肝癌患者併發特定精神疾患及其影響之相關研究探討

Depression, anxiety, and sleep disorders in patients with hepatocellular carcinoma: A nationwide population-based prospective in Taiwan

蔡宜蓁(I-Chen Tsai)

指導教授 ： 馬可容

高雄醫學大學/健康科學院/醫務管理學研究所碩士在職專班/碩士(2012年)

摘要

研究背景
根據行政院生署統計惡性腫瘤續居十大死因之首，其中肝癌佔男性第一位，女性第二位醫療資源耗用是沉重負擔。在癌症患者，睡眠障礙是一種常見的問題。在新診斷癌症患者中報告，睡眠困難有30-50%，在住院癌症患者中，失眠盛行率可高達 67％。大型研究表示，佔44-48％的癌症患者處方安眠藥物。從臨床醫生和研究人員發現癌症病患，精神疾患(憂鬱、焦慮、及睡眠障礙)很少受到關注，大部分是著重臨床診治。本研究探討肝癌病患併發特定精神疾患(憂鬱、焦慮及睡眠障礙)是否會影響其存活情形及有無接受精神科專科治療是否會影響其存活情形。

研究方法
肝癌樣本3，361，本研究並以1:1的隨機取樣方式取一無癌症對照組(在研究期間內無任何癌症診斷的民眾)，本研究採用次級資料分析法，以「全民健保研究資料庫2000年百萬歸人檔」分析年2000年1月至2009年12月共10年間，探討肝癌病患併發特定精神疾患(憂鬱、焦慮及睡眠障礙)是否會影響其存活情形及有無接受精神科專科治療是否會影響其存活情形。採用R(2.14.1)統計軟體工具進行資料整理與統計分析主要統計方法有 Cox迴歸模式存活分析（Cox’S proportional hazards model）。

研究結果
與非癌組比較肝癌病患有較高風險得到焦慮和睡眠障礙，有得肝癌者得到的焦鬱風險機率會比沒有得肝癌者高出1.2708倍(P<0.0001) ，有得肝癌者得到睡眠障礙風險機率會比沒有得肝癌者高出1.2680倍(P<0.0001)。進一步肝癌患者併發睡眠障礙得導致死亡的風險機率提高7.9%(P<0.0001)。但如當肝癌者併發精神疾患接受精神專科醫師治療導致死亡率的會比沒有無接受精神專科醫師治療減少了死亡率的風險0.7267倍(P=0.0047)。

結論
應密切關注肝癌患者併發特定精神疾患。由精神科醫生適當的照顧，將導致隨後併發精神疾患的肝癌患者預後更好。多關注與著重臨床診治及心理治療，以降低肝癌患者的死亡風險。這些肝癌患者併發特定精神疾患更嚴格的治療方案是必要的，以提升癌症患者治療策略。

關鍵字

肝癌 ； 憂鬱 ； 焦慮 ； 睡眠障礙 ； 精神專科照護 ； 台灣

並列摘要

Purpose
According to the statistics of the Department of Health, malignat tumors are still No.1 on the top ten causes of death and the statistics indicate that liver cancer ranks the first for males and the second for females, which results in a bearing burden on medical resources. It is a common problem for most cancer patients to have sleeping disorders. According to cancer patients reports form new diagnoses show that sleeping disorders accounted for 30 to 50% and insomnia prevalence rate reached up to 67% clinical patients which linked sleeping tablets to account for 44 to 48% of patients.
This population-based non-concurrent prospective study aims to estimate the risks of depression, anxiety, and sleep disorders among hepatocellular carcinoma (HCC) patients in Taiwan and to examine whether these symptoms and psychiatric care affect the mortality of HCC patients, after adjusting for the effects of known covariates.

Method
A total of 3, 361 HCC patients were identified from the 2000 Longitudinal Health Issuance Database (2000 LHID) in the National Health Insurance Research Database (NHIRD) of Taiwan. As well, the same numbers of non-cancer subjects were randomly selected from the same 2000 LHID as the control group. We compared the risks for depression, anxiety, and sleep disorders between HCC patients and controls and examined whether mental disorders and psychiatric care affect mortality of HCC patients using Cox’s regression model with time-dependent covariates. Statistical analysis was performed using the R 2.14.1 software (R Foundation for Statistical Computing, Vienna, Austria).

Results
Compared to non-cancer controls, HCC patients had higher hazard rates of subsequent anxiety, and sleep disorders (HR=1.2708, 1.2680, respectively, and p < 0.0001). Furthermore, HCC patients with subsequent sleep disorders had poorer outcome in terms of survivorship (HR=1.1790, and p < 0.0001), but receiving care from psychiatrists would reduce the risk of dying for HCC patients with mental disorders (HR=0.7267, and p < 0.0047).

Conclusion
Close attention should be paid to HCC patients for psychiatric disorders. Proper care by psychiatrists would lead to better prognoses of HCC patients with subsequent mental disorders. A focus needs to be placed on the identification and treatment of subsequent mental disorders through psychiatric intervention, so as to reduce mortality risks for HCC patients. More rigorous investigation of these psychiatric disorders is warranted to improve treatment strategies.

並列關鍵字

Liver cancer ； depression ； anxiety ； sleep disorders ； psychiatric care ； Taiwan

參考文獻

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