醫師的遵循行為可促進病患的存活嗎？以台灣非小細胞肺癌病患為例

Can Physician Adherence to Treatment Guidelines Improve Patient Survival? A population-based Analysis of non-small Cell Lung Cancer (NSCLC) in Taiwan

陳錫杰(His-Chieh Chen) ； 蘇慧芳(Hui-Fang Su) ； 李中一(Chung-Yi Li) ； 賴美淑(Mei-Shu Lai) ； 謝碧晴(Pi-Ching Hsieh)

《台灣公共衛生雜誌》 29卷2期 (2010/04) Pp. 118-130

https://doi.org/10.6288/TJPH2010-29-02-04

摘要

目標：探討在控制病患特性、醫院及醫師特性後，非小細胞肺癌病患接受遵循指引治療，對一年存活情形之影響。方法：此回溯性世代追蹤研究，資料源自2004年台灣癌症診療資料庫、2002到2004年健保資料庫，及2004到2005年死因登記檔。Kaplan-Meier繪製存活曲線，Cox涉險模型進行風險校正，分析病患接受遵循指引治療對存活情形的影響。結果：57%的病患為第四期，66.6%接受遵循指引治療。不同期別，遵循指引者皆比未遵循者有較好的一年存活率(51.1% vs. 22.1%)。校正後，遵循指引治療者在診斷後一年內死亡的風險比未遵循者低(HR=0.44; 95% CI=0.41-0.48)。期別與遵循指引與否有顯著的交互作用。期別早期且遵循指引者，診斷後一年內死亡的風險，比期別晚期者為低。結論：醫師能遵循治療指引提供照護，能顯著提升病患一年的存活情形，特別是期別較為早期者，其診斷後一年內死亡的風險較低。故早期診斷非小細胞肺癌並促進治療指引共識之建立及落實執行是控制疾病的有效策略。

關鍵字

非小細胞肺癌 ； 一年存活 ； 遵循治療指引 ； 台灣癌症診療資料庫

並列摘要

To explore the relationship between adherence to treatment guidelines and one-year survival of all stages of non-small cell lung cancer (NSCLC) patients after adjustment for the characteristics of patients, hospitals and physicians. Methods: Population-based data were retrieved from the Taiwan Cancer Data Base (TCDB) in 2004, National Health Insurance Research Database (NHIRD) in 2002-2004 and Taiwan's Death Registries in 2004-2005. This was a retrospective cohort study and Kaplan-Meier analysis was used to construct survival curves. A multivariate Cox proportional hazard model was employed to estimate the hazard ratio (HR). Results: Fifty-seven percent of NSCLC patients were at cancer stage IV. Overall, 66.6% of NSCLC patients in the study cohort were compliant with treatment guidelines. The patients who received treatments in adherence to guidelines had a higher one-year survival rate than those who did not adhere (51.1% vs. 22.1%), even in various stages of cancer. Multivariate analysis showed that the patients who received treatments in adherence to guidelines had a lower risk of one-year mortality (HR=0.44; 95% CI=0.41-0.48). A significant interaction effect between cancer stage and guideline adherence was found. The early-stage cancer patients who adhered to guidelines had a lower risk of one-year mortality then those diagnosed with late-stage cancer. Conclusions: Physician adherence to treatment guidelines is associated with one-year survival of NSCLC patients regardless of the stage of the cancer. Such a favorable effect is particularly noteworthy for patients diagnosed at an early-stage. Early diagnosis and promotion of the adoption of guidelines for treatment are effective strategies for NSCLC control.

並列關鍵字

non-small cell lung cancer NSCLC ； one year survival ； guideline adherence ； Taiwan Cancer Data Base

參考文獻

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