Recurrence and metastatic cancer concerns of patients and their families after receiving chemotherapy

本研究の目的は，がんの再発・転移の告知を受け外来で化学療法を受けるがん患者とその家族がどのような気がかりを抱えているのかについて，患者と家族，双方の視点から明らかにすることである．外来で化学療法を受けているがん患者１０名とその家族１２名に半構成的面接を行い，質的帰納的に分析した．結果，がん患者の気がかりは【副作用によるさまざまな影響】【がん治療が難しくなっていく】【家族にかける負担の大きさ】【がんの再発・転移を抱える恐れ】【心身のつらさが家族に伝わらない】の5 カテゴリー，家族の気がかりは，【副作用に煩わされている患者のつらさの察知】【がん治療の先行きが見えない】【患者の闘病を支える責任の重さ】【患者の再発・転移による苦悩】【患者へのかかわり方がわからない】の５カテゴリーが抽出された．看護師は，がんの再発・転移を抱え療養しているがん患者と家族が多くの気がかりを抱え，それに対応しながら療養生活を送っていることを理解する．患者と家族の気持ちの根底には，がんという不確かな存在がありお互いの気持ちにずれが生じやすいことを踏まえ，患者や家族の価値観を尊重しながら，タイムリーに支援できるよう，診断早期から患者と家族の状況を把握していくことが大切である．The objective of this study was to clarify the concerns of family members who were living at home with the patients who have been diagnosed with recurring or metastatic cancer, and are receiving outpatient chemotherapy. The study also examined ways of supporting patients who were diagnosed with cancer, and their families. Semi-structured interviews were performed with ten patients with cancer, and twelve family members who were receiving chemotherapy at the outpatient. These interviews were transcribed and analyzed using a qualitative descriptive study design. Findings of the study revealed that the concerns of patients with cancer can be categorized into five factors, namely : ［ Various side effects of treatments］, ［The burden of cancer treatment］ ［The magnitude of the burden on the family］ ［The mind and body are not transmitted to family］ ［Fear of having cancer recurrence or metastasis］. The family’s concerns can be classified into five categories, namely : ［ Patient suffering from side effects］ ［Invisible prognosis of cancer treatment］ ［Burden of responsibility to support the patient’s fight against the disease］ ［Suffering from cancer recurrence and metastasis］ ［Inability to relate to the patient］. However, nurses understand that cancer patients and their families who may have relapsed/metastasized cancer will have greater demands for care, and many family members will have more worries while living life. Underlying the patient’s and family’s concerns are the uncertainty of illness caused by cancer and is likely to cause a divide. Between diagnosis and treatment concerns, early diagnosis was found to be consistent with existing treatment protocols promoting early diagnosis to have timely support, including respecting the patient and their family’s values. It is important to understand the situation of patients and their families

Working Situations of Patients with Cancer : A Literature Review

本研究の目的は，がん患者の就労に関する研究の動向とともに就労状況における特徴を明らかにし，医療職者の立場からがん患者の就労に対する支援体制の方向性を検討していくことである．文献は，医学中央雑誌Web 版（Ver．５）を用いて，「がん」and「就労」，「がん」and「就労支援」，「がん」and「仕事」をキーワードに原著論文に限定し文献検索を行った．がん患者を対象とした就労に関連する文献に限定し，小児がん患者・小児がん経験者を対象とした論文，医療職者が対象である論文，症例報告については除外し，２５論文を分析対象とした．がん患者の就労状況の実態，がん患者の就労継続を左右する要因について着目し整理した．結果，がん患者の就労状況の特徴として，がんの診断から治療開始前までの早い時期に離職する傾向にあった．がん患者の就労継続を左右する要因として，【身体調整】【情報獲得】【就労への価値】【支援体制】【職場の配慮】【経済状況】が明らかになった．医療職者は，社会の動向や施策，就労の場で行われている取り組みを理解し，患者の治療と就労の調整役として，就労継続を左右する要因である【身体調整】【情報獲得】【就労への価値】【支援体制】【職場の配慮】【経済状況】の６視点を持ち，離職が多い診断時から支援する介入プログラムを構築する必要性が示唆された．The purpose of this study was to clarify the characteristics of the working situation derived from the findings of research studies on cancer patients, and to explore the possibilities of support systems towards employment of patients with cancer from the viewpoint of the health care staff. The literature review used the Ichushi-Web（Ver .５）, limiting the search to only original papers using the following keywords : “cancer” and “working”, “cancer” and “working support”, “cancer” and “job”. Moreover, the review included dissertation studies and excluded papers focused on pediatric patients with cancer, papers designed for medical staff, and case reports. From these inclusion and exclusion criteria, only ２５ research papers remained. These were all focused on the actual conditions of working situations of patients with cancer, and the factors affecting the continuation of working by the patients with cancer. An astounding finding was that actual status of employment for patients with cancer was dictated by the status of their cancer treatments. They tended to leave their employment early, often before cancer treatment began. Factors that were found crucial to the characteristics are［Physical adjustment］［Information acquisition］［Value for working］［Support system］ ［Consideration of workplace］［Economic situation］influencing the viewpoint for the continuation of work for patients with cancer. Health care professionals need to understand that the social trends and policies, including the activities being carried out at places of employment are important towards the coordination of treatment and further employment of the patient with cancer. It is suggested that it is necessary to construct an intervention program that supports many types of workers, but most especially those patients with cancer

The dominant origin of diffuse Lyα halos around Lyα emitters explored by spectral energy distribution fitting and clustering analysis

The physical origin of diffuse Lyα halos (LAHs) around star-forming galaxies is still a matter of debate. We present the dependence of LAH luminosity [L(Lyα)_H] on the stellar mass (M⋆), star formation rate, color excess [E(B − V)⋆], and dark matter halo mass (M_h) of the parent galaxy for ∼900 Lyα emitters (LAEs) at z ∼ 2 divided into ten subsamples. We calculate L(Lyα)_H using the stacked observational relation between L(Lyα)H and central Lyα luminosity of Momose et al. (2016, MNRAS, 457, 2318), which we find agrees with the average trend of VLT/MUSE-detected individual LAEs. We find that our LAEs have relatively high L(Lyα)_H despite low M⋆ and M_h, and that L(Lyα)_H remains almost unchanged with M⋆ and perhaps with M_h. These results are incompatible with the cold stream (cooling radiation) scenario and the satellite-galaxy star-formation scenario, because the former predicts fainter L(Lyα)_H and both predict steeper L(Lyα)_H vs. M⋆ slopes. We argue that LAHs are mainly caused by Lyα photons escaping from the main body and then scattering in the circum-galactic medium. This argument is supported by LAH observations of Hα emitters (HAEs). When LAHs are taken into account, the Lyα escape fractions of our LAEs are about ten times higher than those of HAEs with similar M⋆ or E(B − V)⋆, which may partly arise from lower H I gas masses implied from lower M_h at fixed M⋆, or from another Lyα source in the central part

The dominant origin of diffuse Lyα\alpha halos around LAEs explored by SED fitting and clustering analysis

The physical origin of diffuse Ly$\alpha$ halos (LAHs) around star-forming galaxies is still a matter of debate. We present the dependence of LAH luminosity ($L({\rm Ly}\alpha)_H$) on the stellar mass ($M_\star$), $SFR$, color excess ($E(B-V)_\star$), and dark matter halo mass ($M_{\rm h}$) of the parent galaxy for $\sim 900$ Ly$\alpha$ emitters (LAEs) at $z\sim2$ divided into ten subsamples. We calculate $L({\rm Ly}\alpha)_H$ using the stacked observational relation between $L({\rm Ly}\alpha)_H$ and central Ly$\alpha$ luminosity by Momose et al. (2016), which we find agrees with the average trend of VLT/MUSE-detected individual LAEs. We find that our LAEs have relatively high $L({\rm Ly}\alpha)_H$ despite low $M_\star$ and $M_{\rm h}$, and that $L({\rm Ly}\alpha)_H$ remains almost unchanged with $M_\star$ and perhaps with $M_{\rm h}$. These results are incompatible with the cold stream (cooling radiation) scenario and the satellite-galaxy star-formation scenario, because the former predicts fainter $L({\rm Ly}\alpha)_H$ and both predict steeper $L({\rm Ly}\alpha)_H$ vs. $M_\star$ slopes. We argue that LAHs are mainly caused by Ly$\alpha$ photons escaping from the main body and then scattered in the circum-galactic medium. This argument is supported by LAH observations of H$\alpha$ emitters (HAEs). When LAHs are taken into account, the Ly$\alpha$ escape fractions of our LAEs are about ten times higher than those of HAEs with similar $M_\star$ or $E(B-V)_\star$, which may partly arise from lower HI gas masses implied from lower $M_{\rm h}$ at fixed $M_\star$, or from another Ly$\alpha$ source in the central part.Comment: Published in PASJ; 35 pages, 13 figures, 6 table

「看取りの語り」に対する捉えの実態調査

The purpose of this study is to examine how to support healthcare professionals and the general public in a situation where home care is increasing by clarifying the actual situation of how to perceive the end-of-life-care of healthcare professionals and the general public who heard the “narratives of attendance to someone’s death”. A questionnaire survey was conducted targeting palliative care certified nurses and the general public and healthcare professionals in local city A who participated in the lecture on “Narratives of attendance to some one’s death” by the bereaved family. Healthcare professionals perception of “narratives of attendance to someone’s death” were in the following four categories : “Cooperation based on the roles of other professions is essential,” “The way one lives one’s life has an impact,” “It is important to acquire a wealth of knowledge as a practitioner,” and “It is based on the thoughts of the family.” On the other hand, the general public’s perception of “narratives of attendance to someone’s death” was in the four categories of “understanding through experience and information,” “continuing to seek care for the person,” “making people think about the meaning of life,” and “confronting one’s own and one’s family’s view of life and death.” In order to make end-of-life care satisfactory for patients and their families, it is necessary to provide information that can predict the future and adjust the environment to support them together