特集名 | 腎不全における悪性腫瘍 | |
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題名 | 担癌患者の透析導入 | |
発刊年月 | 2001年 06月 | |
著者 | 伊藤 晃 | 増子記念病院内科 |
【 要旨 】 | ターミナル期の担癌患者への透析導入の是非は,医療担当者にとってしばしば踏み絵になる.基本的には患者の「自己決定権」に負うのであろうが,すでに生命予後が決まっている患者に,透析がそのQOLの維持にいかに寄与するか,「医療側の論理」のみでは解決できない. 3症例を呈示し,psycho-socialな観点から考察した.(1) mycosis fungoidesの腫瘍期に導入,死亡まで継続した症例,(2) 肝硬変の非代償期に肝臓癌を合併,肝性昏睡のなか,家族の意向で導入を見送った症例,(3) 大腸癌の諸臓器への転移で,患者の申し出にて中断した症例である. 結論として,(1) 癌も含め患者への病態の告知が必要である,(2) 決断・選択には十分な時間,静かな環境を保証する,(3) 患者・家族への適切な情報提供,チーム医療による柔軟性のある支援体制の確立が必要である. |
Theme | Malignancy in Chronic Renal Failure | |
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Title | Commencement of dialysis for cancer patients | |
Author | Akira Ito | Department of Internal Medicine, Masuko Memorial Hospital |
[ Summary ] | Medical specialists often find it difficult to decide whether they should provide dialysis as a treatment for renal dysfunction in terminal cancer patients. In principle, the decision should be left to the patient. However, there is some question as to the QOL which can be offered to dialysis patients. Medical science alone is insufficient to answer such a question. Here, I present three cases, examined from a psycho-social viewpoint. In case (1) treatment for mycosis fungoides was started in the tumorous stage and continued until the patient's death. In case (2) liver cancer occurred as a complication of liver cirrhosis in an irreversible stage, and dialysis was not provided for the patient, who was in a hepatic coma, in accordance with the wishes of the patient's family. In case (3) colon cancer metastasized to several organs, and dialysis was stopped at the patient's request. Conclusions: (1) It is important that patients be notified of pathogenesis, including cancer. (2) Patients and their families need to be provided with appropriate amounts of time and proper environments, in which to make decisions. (3) Proper disclosure of information, and team support by physicians in charge-including dialytic doctors-is necessary. |