- 學位論文
腫瘤標記及影像檢驗之檢查次數是否影響乳癌術後醫療耗用及醫療療效
Tumor markers and the frequencies of image inspections could affect medical cost and outcomes after breast cancer surgery
摘要
研究目的 針對乳癌(Breast Cancer)手術病人治療方式會因為各種治療準則及經濟因素而有差異，本研究兩個研究目的：(1)探討腫瘤標記檢驗及影像檢查次數對乳癌手術病人人口特性、臨床特性及機構特性之長期趨勢。(2)探討腫瘤標記指數檢驗次數及乳房X光檢查(Mammography)、乳房超音波(Breast Ultrasound)次數對乳癌手術病人醫療耗用及醫療療效之改變情況及重要影響因子。 研究方法 本研究以回溯性次級資料分析，利用全民健保資料庫探討1997年1月至2008年12月間，共計2,393位女性乳癌手術(ICD-9 174)病患進行術後追蹤5年。使用SPSS 22.0版進行描述性，評估檢驗檢查次數相對之治療成效，利用Ｔ-test、卡方檢定、邏輯斯迴歸分析及線性複迴歸分析，進行資料分析與驗證研究假設。 研究結果 發現乳房X光攝影追蹤5年內，執行超過或等於5次攝影者，較少於5次者具較高的5年整體存活率(96.5 % vs 84.3 %, P=0.009)及無病存活率(98.2% vs 94.9%, P=0.006)，乳房超音波追蹤5年內，執行超過或等於9次超音波者較少於8次者具較高的5年整體存活率(95.4 % vs 84.6 %, P=0.005)及無病存活率( 97.0% vs 94.8%, P=0.006)，結果推論5年內每年約一次乳房X光攝影或每半年的乳房超音波檢查是針對乳癌術後追蹤最具效益。兩種乳癌相關腫瘤標記CEA次數越多，其存活率愈差(P<0.05)，CA15-3依Cox regression 統計顯示5年內追蹤次數愈多，其存活率愈差，這可能與死亡末期較多使用腫瘤標記檢查有關檢查次數多且增加其費用，較無醫療效益。 結論與建議 本研究建議，對於乳癌病患於術後，藉由定期檢驗檢查追蹤，有助於早期乳癌復發之偵測。建議乳癌術後5年追蹤以每年乳房X光攝影或每半年乳房超音波檢查最具醫療效益，乳癌相關腫瘤標記(CEA、CA15-3)，則可能未具醫療效益。台灣健保制度實施及重大傷病的政策，國人普遍知識水平提升，醫療資訊不對等，醫療糾紛案例多，依此研究結果可以建立標準共識，以降低醫療費用並可提升醫療品質及水準，並提升存活率。
並列摘要
Purpose This study will aim researching for the tendencies of tumor markers examination and the frequencies of breast mammography and breast ultrasound could affect medical cost and treatment efficiency after breast cancer treatments. There are two purposes of this research: (1) to realize the long-term trend of impacts and features on the demography, clinical experiences and the efficiencies of breast cancer treatment in terms of tumor markers and mammography. (2) to explore the impacts on the frequencies of tumor markers inspections and mammography for breast cancer patients, and the crucial factors of the impacts. Method This research applies to retrospective secondary data analysis study among the database of National Health Insurance from January 1997 to December 2008; total samples are 2,393 with women breast cancer post-operation (ICD-9 174) for the duration of 5 years. SPSS 22.0 is applied to describe and access the frequencies of tumor markers inspections on the efficiencies of post-op treatment. T-test, Chi-square test, logistic regression and linear multiple regression analysis were also applied to analyzed the data and verified the assumption of this research. Results The five-year survival rate and the disease-free survival rate for the patients who had 5 or more than 5 times of mammography is higher than those who had less then 5 times of mammography (96.5% v.s 84.3%, p=0.009); (98.2% v.s 94.9%, p=0.006). And the five-year survival rate and the disease-free survival rate or the patients who had 9 or more than 9 times of mammography is higher than those who had less then 8 times of mammography (95.4% v.s 84.6%, p=0.005); (97.0% v.s 94.8%, p=0.006). The most effective post-op observation tracking is by conducting mammography once a year or breast ultrasound once for every 6 months. The more of these tumor markers the worse for the survival rate (p<0.05). According to the statistics of Cox regression of CA15-3, the more racking actions being conduct, the lower the survival rate does. This conclusion could be related to the late stages of cancer, who uses more tumor marker tracer than others, which means it is economically inefficient. Conclusion and Recommendations This research has concluded that periodically mammography for post-op breast cancer patients would be helpful in terms of early detection of breast cancer recurrence. The most recommended method is to conduct a mammography or breast ultrasound once a year in a duration of 5 years. It is assumed that tumor markers (CEA & CA15-3) might not have the same medical efficiency as the above-mentioned. Due to medical information asymmetry, even though the Taiwan National Health Insurance system and the catastrophic illness policy has been conducted; cases of medical disputes are still significant currently. This study aims to build up common standards and further, to lower unnecessary medical cost, improve treatment quality to increase survival rate in general.