口腔癌病患初始階段盛行率、醫療資源耗用、死亡率分佈趨勢及影響因素之探討

研究目的口腔癌為我國男性十大癌症之一，發生率在世界排名第3，在東亞地區名列第1，且罹病年齡層偏低，常見已是第四期，這除造成生產力的損失外，亦為健保財務一大負擔，故針對這些病患的醫療資源耗用及成效進行探討。研究方法採回溯性縱貫性研究設計，利用國家衛生研究院「全民健康保險資料庫」中2010年「100萬承保抽樣歸人檔」的次級資料，探討2000年至2010年間，2536位口腔癌新確診個案在確診當次、確診前半年及確診後一年間接受各種治療的醫療資源耗用、死亡率的分佈趨勢、影響因子及各國的差異性比較。研究結果一、初始階段口腔癌病患每十萬人口的盛行率有增加趨勢（P＜0.001）；在醫療總費用、各種治療等醫療耗用方面亦有增加趨勢（P＜0.001）；但在住院天數趨勢無顯著差異（P＝0.940、0.868 ）。二、年齡、CCI、教學醫院、腫瘤部位、不同治療模式會影響病患初始階段醫療總費用。三、一、三、五年的存活率分別為71.9%、45.7%及30%，年齡、性別、CCI指數、區域醫院、腫瘤部位、確診後一年的治療模式會影響病患存活狀況。四、對不同年齡層施行放射治療及對腫瘤部位施行相關手術治療在醫療總費用有顯著性差異（P分別為0.003、0.001及0.031）及對腫瘤部位執行放射治療在死亡率有顯著差異（P=0.016）結論與建議本研究結果顯示口腔癌病患之人口學特性、臨床特性、時間特性、住院天數及總費用間皆有顯著的相關。治療模式對不同性別的醫療資源耗用及死亡率無顯著不同，但對不同年齡層的醫療總費用及腫瘤部位的死亡率，則有顯著性差異。初始階段之住院天數無顯著增加，但醫療總費用有增加之趨勢，且死亡率並未有效改進，顯示目前的科技對口腔癌的治療並未達有效的改善，建議宜加強防治口腔癌有效政策的改善及推動來有效控制口腔癌的發生。

關鍵字

口腔癌；初始階段；醫療費用；住院天數；死亡率；手術治療；化學治療；放射治療；重建手術；標靶治療

並列摘要

Purpose Oral cancer is one of the top 10 male cancers in Taiwan. The prevalence of oral cancer is ranking N0.3 in the world and N0.1 in East Asia. Most of the patients suffered from oral cancer are in youth and in terminal stage, result in the loss of productivity and a heavy burden for the NHI system. Therefore, we purposed to explore the consumption of medical resources and the distribution of mortality of oral cancer patients in the initial phase. Research Methods A total of 2536 patients whose primary or secondary diagnoses were oral cancer and newly diagnosed cases of oral cancer were randomly selected for this research. This research evaluated the consumption of medical resources, including the length of days (LOS), medical cost of different treatment at the initial phase（6 months before diagnosis, and 12 months after diagnosis.） Results At the initial phase, the prevalence of oral cancer patients per 100,000 population showed an increasing trend over time (from 24 to 28.9, respectively; P <0.001); the total medical cost of different treatment also showed an increasing trend over time, and reached a significant difference (P <0.001); the trend of LOS was not significantly different (P = 0.940, 0.868). Survival analysis showed that: 1-3-5-year survival rates were 71.9%, 45.7% and 30%, the factors affecting patient survival rates were age, gender, CCI, regional hospital, the tumor subsite, chemotherapy, radiotherapy at one year after diagnosis. In the purposes of radiation therapy of different ages and surgery type of different tumor site, the total medical cost of treatment showed a significant difference (P =0.003,0.001 and 0.031). The implementation of radiation of different tumor subsite showed a significant difference of five years in mortality after diagnosis (P = 0.016). Conclusion and Recommendations Demographic characteristics, clinical characteristics, time characteristics, hospital days and total medical cost are all significantly related to each other. No significant difference in medical resource utilization and mortality with the The implementation of treatment modalities in terms of gender, but the total medical cost of different ages and the mortality of tumor subsite are significant differences in the initial phase. The LOS was not significantly increasing over time, but there is an increasing trend of total medical costs, and the trend of mortality did not decrease over time. The results of this study show that the current technology for the treatment of oral cancer dose not improve effectively. In order to achieve effective control of oral cancer, it is recommended that should strengthen the effective policies fight against oral cancer to improve and promote the prevention and treatment of oral cancer.

並列關鍵字

oral cancer ； the initial phase ； medical expenses ； hospital stay ； mortality ； surgery ； chemotherapy ； radiation therapy ； reconstructive surgery ； targeted therapy