- 學位論文
頭頸癌病人確診後拒絕治療之因素
Relevant factors of refusal treatment after the diagnosis of head and neck cancers
摘要
背景 台灣每年有超過7,000位民眾被診斷出口腔癌、近3,000人死於口腔癌，患者因種種的因素而延誤了黃金治療時間，最後當病人因疾病所產生的不適症狀再回到醫院接受相關治療時，腫瘤已從原本的初期進展到晚期，或是進展到無法治療的程度。經研究大約50％的未經治療的頭頸癌患者將在診斷後4個月內死亡。 目的 了解頭頸癌患者拒絕治療的特性，進而給予患者協助，盡可能讓患者增加早期治療的意願，除可增加患者存活率外，也以降低後續社會醫療成本。 方法 本研究採病例對照研究法(case-control study)，使用癌症登記資料庫回溯2011年1月至2015年12月期間的癌症病人。拒絕治療為病例組，並以有治療為對照組；統計資料使用 SAS EG進行建檔。一開始採用百分比、次數分配等計算描述性資料，呈現出不同癌別的治療狀態分佈及頭頸癌的特性分佈，之後使用卡方檢定呈現出拒絕治療組與對照組之關聯性，最後使用邏輯式回歸分析推論性統計分析，以瞭解拒絕治療組與對照組之危險因子勝算比。 結果 在本研究中，呈現出頭頸癌並非癌症中個案量最多，但卻是拒絕治療比率最高的癌別；另外，發現了頭頸癌大多發生在中壯年並有菸酒檳榔史的男性，且確診時多為第四期，但在拒絕治療方面卻是女性及早期(0-II期)患者較容易拒絕治療。 結論 患者拒絕治療主要取決於個人價值觀或經驗，因此瞭解患者未積極治療的因素後，藉由癌症團隊給予相關協助，幫助患者早日 接受治療，以期增加存活率並減少因拒絕治療後續所造成的醫療負擔。
並列摘要
Background: There are more than 7,000 people in Taiwan being diagnosed with oral cancer, and nearly 3,000 of them die from it annually. Patients have delayed the treatment of gold due to various factors. Eventually, tumors of the patients have either progressed into late stage or to untreatable extent upon returning to the hospitals for treatments because of the discomfort caused by the disease. About 50% of patients with head and neck cancer do not receive active treatment and die within 4 months of diagnosis. Purpose: To understand the characteristics of treatment refusals for patients with head and neck cancer, to provide assistances to patients who refuse treatment, and to possibly maximize patient's willingness to early treatment. These could not only increase the survival rate of patients, but also reduce the expense of follow-up social care. Method: This study employed a case-control study to retrospect cancer patients from January 2011 to December 2015 by assessing the cancer registry. Patients refuse treated were classified into the case group, and those receiving active treatment as the control group; statistical data was archived using SAS EG. At the beginning, descriptive data has been calculated via percentage and frequency distribution, presenting different distribution of treatment status and features of head and neck cancer. Chi-square test was applied after grouping, association between the refuse treatment and control group was presented. Finally, logistic regression was used to conduct inferential analysis, in order to comprehend the odds ratio of risk factors for the refuse treatment group and the control group. Result: In this study, head and neck cancer does no occupy the most cancer cases but tend to be the category with the highest rate of active treatment. In addition, head and neck cancer has the highest incidence in middle-aged male with the history of tobacco and betel nut usage, result also shows that it is normally stage IV when diagnosed. However, in the cases of refuse treatment, it is easier for female and early staged (0-II) patients to be inactively treated. Conclusion: Refuse treatment depends mainly on personal values or experiences. Therefore, after understanding the factors of patients who turned away from active treatment, cancer teams could provide relevant and necessary assistances to help patients receive early treatment, increasing the survival rate and reducing medical burden rooted from refuse treatment.
參考文獻
延伸閱讀
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