D型人格之早期乳癌病患罹病後醫療資源耗用之相關性探討

摘要國健局於2011年所公佈的資料，癌症仍是國人十大死因之首，而乳癌更是女性癌症之首，也是女性癌症死亡率第四位。因此，近年來衛生署國健局及各種癌症照護中心及台灣乳房醫學會，制定了乳癌之治療指引及核心測量指標，透過跨科別的團隊治療，不僅大幅提昇乳癌治療成效，並對早期乳癌（第一期及第二期）的存活率有顯著性的提昇。然而乳癌病患在罹病及治療後其生活品質和精神層面常有重大的改變，其中是否因擔心癌症復發及轉移所產生之負面情緒，抑或手術、化學治療、放射治療所產生形象改變而造成的社交壓抑是否跟其人格特性有關，目前有關負面情緒及社會抑制、Ｄ型人格之探討應用於心血管疾病已有相當廣泛之討論與研究，但是對於乳癌病患中有Ｄ型人格其罹癌後的相關研究較少。因此本研究目的欲探討早期乳癌病患Ｄ型人格比例與非D型人格患者在醫療資源耗用之相關性。本研究以區域教學醫院在五年內已接受並完成全程治療之第一期及第二期乳癌病患為主要對象，以問卷調查進行探討早期乳癌病患中D型人格之比例與醫療資源耗用之相關情況。問卷內容包含疾病相關資訊、D型人格量表等共34個問項，研究期間從於2011年10月01日至2012年03月31日間以專職人員面訪共收集212份，再運用SPSS 14.0來進行探討分析。研究結果發現，早期乳癌的患者之D型人格之比例(37.3%)高於一般族群(23~28%)。並將乳癌的患者中D型人格與非D型人格其醫療資源耗用進行統計分析，發現早期乳癌具D型人格與非D型人格患者之「門診次數」、「住院天數」、「門診醫療費用」與「住院醫療費用」均呈現無顯著差異。綜合本研究的分析結果，儘管醫療資源耗用沒有顯著性差異，但可印證目前在健保制度下乳癌治療在核心測量指標及癌症治療認證評鑑等規範下，乳癌治療之醫療資源利用已趨於標準化。因我們發現D型人格之乳癌病患仍屬於較低收入與較低教育水準，而且職業以家管為主，是屬於社會資源與醫療資源較缺乏之族群，未來相關單位應著重此一族群在醫療資訊及社會資源提供較多之幫助，提昇乳癌篩檢與確診，確保罹病後之醫療照護環境與品質，進而改善並增進其生活品質與社會活動。

關鍵字

D型人格；乳癌治療；醫療資源耗用

並列摘要

According to the information published by Bureau of Health in 2011, cancer is still the first among the ten leading causes of death in Taiwan. Breast cancer is the highest occurrence for females, and fourth in cancer mortality. in order to enhance the effectiveness of breast cancer treatment, the Bureau of Health of Department of Health, various cancer treatment centers, and Taiwan Breast Medical Association, have developed guidelines for breast cancer treatments and the parameters of core measure in recent years. In addition to a combination of surgery, chemotherapy, radiation therapy, hormone therapy, and targeted treatment, teamwork through multidisciplinary treatments, as well as evaluation of cancer biopsy, has significantly improved the outcome of the breast cancer treatments. Moreover, these measures have significantly improved the results of treatment and survival rate of early stage breast cancer (Phase I and Phase II). However, breast cancer patients often encounter great changes in the their quality of life and emotion after the occurrence of breast cancer and treatments, among which include the negative emotions cause by the concern of recurrence and metastasis, as well as the social repression resulted from surgery, chemotherapy, radiation therapy, and image change. These are all related to their personality traits. To date, there has been a wide range of discussions and research on social repression, negative emotions and type D personality in cardiovascular diseases, but studies related to the presence of type D personality after occurrence among breast cancer patients are relatively sparse. The purpose of this study was to investigate the proportion of type D personality in early breast cancer patients and the correlation of patients with non-type D personality and medical resource consumption. The subjects of this study were patients from a regional teaching hospital, who have received and completed the full treatments for phases I and II breast cancer, within the last five years. The proportion of type D personality in early breast cancer patients and the consumption of medical resources were investigated by questionnaire. The content of the questionnaire contains disease-related information, evaluation of type D personality, with 34 items in total. During the period of study between October 1, 2011 and March 31, 2012, 212 questionnaires were completed by interviews in person done by full-time staff members. Then SPSS 14.0 was used to analyze the data. The study found that the proportion of early breast cancer patients with type D personality (37.3%) was higher than the general population (23 ~ 28%). In terms of medical resource consumption, the study indicates that type D personality and non-type D personality among breast cancer patients show no significant difference in outpatient visits, hospital days, outpatient medical costs and the cost of hospitalization. Analyzing the results of this study, although there is no significant difference in the consumption of medical resources, this witnesses to the breast cancer treatment in the health care system, through the regulations such as core measure parameters and evaluation of cancer biopsy, have become more and more standardized. Since breast cancer patients with type D personality, we found, generally belong to lower income and lower educational level, additionally, with occupations such as housewife, they belong to groups lacking social and health care resources. Therefore, relevant offices should focus on this population and provide more assistance in obtaining medical information and community resources, as well as enhancing breast cancer screening and diagnosis, to ensure post-occurrence health care environment and quality, and thereby improving their quality of life and enhancing their social activities.