiences during the chemotherapy treatment and recuperation processes when a cure is unlikely to be achieved.

　Eighteen patients with primary hepatobiliary pancreatic cancer at the Department of Oncology of a metropolitan university hospital were included in the study. Interviews were conducted, and data were analyzed using a grounded theory approach. From the 31 total categories, five core categories were extracted: being caught in an unusual situation, receiving multiple announcements in addition to the name of the disease, continuing to search for a satisfactory conclusion while ill, continuing to move forward following a guiding light called chemotherapy and painfully realizing that one is on the borderline between life and death.

　The results revealed that patients receive severe cancer announcements and are looking for a specialized hospital that can provide a satisfactory diagnosis and treatment without support from medical professionals. Furthermore, the analysis revealed that patients are deeply distressed amidst the ups and downs of treatment effectiveness. The treatment and recuperation process changed over time, with these phases: the period before cancer detection, the period of diagnosis and notification, the period of seeking treatment, the treatment period, and the treatment modification period-each corresponding to the five core categories.

　Regarding nursing support, a system should be established that enables patients to receive a prompt and accurate diagnosis. In addition, when there are fluctuations in treatment efficacy, nurses must listen to the patient's thoughts, support continued treatment, and remain actively involved to ensure that treatment does not end abruptly.