学位論文内容の要旨

博士の専攻分野の名称

博士（医 学）

氏 名

大 島 寿

美 子

学 位 論 文 題 名Survivorship care after gynecological cancer: a qualitative study exploring experiences
and perspectives of patients and specialists on post-treatment follow-up（ 婦 人 科 が ん 術 後 の サ バ イ バ ー シ ッ プ ケ ア ： 術 後 フ ォ ロー ア ッ プ に 対 す る 患 者 と 医 師 の 意 識 に 関 す る 質 的 研 究 ）Background and Objectives: With an increase in the number of cancer patients andtheir survival rate owing to the development of effective treatments, the number ofpeople living with and beyond cancer has been increasing. These people are now called“cancer survivors,” regardless of the length of time from their first diagnosis. As a result,a new research field related to cancer survivorship has emerged as the public and themedical community have become more concerned with the health and the lives of thesesurvivors.
Still in its early years, cancer survivorship research has already illuminated lingering
physical and psychosocial consequences left on cancer survivors. The research has also
highlighted survivors’ information and care needs. As it became increasingly evident
that the demand is high among the survivors for more care and support, proposals andpolicy initiatives such as establishing a system for providing survivorship care are now
under discussions.
One of the issues that has been discussed is the question of how to provide
post-treatment follow-up care. This issue directly addresses the concerns and needs ofcancer patients and is a topic that has been researched in recent years motivated by theneed to reduce the extra burden in medical institutions caused by the increase in thenumber of survivors.
However, evaluations of post-treatment follow-up from the view of providing
patient-centered care have rarely occurred. Particularly in gynecological cancer, few
studies have investigated the needs and expectations of the patients.
Moreover, in Japan, there has been a paucity of discussion about survivorship care.
The purpose of this study is to explore the perceptions of survivors and specialists withregards to post-treatment follow-up care in gynecological cancer.
Methods: This study employs qualitative methodological approaches in order toexamine experience, perceptions and expectations of both survivors and specialists indepth. The study used two types of data collection: focus groups and individualinterviews. Focus groups were adopted to promote self-disclosure and active
discussions among the patients through interactions within the groups. Twenty-eight
gynecological cancer survivors who had received 1 to 10 years of post-treatment wereasked about their experience with and perspectives of follow-up care. For specialists,individual interviews were conducted to capture a variety of participant views. In total,
17 specialists were interviewed. All sessions were audio taped and transcribed.
The data were analyzed by following the steps of qualitative data analysis. Specifically,
the following methods were used:
1. Thematic analysis was used to extract themes comprising of key components ofsurvivors’ perceptions about follow-up care.
2. Thematic analysis and event flow network techniques were used to elucidate thecare-seeking behaviors of survivors suffering from adverse effects.
3. Grounded theory approach was used to extract themes comprised of the key
components of the specialists’ perceptions about follow-up and role-sharing withprimary care physicians.
Results: Japanese gynecological survivors regarded follow-up as an opportunity forreassurance; however, they also wanted treatment for adverse effects and theopportunity to discuss their physical and psychological concerns they had experienced
during the course of recovery. The expectations for communication and care were notfully met during follow-ups. Survivors sought care through specialty clinic visits whenregular follow-ups did not fulfill their expectation for care of post-treatment adverse
effects and when symptoms were not regarded as treatment-related. Lack of knowledge
and inaccurate symptom interpretation delayed help-seeking, exacerbating symptoms.
Specialists differed widely in terms of their attitudes towards patients’ complaints andthe care provision. This difference was caused by the specialists’ perception about their
responsibility in gynecological cancer follow-up and the time constraints that specialists
felt. Specialists assumed primary care obstetrician-gynecologists could serve as
potential partners and were open to the idea of transferring part of their responsibilities
if a system for role-sharing were developed.
Discussion and Conclusion: The findings indicate that care of post-treatment
symptoms and doctor-patient communication are just as important as recurrence
management during follow-up from the perspectives of Japanese gynecological cancer
patients. Their expectation for the care represents the patients’ desire for their body andtheir life to recover and to be reconciled with their daily lives. This indicates that thefailure to fulfill this expectation does not merely mean the prolongation of debilitating
symptoms; it could also lead to a delay in their recovery from cancer. Althoughspecialists’ attitudes are keys in care provision, the findings from specialists’ interviewssuggest that the quality of care offered to a patient in follow-up can greatly vary basedon the scope of responsibility defined by each doctor and the environment surrounding
them. These observations suggest the importance of establishing guidelines for treating
not only recurrence but also adverse effects and other supportive care, and fordeveloping a system for role-sharing among health professionals that would support therecovery process of gynecological cancer survivors. Post-treatment follow-up careshould be integrated in light of how to best assist gynecological cancer survivors
seeking rapid recovery.