[研究報告] がん相談に従事する看護師の就労支援の困難の内容分析

要旨：就労年齢におけるがん罹患者の増加に伴い、医療機関と企業や労働機関が連携する包括的な就労支援が2016年に始まった。そこで、本研究はがん相談に従事する看護師の就労支援とその困難の実態を明らかにすることを目的とした。　がん診療連携拠点病院426施設の看護師を対象として質問紙調査を実施し、106名（回収率24.9%）の回答を得た。　就労先との情報共有や就労可否の判断の調整など連携する支援内容、進行・再発・転移時や緩和ケア移行時など身体状況が変化する支援時期は、他の支援内容・時期と比べて困難を感じる割合が高かった。　困難を感じる理由を分析した結果、就労先との連携に関する支援の困難の要因は、看護師の知識・経験不足、就労先の就労支援に対する理解不足、就労支援の体制整備・連携不足と考えられた。身体状況が変化する時期の就労支援の困難の要因は、先の見通しの不確かさの中で時期に応じた就労可否の判断や多様で個別性の高い対応が求められることに加えて、医療者の病状認識と就労者の就労意欲とのズレがあることが考えられた。　がん就労支援の課題解決で重要なのは、就労がん患者自身の症状のセルフケア能力と職場との調整能力が向上するよう支援することである。そのためには、就労がん患者自身が疾患・治療に伴う症状や生活の障壁となるものを具体的にアセスメント・対処ができ、今後の治療や病状管理の見通しをイメージできるよう支援することが必要である。Abstract：With the increasing number of patients with cancer within the working-age population, a comprehensive working support system was initiated in 2016 as a collaborative effort between medical institutions, companies and labour organizations. This study aimed to discuss and clarify the working support system provided by nurses and the difficulties they face while engaging in cancer consultations.A questionnaire survey that included nurses at 426 core hospitals that deliver collaborative cancer treatment was conducted, and answers were collected from 106 respondents（collection rate, 24.9%）.Based on the survey, nurses were found to have relatively more difficulties in terms of providing assistance such as sharing information with employers, coordinating assessment on patients’ ability or inability to work and the timing of providing assistance when physical condition changes including progression, recurrence, metastasis or transition to palliative care were involved compared to other types of assistance.In the analysis, factors that have contributed to the difficulties in cooperating with employers were a lack of knowledge and experience of nurses, a lack of understanding of the working support system by employers, the inadequacy of the working support system and insufficient cooperation. Conversely, factors that influenced the difficulties of the working support system, regarding the timing of providing assistance were assessment of patients’ working ability or inability while facing an uncertain future and the requirement of providing highly personalized assistance. In addition, it was suggested that there is a gap between medical personnel’s ability to recognize the disease condition and the patient’s motivation to work.To resolve these difficulties, it is important to provide assistance in order to improve the self-care agency of working patients with cancer, as well as their ability to adjust to workplaces. To this end, it is necessary to support working patients with cancer by assessing specific symptoms of their disease and symptoms post treatment, and helping them cope with obstacles of daily life to ensure that they can anticipate future treatment and disease management

Efficacy and safety of a combination antihypertensive drug (olmesartan plus azelnidipine): “Issues with hypertension studies in real-world practice”

Background: This study investigated whether a combination drug containing an angiotensin II receptor blocker (ARB) and a calcium channel blocker (CCB) could provide effective antihypertensive therapy. Methods: A multicenter, prospective, open-label study was conducted at the clinics of Clinical Research Network. The subjects had uncontrolled blood pressure (BP) despite ARB or CCB monotherapy. The effect on both office and home BP was examined after patients switched to a combination drug (REZ: containing 20 mg of olmesartan [OL] and 16 mg of azelnidipine [AZ]). Results: A total of 78 patients were enrolled. After switching to REZ, a significant and sustained reduction of office BP was observed. The proportion of patients who achieved the target for both office and home BP was an increase from 0% to 55%. Switching from amlodipine to REZ resulted in a significant and sustained decrease of office and home BP. There was also a significant decrease of home pulse rate (PR), but office PR was unchanged. To determine the accuracy of the BP and PR values reported by patients, the frequency of each number as the first digit was determined. The frequency of “0” was extremely high for both office and home BP values, and the same was noted for home PR values. Conclusion: The results of this study suggested that switching from a single drug to combination therapy with REZ could achieve a stronger antihypertensive effect. However, concern was raised regarding the methods of BP and PR measurement and recording in this clinical trial involving general practitioners

Usefulness of the cardiopulmonary exercise test up to the anaerobic threshold for pati-ents aged ≥ 80 years with cardiovascular disease on cardiac rehabilitation

Objective: A cardiopulmonary exercise test provides information regarding appropriate exercise intensity, but there have been few reports on its use in patients over 80 years of age. Design: Retrospective observational study. Patients: A total of 511 cardiovascular disease patients who performed a cardiopulmonary exercise test from February 2011 to January 2020 were investigated. Methods: Patients were stratified according to age: < 70 years, 70–79 years, and ≥ 80 years, and the results of the cardiopulmonary exercise test up to anaerobic threshold were compared. Results: Patients in the < 70 age bracket showed higher oxygen consumption, carbon dioxide output, and ventilatory volume and lower ventilation equivalents per oxygen consumption and carbon dioxide output in all time periods. However, there were no significant differences in these parameters or the work rate (70–79 years of age: 41.4 ± 11.7 watts, vs ≥ 80 years: 42.2 ± 10.9 watts, p = 0.95) or oxygen consumption per body weight at anaerobic threshold (12.2 ± 0.2 ml/min/kg, vs 12.1 ± 0.4 ml/min/kg, p = 0.97) between the 70–79 year age bracket and the ≥  80 year age bracket. Conclusion: Even for cardiovascular disease patients age ≥ 80 years, a cardiopulmonary exercise test up to anaerobic threshold can supply useful information for guiding cardiac rehabilitation

Depression and Anxiety Are Associated with Physical Performance in Patients Undergoing Cardiac Rehabilitation: A Retrospective Observational Study

Background: Cardiac rehabilitation (CR) combined with stress management training has been shown to be associated with fewer clinical events than CR alone. However, there have been no reports on the associations of CR with the psychological condition and detailed physical activities evaluated on the same day. Method: One hundred outpatients who participated in a CR program were graded on the hospital anxiety and depression scale (HADS). We divided them into a high HADS group (n = 32) and a normal HADS group (n = 68) and investigated by whole patients, ischemic heart disease (IHD) patients, and heart failure patients. Results: Overall, the patient age was 70.5 ± 9.6 years, the percentage of males was 73.0%, and the body mass index was 23.4 (21.7–26.0) kg/m2. In the high HADS group, overall functional mobility was poor and the distance in a two-minute walking test was short. Especially in IHD patients, the high HADS group showed high fat mass in body composition and low exercise tolerance and ventilator equivalents in cardiopulmonary exercise test. Conclusions: Depression and anxiety involved poor physical performance in CR outpatients and particularly involved low exercise tolerance in IHD patients. To evaluate accurate physical performance, it is necessary to investigate psychological condition

Influence of Discontinuation of Cardiac Rehabilitation in Elderly Outpatients Due to the COVID-19 Pandemic

Background: The coronavirus disease 2019 (COVID-19) pandemic has restricted people&rsquo;s activities and necessitated the discontinuation of cardiac rehabilitation (CR) programs for outpatients. In our hospital, CR for outpatients had to be discontinued for 3 months. We investigated the influence of this discontinuation of CR on physical activity, body composition, and dietary intake in cardiovascular outpatients. Method: Seventy-eight outpatients who restarted CR were investigated. We measured body composition, balance test, stage of locomotive syndrome, and food frequency questionnaire (FFQ) results at restart and 3 months later. We also investigated the results of examination that were obtained before discontinuation. Results: With regard to baseline characteristics, the percentage of male was 62.7% (n = 49), and average age and body mass index were 74.1 &plusmn; 8.5 years and 24.9 &plusmn; 7.0 kg/m2, respectively. Stage of locomotive syndrome and the results of FFQ did not change significantly. The one-leg standing time with eyes open test significantly worsened at restart (p &lt; 0.001) and significantly improved 3 months later (p = 0.007). With regard to body composition, all limb muscle masses were decreased at restart and decreased even further 3 months later. Conclusions: Discontinuation of CR influenced standing balance and limb muscle mass. While the restart of CR may improve a patient&rsquo;s balance, more time is required for additional daily physical activities. The recent pandemic-related interruption of CR should inspire the development of alternatives that could ensure the continuity of CR in a future crisis

Difference in Prognosis between Continuation and Discontinuation of A 5-Month Cardiac Rehabilitation Program in Outpatients with Heart Failure with Preserved Ejection Fraction

Background: Cardiac rehabilitation (CR) is a requisite component of care for patients with heart failure (HF). We aimed to evaluate the clinical outcomes in outpatients with HF with preserved ejection fraction (HFpEF) compared to those in patients with non-HFpEF who did and did not continue a 5-month CR program. Methods: 173 outpatients with HF who participated in a 5-month CR program were registered. We divided them into two groups: HFpEF (n = 84, EF 63 ± 7%) and non-HFpEF (n = 89, EF 31 ± 11%). We further divided the patients into those who continued the CR program (continued group) and those who did not (discontinued group) in the HFpEF and non-HFpEF groups. The clinical outcomes at 5 months were compared among the groups. Results: There were no significant differences in patient characteristics at baseline between the continued and discontinued groups in the HFpEF and non-HFpEF groups except for % diabetes mellitus in the non-HFpEF group. The rates of all-cause death and hospital admissions in the continued group in both the HFpEF and non-HFpEF groups were significantly lower than those in the discontinued group. The all-cause death and hospital admissions in each group were independently associated with the continuation of the CR program. Conclusions: The continuation of a 5-month CR program was associated with the prevention of all-cause death and hospital admissions in both the HFpEF and non-HFpEF groups