がんサバイバーシップケアの研究の動向に関する英字文献レビュー

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  • ガン サバイバーシップ ケア ノ ケンキュウ ノ ドウコウ ニ カンスル エイジ ブンケン レビュー
  • Trends in Cancer Survivorship Care: A Literature Review of English Articles on Cancer Survivorship

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がんサバイバーシップの捉え方,サバイバーシップケアの研究の動向を知ることを目的として, 英字文献のレビューを行った.英字文献は,1985～2012年の23件で,サバイバーシップの捉え方やサバイバーシップケアが14件,調査研究が9件だった. がんサバイバーの捉え方は, 1985年にMullan が,がんと診断されたときから始まり,急性期,延長期,永続期の3時期に分類し,2003年には"Cancer Care Trajectory"が示され,緩和ケア・終末期が追加されていた. サバイバーシップケアの対象は,がんの治療を終えたサバイバーや無病者であり,治療の後遺症や晩期症状のマネジメント,再発や2次がんのリスクの早期的対処が課題となっていた.がんサバイバーが必要とするケアは,がん種,治療法,後遺症,再発のリスクなどによっても多種多様であり,オンコロジスト,プライマリー医,地域の看護師,専門看護師などの実践が重要である.今後の課題は,継続教育が主流となっているのでその推進と医学や看護学の基礎教育や大学院教育のカリキュラムを増やすこと,サバイバーシップケアを適切に選択し提供することである.また,がんサバイバーのニーズにあったサバイバーシップケアプランの見直しを行うことも必要である.

We reviewed 23 articles written in English, published between 1985 and 2012, in order to better understand the revolution of the concept of cancer survivorship as well as the trends in survivorship care. Of those articles, 14 were regarding the concept of survivorship or survivorship care and 9 were survey-based. The concept of cancer survivorship was first introduced by Mullan in 1985, who defined that cancer survivorship begins at diagnosis, and depicted three seasons of cancer survival: acute,extended, and permanent survival. In 2003, the notion of "Cancer Care Trajectory" was proposed, and palliative care and end of-life phases were included in the trajectory. Survivorship care is primarily for post-treatment cancer survivors and cancer-free survivors. The challenges in survivorship care include managing sequelae and late effects of treatment and addressing early the risk of recurrence or second cancers. The type of care needed by cancer survivors varies substantially depending on the types of cancer, types of treatment, sequelae, and the probability of recurrence. Therefore, the involvement of oncologists, primary care physicians, local nurses, and nurse specialists, not only in cancer treatment, but also in survivorship care was found to be important. We also identified issues that have yet to be addressed, including promoting education in medical and nursing basic courses as well as in graduate schools' curricula, especially with the growing trend of continuing education, and selecting the appropriate type of survivorship care to provide. In addition, it is also necessary to modify the survivorship care plans in order to meet the needs of cancer survivors.

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