著者

伊藤 登茂子 浅沼 義博 白川 秀子 久米 真 ITO Tomoko ASANUMA Yoshihiro SHIRAKAWA Hideko KUME Makoto

出版者

秋田大学大学院医学系研究科保健学専攻

雑誌

秋田大学大学院医学系研究科保健学専攻紀要 (ISSN:18840167)

巻号頁・発行日

vol.17, no.2, pp.29-36, 2009-10-01

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膵癌の治療成績は不良であり, 現在においても, 膵頭部癌切除例の生存期間の中央値は12.3ヶ月, 5年生存率は13.0%と低値である. 浸潤性膵管癌は膵癌の大多数を占めるものであるが, 同診断により手術を受けたのち, 19年が経過したサバイバーに, 病気との向き合い方についてインタビューする機会を得た.1) 疾病の理解, 2) 病気に対する自分自身の構え, 3) 病気への対処行動と予防行動について, その語りを健康生成論的視点で分析したところ, 首尾一貫して健康のベクトルを健康軸に向けるよう, 自分はこれでは死なないと信じて, 病名告知がない状況で自ら文献を調べて疾患を理解し, 回復手段を考え, 便秘やガス貯留が無いように代替療法を取り入れるなど, 主体的かつ積極的に過ごしてきたことが分かった. また, 入院中の生活で感じたさまざまな不合理や, 職業的背景や価値観を尊重した対応がされなかった際に感じた疎外感については, 今後のケアで留意すべき示唆となった.\nThe prognosis of invasive ductal pancreatic cancer is not satisfactory even at present. The median survival is reportedly 12.3 months, and 5 year survival rate is as low as 13.0% in patients who underwent pancreatoduodenectomy.We interviewed a pancreatic cancer patient who survived for more than 19 years following pancreatoduodenectomy, with regard to the way he coped with the disease. We have analyzed the interviewfrom a salutogenic standpoint such as 1) understanding of the disease, 2) his own preparedness, 3) manageability and preventive approach to the disease.As the result, we realized that he maintained a proactive and positive attitude : he had a strong sense of coherence to maintain his health, he believed that he would not die from the disease, he examined the literature to comprehend the disease (since informed consent had not been achieved sufficiently in those days), and he managed constipation and abdominal distension well by resistance training, special supplements and devised abdominal massage. Furthermore, he sometimes felt irrational and alienated during his hospitalization, because his value judgment fostered through his long career of journalist was not respected during his treatment. This should be given consideration in future.