論文

目的：在宅で経口がん薬物療法を受ける高齢がん患者に対して，訪問看護師がどのように服薬自己管理に関するケアを行っているかを明らかにする．方法：在宅で経口がん薬物療法を受ける高齢がん患者への看護の経験がある訪問看護師14名を対象に，半構造化面接とテーマ分析による質的記述的研究を行った．結果：在宅で経口がん薬物療法を受ける高齢がん患者に対するケアとして【二義的な目的としての服薬支援】【患者にとっての治療の意味を探求】【限界のなかでの最善】という3つのテーマが導かれた．結論：訪問看護師は，高齢がん患者との関係構築を最優先し，患者の自律の尊重や自宅での生活が成り立つことを重視し，服薬管理は二義的なことととらえて支援していた．また，訪問看護師は，高齢がん患者の治療適用に葛藤を抱きながらも，患者の根底にある意向を模索し，治療の意味を探求する姿勢を保っていた．患者の生活に服薬を織り込み，リスクに備えたネットワークを築きながらも，患者を擁護するために自ら行動を起こすことで，限界のなかでも最善を尽くそうとしていた．

Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of anticancer medicines that causes muscular weakness and falls in cancer patients. Therefore, we compared the methods for identifying and estimating the factors that cause symptoms in CIPN based on factor analysis and four different machine learning algorithms. The results of factor analysis showed that the latent factors causing CIPN can be classified into three categories: "Morning body condition", "Pain in the legs"and "Dizziness". We chose models for machine learning based on the premise of multi-task learning and built numerous machine learning models to estimate various CIPN symptoms. According to the results of the comparison studies, TabNet has the best generalization performance.

Objective: This study examined the relationship between symptom burdens and work-related outcomes, including work participation and overall work impairment (OWI) among breast cancer survivors (BCS) receiving adjuvant endocrine therapy (AET). Methods: This was a cross-sectional study with 140 BCS of working age receiving AET. Data were collected using self-report questionnaires that included an assessment of symptoms and their employment status, and OWI. Data were analyzed using descriptive statistics and multiple logistic regression analysis. Results: A total of 111 (79%) survivors reported being employed at the time of the survey. Symptom burdens were not associated with unemployment. Of the 110 working BCS receiving AET, symptom burdens were significantly related to a higher degree of OWI (OR ​= ​2.14, 95% CI, 1.58–2.89, P ​≤ ​0.001). Conclusions: Participating BCS receiving AET continued to work while experiencing symptoms, with survivors who experienced high symptom burdens being negatively affected in their work life. Healthcare providers need to assess and manage symptoms and their impact on work, with the help of employers, to improve the quality of work life of BCS receiving AET.

Objective: The global understanding of cancer survivorship care leads to optimal care delivery for cancer survivors. This study aimed to assess the perceptions of Japanese oncology nurses regarding cancer survivorship care and explore the factors influencing the provision of survivorship care. Methods: A questionnaire survey of oncology nurses was conducted as part of a multinational, cross-sectional survey. A 29-item measurement scale with four subscales regarding survivorship care was used to assess nurses’ perceptions regarding responsibility, confidence, and frequency of practice for cancer survivors. Additionally, we investigated a list of 16 factors influencing the provision of survivorship care. Results: Among 181 oncology nurses, the mean adjusted scores for survivorship care items were 65.6–84.7, 16.8–44.7, and 29.2–47.2 for responsibility, confidence, and frequency, respectively. Significant correlations were observed in the subscales for frequency of care with responsibility (r ​= ​0.315–0.385, P ​< ​0.001) and confidence (r ​= ​0.428–0.572, P ​< ​0.001). Participants with >10 years of experience in cancer care reported more frequent performance on surveillance than those with ≤ 5 years of experience (P ​= ​0.03). The major barriers for providing survivorship care by oncology nurses were lack of knowledge and skills (87.8%), lack of time (81.8%), and not seeing the value of survivorship care (79.6%). Conclusions: Oncology nurses face many challenges regarding survivorship care, even though they recognize their responsibility. Educational support for oncology nurses is warranted to overcome impeding factors and improve confidence.

Objective: Patients with relapsed or refractory (r/r) indolent non-Hodgkin lymphoma (iNHL) live with incurable disease for a long-term, experiencing multiple relapses and treatments that impair their health-related quality of life (HRQOL). We aimed to better understand the unmet needs and HRQOL of patients with r/r iNHL. Methods: This convergent mixed-methods study evaluated patients with r/r iNHL who received treatment. Unmet needs and HRQOL were assessed quantitatively using self-administered questionnaires and analyzed statistically. Qualitative data were collected through face-to-face semi-structured interviews for reflexive thematic analysis. Quantitative and qualitative findings were integrated through narrative discussion and joint display. Results: Questionnaire respondents (50 participants, mean age: 72.42 years) reported unmet needs in the health system and information and psychological domains and a negative association between unmet needs and HRQOL. Interviews (20 participants, mean age: 72.75 years) identified four themes: “unremarkable symptoms,” “anxiety of progression in the near future,” “make the best of life,” and “means to live with uncertainty.” Integration revealed that participants accepted their low HRQOL and attempted to make the best of life, influencing their perception of unmet needs. Conclusions: Throughout the long course of r/r and repeated treatment, patients with iNHL accepted their low HRQOL, valued their current situations, and endeavored to make the best of life. In this situation, support in the psychological and health system and information domains is crucial. Support for the unmet needs of patients with r/r iNHL is essential as they strive to live their best lives while maintaining a favorable HRQOL.

Background: As the Japanese population continues to age, functional decline with aging will inevitably become more pronounced. Vision loss and decline in lifestyle and motor functions are the main causes of functional decline. To date, a few studies have examined the relationship between visual and overall physical function. Therefore, this study aimed to quantitatively investigate the relationship between loss of visual acuity and the decline of physical functionality. Methods: This cross-sectional study was based on the data of 86 community-dwelling older adults (average age ± standard deviation, 75.7 ± 5.5 years; 34 men) who participated in the October 2020–May 2022 baseline survey. Visual function was assessed based on the measurement of binocular near functional visual acuity (NFVA) using the Smart Vision Check application. Physical function tests were performed by measuring grip strength, 30-second chair stand (CS-30), Timed Up and Go (TUG), with eyes open, one-leg standing balance (OLSB), and two-step test. Multivariate regression analysis was performed to examine the association between NFVA and physical function, and partial regression coefficient (β) and 95% confidence interval (95%CI) were calculated. Results: After adjusting for all covariates, NFVA was significantly associated with grip strength (β: 3.54, 95%CI: 0.39, 6.70). Meanwhile, no association was noted between NFVA and CS-30 (β: -0.35, 95%CI: -2.68, 1.97), TUG (β: -0.23, 95%CI: -0.65, 0.19), OLSB (β: 6.13, 95%CI: -5.09, 17.35), and two-step test (β: 0.01, 95%CI: -0.05, 0.08). Conclusions: The study showed an association between quantitatively assessed visual and physical functions in community-dwelling older adults living in Japan. Thus, the findings indicate that maintaining and enhancing grip strength and visual function in older adults may be an important factor in leading a healthy and fulfilling life. Trial registration: Registration number, UMIN000041970.

Introduction: Studies on well-being and life expectancy of cancer survivors with exceptional longevity are scarce. We explored the relationship between cancer history and well-being and blood biomarkers in centenarians and very old adults. We also aimed to examine the life expectancy of cancer survivors. Materials and Methods: Within three population-based cohorts in Japan, we recruited very old adults (85–94 years) and centenarians (100–115 years) between 2000 and 2020, and followed them up. Cancer survivors were defined as having been diagnosed with cancer regardless of whether they had been treated or not. Participants lacking history of cancer diagnosis or those who were not assessed using the Philadelphia Geriatric Center (PGC) Morale Scale were excluded. Participants' well-being was measured using the PGC Morale Scale, which included three subcategories: age attitude, social well-being, and psychological well-being. Multivariate LASSO (Least Absolute Shrinkage and Selection Operator) regression analysis and linear regression analysis were used to investigate whether having been diagnosed with cancer predicted the total PGC Morale Scale score, and multivariate Cox regression analysis was performed to assess life expectancy from the baseline survey. Results: Among 1531 participants (very old, n = 532; centenarians, n = 999), 207 (13.5%) had been diagnosed with cancer. The association between cancer history and well-being differed significantly by age group. Very old individuals with a cancer history were not significantly associated with well-being scores. In contrast, centenarians with a cancer history had higher total well-being (B [95% CI] = 1.28 [0.08–2.49]) and showed a trend toward higher social well-being (B [95% CI] = 0.46 [−0.08–0.99]). No significant life expectancy differences were found between the very old and centenarian cancer survivors. Discussion: The impact of a history of cancer on well-being differed between very old adults and centenarians. Centenarian cancer survivors showed greater well-being, particularly in social well-being. Moreover, the life expectancy of cancer survivors did not differ significantly from that of individuals without a cancer history.

Background: Extravasation (EV), or the leakage of anticancer drugs into perivascular and subcutaneous tissues during intravenous administration, can cause serious conditions that may require surgical intervention. Therefore, updated guidelines for EV based on systematic review are needed. Additionally, classifications for anticancer drugs that cause EV are not standardized across the current guidelines, and some novel drugs have not been classified. Therefore, this study aimed to formulate guidelines using evidence-based information for shared decision making on prevention, early detection, treatment, and care for EV in Japan and provide additional classification for tissue injury based on systematic review. Materials and methods: The members of the Japanese Society of Cancer Nursing (JSCN), Japanese Society of Medical Oncology (JSMO), and Japanese Society of Pharmaceutical Oncology (JASPO) were surveyed about significant clinical challenges related to EV, and 17 clinical questions (CQs) were formulated. PubMed and ICHUSHI Web were searched using the Patient, Intervention, Comparison, and Outcomes terms listed in each CQ as key words. For the classification of new drugs, articles published through February 2021 were selected using the search terms ‘extravasation’, ‘injection-site reaction’, ‘adverse events’, and the names of individual drugs as key words. Results: Recommendations based on the results of randomized controlled trials (RCTs) were made with regard to the selection of central venous (CV) devices (CQ2, CQ3a, CQ3b, and CQ3c), regular replacement of peripheral venous catheters (CQ5), and use of fosaprepitant (CQ7). These CQs are novel and were not mentioned in previous guidelines. Warm compression monotherapy (CQ10b) and local injection of steroids (CQ12) are discouraged for the management of EV. Ten new drugs were classified for EV tissue injury. Conclusions: This study provides updated guidelines for the prevention and treatment of EV, which can be used to help health care providers and patients and their families practice better EV management.

Background: The number of nonagenarians is growing globally. The promotion of mental wellbeing is increasingly important. The aim of this study was to explore mental wellbeing and psychological experiences of older adults in their early 90 s who were living at home. Methods: We conducted a qualitative study using semi-structured face-to-face interviews with 20 older adults in their early 90 s. A thematic analysis, according to Braun and Clarke, was used to analyze data. Results: An inner process of older adults in their early 90 s was revealed; its three themes were the “reality of aging,” “seeking emptiness of the mind,” and “still moving on.” Older adults in this study experienced functional decline, regret, and loneliness. They were tired of life and nearly gave up. Emptying their minds helped them reset their attitudes and find a way to move on. After realizing that negative thinking did not help anything, they focused on what they could do and their daily routines. Perceived social usefulness validated participants’ self-worth. However, a few were consistently active without negative perceptions of aging. Conclusion: Understanding the psychological process and mental wellbeing in later life aids in the development of practical healthcare policies to assist the growing oldest-old population in cope with age-related challenges and improve their mental wellbeing.

Purpose: To evaluate the effects of a short web-based educational program on Japanese nurses’ self-reported attitudes toward tobacco cessation and their use of interventions to help smokers to quit. Design: Prospective, single-group design with a pre-educational survey, a short web-based educational program, and a follow-up survey at 3 months. Methods: Clinical nurses were asked to view two prerecorded webcasts about helping smokers quit. They completed two online surveys, one at baseline and one at a 3-month follow-up. Generalized linear models were used to determine changes in nurses’ self-reported routine practice after the study intervention. Findings: A total of 1401 nurses responded to the baseline survey, 678 of whom completed the follow-up survey. Compared with baseline, nurses at follow-up were more likely to advise smokers to quit (odds ratio [OR] = 1.45, 95% confidence interval [CI: 1.15, 1.82]), assess patients’ interest in quitting (OR = 1.46, 95% CI [1.01, 1.04]), and assist patients with smoking cessation (OR = 1.34, 95% CI [1.04, 1.72]). However, the proportion of nurses who consistently recommended resources for tobacco cessation did not significantly improve at follow-up. Conclusions: This study provides preliminary evidence that a web-based educational program can increase nurses’ implementation of tobacco dependence interventions in cancer care practice. Sustaining these educational efforts could increase nurses’ involvement in providing these interventions, encourage nurses to refer patients to cessation resources, and support nurses’ attitudes towards their role in smoking cessation. Clinical relevance: Our short web-based educational program can increase nurses’ use of tobacco-dependence interventions in cancer care practice. This role can be enhanced with additional information about existing cessation resources that nurses could use to refer patients for support post-discharge. Japanese nurses, when properly educated, are willing and significant contributors to promote tobacco use cessation for cancer patients. The contribution can be facilitated through nursing care protocol that integrate tobacco use cessation interventions within evidence-based cancer care approaches.

Background: Cancer treatment significantly impacts the diet of older adults with cancer. Professional support is required for such patients to manage their eating problems at home. Objective: To explore the dietary experiences of older adults with gastrointestinal cancer undergoing treatment, and their perceptions of how the disease and its treatment affected their eating. Interventions/Methods:Semi-structured interviews were conducted with 21 older patients (aged ≥ 70 years) with gastrointestinal cancer in Japan. Interview data were analyzed using thematic analysis. Results:Three key themes were identified: impact on daily life, significance of eating, and rediscovering the joy of eating. Participants experienced dietary changes and reduced social interactions. Challenging situations allowed them to reassess their eating values and habits. By seeking their own coping strategies, they rediscovered the pleasure of eating. Conclusions:Older adults with gastrointestinal cancer tried to cope with dietary changes based on their reaffirmed values while seeking the joy of eating. Implications for Practice: A multidisciplinary healthcare team can support patients’ self-management by seeking to understand patients’ eating values and habits rather than focusing only on patients’ weight control and nutritional status.

Strong evidence exists regarding multiple benefits of physical activity among cancer patients. Patients undergoing esophagectomy received counseling for physical activity by a nurse and instructions to keep a diary of physical activities before surgery, followed by 2 counseling sessions after surgery. Physical activity, body mass index, psychological distress, and quality of life were measured at baseline, 2-4 weeks, and 3 and 6 months after discharge. Of 29 participants (mean age = 65.9 years), 72.5% underwent thoracoscopic esophagectomy in the prone position with 3-field lymphadectomy. The results of the International Physical Activity Questionnaire indicated that postoperative physical activity returned to nearly preoperative level, and the number of inactive patients gradually decreased by half at 6 months after discharge. Quality of life scores, except those for role function and social function, tended to return to the baseline at 6 months after discharge. Psychological distress measured by the Kessler 6 remained lower than the baseline, whereas the mean score of body mass index gradually declined after discharge. Patients undergoing esophagectomy and receiving nurse counseling can return to preoperative physical activity level in their daily lives after surgery. Nurses should integrate physical activity promotion into cancer care.

Background: With the increased use of targeted therapies in oncology, dermatological adverse events (dAEs) have drawn attention. Because the face is crucial for human identity and social interactions, facial dAEs have significant impact on a patient’s quality of life. This study aimed to explore patients’ experience with regard to the management of targeted oncological therapy-induced facial dAEs. Methods: In this qualitative study, 20 patients at a university hospital in Japan with advanced/metastatic cancer and targeted therapy-induced facial dAEs were individually interviewed to collect data. Thematic analysis was used to analyze the data. Results: Patients with cancer and targeted oncological therapy-induced facial dAEs who were referred to the Department of Dermatology had certain expectations from specialist services. Three key themes were identified: professional input and advice, empathetic commitment to individual management, and integrated care across specialties. Conclusions: The referred patients with cancer and facial dAEs needed more in-depth information and advice from dermatological services and were reassured by the empathetic commitment to individual management in integrated care across specialties. These findings suggest that attention to the patient’s perspective with a “sick person first” attitude and a collaborative effort across different specialties is important to minimize the effects of facial dAEs on the quality of life of patients with cancer.

Purpose: Current healthcare systems are not suitable for serving future societies in which the oldest old are commonplace. The objective of this study was to understand what the oldest old care most about in their daily lives. Methods: Semi-structured in-depth interviews and thematic analysis were used. Face-to-face interviews were conducted in 17 elderly residents (≥ 95 years) of Arakawa-ku, Tokyo, Japan from July to November 2017. Results: Three themes emerged from the interview responses: “unshakable beliefs and social ties,” “natural acceptance,” and “my day-to-day life with precious moments.” The oldest old strongly believe in diligence and compassion and maintain strong relationships with people around them. Despite their small social networks, they are concerned about future society. They accept their selves and their lives, including their impending deaths. Despite their functional decline, they control their lives by making very small decisions. They live on a moment-to-moment basis, cherishing simple events. Conclusion: Maintaining autonomy through making small decisions and enjoying small pleasures are important to the oldest old. Understanding the needs of the oldest old is the first step towards developing optimal geriatric care for an aging population.

Objective: Targeted therapy-induced facial skin toxicities may reduce overall quality of life (QoL) in cancer patients. We investigated whether facial skin toxicities affect QoL and attempted to identify factors related to QoL in patients with advanced/recurrent cancer. Methods: We performed a cross-sectional study in 34 outpatients with advanced/recurrent cancer showing targeted therapy-induced facial skin toxicities in Japan between November 2016 and February 2017. For measurement, we used the Kessler Psychological Distress Scale (K6), Mental Adjustment to Cancer (MAC) Scale, and Dermatology Life Quality Index (DLQI). Data were analyzed using Spearman's rank correlation coefficient. Results: Mean DLQI score in 34 patients was 4.59 (standard deviation ± 4.70), which was interpreted as a small effect on a patient's life. Acneiform rash was the most common skin condition noted, followed by xerosis, pruritus, and erythema. Analysis of DLQI scores revealed that symptoms and feelings was the domain most commonly affected among different domains constituting the DLQI. MAC analysis revealed that the fighting spirit score was the highest among MAC scales. We found that age, K6, and fatalism construct in MAC were significantly correlated with total DLQI scores (age: Spearman's ρ= -0.48, P = 0.004; K6: ρ= 0.58, P < 0.001; fatalism; ρ= -0.39, P = 0.025). Conclusions: This is the first study investigating targeted therapy-induced facial skin toxicities in cancer patients. Our results suggest potential negative effects of facial skin toxicities on overall QoL in patients with advanced/recurrent cancer in middle and early old age.

Background: In the context of worldwide public health, it is very important to promote physical activity among the older people. This study explored the roles and attitudes of senior leaders in promoting group-based exercise in their local communities, specifically to determine the level and extent to which to elderly participation was encouraged. Methods: This study conducted semi-structured face-to-face in-depth interviews and employed a subsequent thematic analysis. Participants included 10 club leaders and five sub-leaders who were working at senior clubs in Fujisawa-city, Kanagawa, Japan, from July to September 2018. Results: Four themes emerged from the interview responses, including "unwavering attitude/conviction in relation to the vision,""leaders must set an example,""a search for balance in delegating responsibilities to members,"and "creating and fostering culture and environment of mutual help."Further, each participant outlined several aims, including "achieving healthy longevity for the entire local community,""having older people promote healthy activities among the older people,"and "creating a pro-health town."Conclusions: Findings indicate that policymakers, public health workers, and healthcare providers should recognize the pivotal roles that senior group leaders play in promoting healthy activities for the older people. These efforts should be strongly considered when developing policies and strategies designed to promote overall healthy longevity from a general community perspective.

Purpose: The objective of this qualitative study was to understand the perceived needs of advanced-stage cancer patients with chemotherapy-related hand-foot syndrome (HFS) and/or targeted therapy-related hand-foot skin reaction (HFSR). Method: Face-to-face interviews were conducted with 20 outpatients with advanced/recurrent cancer and chemotherapy-related HFS and/or targeted therapy-related HFSR using a semi-structured interview guide at Keio University Hospital, Tokyo, Japan. Thematic analysis was used to analyse the data. Results: The unmet needs of cancer patients with chemotherapy-related HFS and/or targeted therapy-related HFSR was identified through four themes: a sense of helplessness with persistent symptoms, noticeable appearance as a barrier to social participation, decreased willingness to work and continue treatment, and need of individual coping strategies. Conclusion: This study revealed unmet needs of cancer patients with chemotherapy-related HFS and/or targeted therapy-related HFSR that are not often voiced. Health care providers should provide full information in advance and find the best coping strategy for individual patients.