臺中市西屯區大腸癌糞便潛血篩檢（FIT）結果異常民眾之大腸直腸鏡檢行為與篩檢服務提供方式之關聯性

背景台灣地區自民國93年開始推動全國性的大腸直腸癌篩檢，先透過免疫法糞便潛血檢查法(immune fecal occult blood test, iFOBT，以下簡稱FIT)，FIT異常者，建議進一步接受大腸鏡檢查亦或者是鋇劑攝影及乙狀結腸鏡檢查(以下簡稱「確診」)，FIT陽性者之確診行為是大腸直腸癌篩檢是否能夠有效降低疾病率的重要關鍵。另一方面，公共衛生單位為推動大腸直腸癌篩檢，提供多元的篩檢管道，包括醫院、診所、衛生所於其門診或外展至社區，除鼓勵民眾接受FIT外，並提醒陽性民眾接受確診服務，惟，目前鮮少研究探討大腸直腸癌篩檢服務提供模式與FIT陽性民眾確診行為間之關聯性。研究目的透過次級資料分析，以臺中市西屯區為例，針對FIT異常民眾，探討其後續大腸鏡確診行為與篩檢服務提供模式之關聯性。材料與方法本研究之次級資料包括：衛生福利部國民健康署癌症篩檢大腸癌篩檢系統(簡稱大乳口系統)及衛生所公衛護理師之個案追蹤記錄。研究對象為民國106年50至74歲且居住在臺中市西屯區之FIT異常個案，共656人，依變項為後續之大腸鏡檢查確診行為(簡稱確診行為)，係以至民國107年3月31日為止之大乳口系統資料中的鏡檢紀錄為依據，並區分為90天內及90天後及未接受鏡檢三類。篩檢服務提供方式為自變項，本研究依據其申報單位、服務提供地點、提供形式組合為六種服務提供模式。控制變項包括：個案的社會人口學(性別、年齡、教育程度)、個人健康相關因素(包括個人腸胃道症狀、大腸癌及其他癌症家族史)、個人篩檢史(過去之FIT及鏡檢經驗)。使用SAS 9.4版進行卡方檢定及多類別羅吉斯回歸分析其關聯性。結果 (1)研究對象(FIT異常個案656人)中有67.99%於FIT結果通知後90天內完成鏡檢，4.73%於90天已後完成鏡檢，有27.29%未完成鏡檢之確診行為。(2)篩檢服務模式可分為六類，以比例高低依序為：以醫院為基礎之院內篩檢(67.84%)、以診所為基礎之FIT篩檢(14.08%)、醫院與公衛合作於衛生所之篩檢(8.0%)、醫院與公衛合作之社區整合性篩檢(7.52%)、醫院與公衛合作之社區癌症篩檢(5.28%)、以衛生所為基礎之癌症篩檢(2.24%)。(3)控制個人及機構因素後，篩檢服務模式與後續之確診行為有顯著關聯性：(a)以衛生所為基礎之癌症篩檢模式之FIT陽性個案於90天內之確診率顯著高於診所的癌症篩檢模式(OR=4.05)；(b) 醫院與公衛合作之社區整合式篩檢模式之確診率顯著高於醫院內之癌症篩檢模式、以及醫院與公衛合作於衛生所之癌症篩檢(OR值分別為3.38及4.37)。(4)除檢服務模式外，FIT陽性之確診行為也與個人之年齡與篩檢經驗、其他癌症家族史、申報單位所在區域、及申報單位鏡檢設備有顯著關聯性。結論本研究顯示篩檢服務提供模式與大腸鏡檢查確診行為有顯著之關聯性，即使是同樣以醫院為基礎之不同服務模式的後續確診行為亦有顯著差異，可供有關單位對於提高FIT異常結果個案確診率之策略設定的參考，至於造成此差異之機制也值得未來進一步探討。

關鍵字

糞便潛血篩檢異常；大腸鏡檢查確診；篩檢服務提供

並列摘要

Background Since 2004, Taiwan has been promoting the national screening for colorectal cancer. First, the immune fecal occult blood test (iFOBT, or FIT) will be implemented. Patients with FIT abnormalities are recommended for further colonoscopy or GI series and sigmoidoscopy (confirmed diagnosis). The diagnosis of FIT-positive patients is an important key to whether colorectal cancer screening can effectively reduce incidence rates. On the other hand, public health administrations provide multiple screening strategies for colorectal cancer screening, including hospitals, clinics, health clinics, and their outreaches to the community. In addition to encouraging people to accept FIT, they also remind patients with positive FIT results to follow-up colonoscopy, however, little to none study has been conducted to explore the association between the screening delivery model and the follow-up of colonoscopy of FIT-positive patients. Objectives We identified FIT-positive patients in Xitun District of Taichung City as subjects for this study. By analyzing administrative data abstracted from the Health Promotion Administration’s R.O.C system, we are able to investigate association between the follow-up of colonoscopy and the screening delivery model. Methods: The secondary data of this study includes: Health Promotion Administration’s Cancer Screening System (abbreviated as R.O.C system) and the case records of the Health Department's public health nurses. The study was conducted in Taiwan on 656 patients from 50 to 74 years old living in Xitun district with an abnormal FIT result and their follow-up colonoscopy examination (diagnosis behavior). The data used for this study is extracted from the R.O.C system as of March 31, 2018, and are classified into three types, those who underwent follow-up colonoscopy within 90 days after receiving FIT results, those who did it after 90 days, and those who didn't do it. The screening delivery model is an independent variable. There are six screening delivery model based on different combinations of its reporting unit, the location where the service was provided, and forms of service provided. The control variables are the demographic (sex, age, education), health-related factors (including personal gastrointestinal symptoms, family history of colorectal cancer and other cancers), and screening history (past FIT and colonoscopy experience) of the individual. By using the SAS version 9.4, we ran a chi-square test and multiple logistic regression analysis to analyze the relationship between the two. Results (1) Among the patients (656 people with FIT abnormalities), 67.99% received a follow-up colonoscopy within 90 days after receiving the notification of the FIT result, 4.73% received a follow-up colonoscopy after 90 days, and 27.29% did not receive a follow-up colonoscopy. (2) The screening delivery model can be divided into six categories, in order of proportionality: hospital-based in-hospital screening (67.84%), clinic-based FIT screening (14.08%), hospital screening outreached in health clinics (8.0%), hospital integrated screening outreached in communities (7.52%), hospital cancer screening outreached in the community (5.28%), and health clinic-based cancer screening (2.24%). (3) After controlling individual and institutional factors, the screening strategy model has a significant relationship with subsequent behavior: (a) FIT-positive cases in health clinic’s cancer screening strategy have a significantly higher follow-up rate within 90 days than cancer screening strategy in clinics (OR=4.05), (b) FIT positive in hospital integrated screening outreached in the community have a significantly higher follow-up rate than the cancer screening strategy in the hospital and the cancer screening of the hospital outreaching clinic (OR values were 3.38,4.37, respectively). (4) In addition to the screening strategies, the FIT-positive diagnosis behavior is also significantly related to the age of the individual, the cancer family history, the area where the institution is located, and the colonoscopy equipments of the institution. Conclusions This study shows that there is a significant relationship between the screening strategy model and behavior of the patients towards colonoscopy, even the behavior towards different service models provided by the same hospital is significantly different. Whether the difference is related to the way different models issue and explain the screening report is worthy of further discussion in the future, in order to provide a reference of strategy setting for concerned units to improve the diagnosis rate of FIT abnormal results.

並列關鍵字

FIT positive ； colonoscopy ； screening strategy

參考文獻

Azulay, R., Valinsky, L., Hershkowitz, F., & Magnezi, R. (2019a). CRC Screening Results: Patient Comprehension and Follow-up. Cancer Control, 26(1), 1073274819825828. doi:10.1177/1073274819825828

Google Scholar

Azulay, R., Valinsky, L., Hershkowitz, F., & Magnezi, R. (2019b). Repeated Automated Mobile Text Messaging Reminders for Follow-Up of Positive Fecal Occult Blood Tests: Randomized Controlled Trial. JMIR Mhealth Uhealth, 7(2), e11114. doi:10.2196/11114

Google Scholar

Barzi, A., Lenz, H. J., Quinn, D. I., & Sadeghi, S. (2017). Comparative effectiveness of screening strategies for colorectal cancer. Cancer, 123(9), 1516-1527. doi:10.1002/cncr.30518

Google Scholar

Bhurgri, H., & Samiullah, S. (2017). Colon Cancer Screening - Is It Time Yet? J Coll Physicians Surg Pak, 27(6), 327-328. doi:2629

Google Scholar

Bibbins-Domingo, K., Grossman, D. C., Curry, S. J., Davidson, K. W., Epling, J. W., Jr., Garcia, F. A. R., . . . Siu, A. L. (2016). Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. Jama, 315(23), 2564-2575. doi:10.1001/jama.2016.5989

Google Scholar

國際替代計量

臺中市西屯區大腸癌糞便潛血篩檢（FIT）結果異常民眾之大腸直腸鏡檢行為與篩檢服務提供方式之關聯性

不提供下載

主題瀏覽