浅田 裕美

【目的】本研究では、がん患者の呼吸困難に対するマッサージについて報告されている論文を体系的に記述し、まとめることを目的とした。【方法】PRISMA-ScRの方法論に則り、スコーピングレビューを行った。検索については、電子データベースである医中誌WebとPubMedを用いて、2021年6月18日までの期間に発表された論文に限定した。検索ワードは、「がん」「呼吸困難」「マッサージ」とした。文献の選定は、一次スクリーニングとして、検索で得られた全ての論文について、2名の著者が選定基準をもとにタイトルと抄録を評価した。次に、一次スクリーニングで得られた全ての文献を取り寄せ、二次スクリーニングとして同じ2名の著者が全文のスクリーニングを行い、採用論文を確定した。採用された論文から、著者、出版年、報告された国名、論文の種類、対象者数、介入方法、介入の実施者の情報についてデータを抽出し、分類を行った。【結果】42件の文献を対象にスクリーニングを行い、最終的に6件の文献を採用した。採用文献の概要について、投稿された国別では、6件中3本が日本からの投稿であった。研究デザインでは、無作為化比較試験と非無作為化クロスオーバー試験がそれぞれ2件であった。全ての文献が介入研究であり、対象人数は合計464名であった。介入については、フットリフレクソロジーが2件と最多で、介入者について記載のあった文献のうち、4件はリフレクソロジストやアロマセラピストの資格を有するものが実施していた。【結論】がん患者が体験する呼吸困難に対するマッサージについて報告された論文を体系的にまとめた結果、がん患者の呼吸困難の改善を目的としてマッサージを行っている文献が少ないこと、呼吸困難の緩和に対するマッサージにおいて、方法論は確立されていないこと、が明らかとなった。今後は、がん患者の呼吸困難に対する適用可能性の高いマッサージ方法の確立が課題である。(著者抄録)

Purpose: Patients undergoing radiotherapy often have their skin marked. Previous studies on skin markings examined the durability and physical effects of the markings, but no study has focused on patients' emotional experiences toward the markings. This study aimed to clarify how patients undergoing radiotherapy feel about skin markings, as well as factors that affect patients' emotional experiences. Patients and Methods: We conducted a cross-sectional study using a self-administered questionnaire and medical records. Participants were patients aged ≥20 years undergoing cancer radiotherapy at a designated cancer care hospital. The primary outcome was the level of uncomfortable emotions toward skin markings, and the secondary outcome was the level of favorable ratings on skin markings. To examine factors related to uncomfortable emotions, ordinal logistic regression analysis was performed. Results: Questionnaire forms were distributed to 153 patients, and responses were collected from 132 (86%). Among 108 patients included in the analysis, 56% (59/105, excluding 3 who did not answer this question) responded that they were uncomfortable with skin markings. The proportion of patients who favorably rated skin markings was 63% (59/93, excluding 15 who did not answer this question). No factors were significantly associated with the primary outcome. Conclusion: Many patients accepted skin markings with resignation, as they understood the necessity of the markings in their treatment. Medical staff should understand the emotional experiences of patients toward skin markings and take sufficient care to ensure that they are provided with explanations, including the impact of skin markings on their daily lives, as well as a sense of security that treatment is being performed in a precise manner.

BACKGROUND AND PURPOSE: We created a scoring system incorporating dosimetric and clinical factors to assess the risk of severe, acute skin reactions in patients undergoing intensity-modulated radiation therapy (IMRT) to treat head and neck cancer (HNC). MATERIALS AND METHODS: A total of 101 consecutive patients who received definitive IMRT or volumetric modulated arc therapy (VMAT) with a prescription dose of 70 Gy to treat HNC between 2013 and 2017 in our hospital were enrolled. Skin V5Gy, V10Gy, V20Gy, V30Gy, V40Gy, V50Gy, and V60Gy values delivered 5 mm within the body contour were compared between patients with Grades 1-2 and Grade 3 dermatitis. A scoring system was created based on logistic regression analysis (LRA) that identified the most significant dosimetric and clinical factors. RESULTS: The V60Gy was significantly associated with radiation dermatitis grade in both LRA and recursive partitioning analysis (RPA). A scoring system incorporating the V60Gy, concurrent chemotherapy status, age, and body mass index was used to divide all patients into three subgroups (0-1, 2-3, and 4-6 points) in the RPA. The incidence of Grade 3 dermatitis significantly differed among the subgroups (0, 20.5, and 58.6%, respectively, P < 0.01). CONCLUSIONS: A risk analysis model incorporating dose-volume parameters successfully predicted acute skin reactions and will aid in the appropriate management of radiation dermatitis.