Social isolation and cancer management – advanced rectal cancer with patient delay following the 2011 triple disaster in Fukushima, Japan: a case report

Journal of Medical Case Reports

卷:11

Tetsuya Tanimoto¹  Masaharu Tsubokura²  Claire Leppold³  Toyoaki Sawano⁴  Hiromichi Ohira⁴  Akihiko Ozaki⁴  Manabu Tsukada⁴  Masahiro Kami⁵ 

[1] Department of Internal Medicine, Jyoban Hospital of Tokiwa Foundation;

[2] Department of Radiation Protection, Minamisoma Municipal General Hospital;

[3] Department of Research, Minamisoma Municipal General Hospital;

[4] Department of Surgery, Minamisoma Municipal General Hospital;

[5] Medical Governance Research Institute;

关键词: Patient delay;    Colorectal cancer;    Social isolation;    Social support;    Social change;    Social relationships;   

DOI  :  10.1186/s13256-017-1306-3

来源: DOAJ

【 摘 要 】

Abstract Background Little is known about the effects of social isolation in the elderly on their process of gaining health information and seeking health care. Case presentation In March 2011, Fukushima, Japan experienced an earthquake, tsunami, and nuclear disaster, also known as Japan’s triple disaster. In June 2016, an 80-year-old Japanese man, who lived alone after divorce at the age of 42, presented to our hospital with bloody stools and dizziness. Although his bloody stools initially occurred in May 2015, a year earlier, he did not pursue the possibility of malignancy. He was diagnosed as having stage IIIA rectal cancer. Detailed history taking revealed that he experienced social isolation after the disaster, due to the evacuation of his friends, losing his regular opportunities for socialization. He additionally reported that the current diagnosis of rectal cancer made him feel he had lost his health in addition to his social relationships. Although radical surgery was attempted, it failed to resect the lesion completely, and thereafter his disease gradually progressed. As support from family or friends was not available, he was not able to receive palliative radiation therapy or home-based care in his end-of-life period. He died at a long-term care facility in February 2017. Conclusions This case suggests that intense social isolation after the Fukushima disaster was a likely contributor to the patient delay, poor treatment course, and poor outcome of an elderly patient with rectal cancer. Direct communication with family and friends may play an indispensable role in increasing health awareness and promoting health-seeking behaviors, and in the midst of social isolation, elderly patients with cancer may lose these opportunities and experience increased risk of patient delay. Although health care providers may be able to alleviate isolation-induced delay by promoting cancer knowledge and awareness widely among local residents, policy-led interventions at the community level may be essential to reducing social isolation and its health consequences.

【 授权许可】

Unknown