延遲治療與病患存活及醫療費用之研究-以結直腸癌為例

The relationship of treatment delay to treatment outcome: an example from colorectal cancer study

林曉彤(HSIAO TUNG LIN)

指導教授 ： 李亞欣

中山醫學大學/健康管理學院/醫療產業科技管理學系碩士班/碩士(2015年)

https://doi.org/10.6834/CSMU.2015.00101

摘要

研究背景與目的
結直腸癌(Colorectal Cancer，CRC)為全球常見癌症第三名，更在民國85年起連續為我國國人癌症死因之第三位。根據過去文獻，大多為探討結直腸病患之臨床治療、篩檢預防等情形，鮮少探討結直腸癌病患之延遲治療其影響因素。因此本研究目的主要探討接受治療之結直腸癌病患其延遲治療之可能相關因素及成本效益、存活情況以及醫療資源利用之情形。
研究方法
本研究以回溯性方式進行研究。本研究資料來源為「衛生福利部統計處之健康加值應用協作中心」提供之健保資料庫，研究對象為2008年新診斷結直腸癌病患共9569人，本研究對治療延遲治療分為二階段，分別為病患初次確診至首次就醫，與病患首次就醫至開始治療之時間。統計分析為採用SPSS20.0統計分析軟體，利用描述性檢定、卡方檢定、獨立樣本t檢定、變異數檢定、複迴歸分析、Kaplan-Meier存活分析、Cox迴歸模型。
研究結果
本研究樣本數為9569人，平均年齡65歲，男性患者之死亡人數顯著高於女性。其投保金額較低、都市化程度較高，癌症確診期別較晚者死亡人數顯著較多。其第二階段延遲天數影響因子為性別、前一年門診次數、期別、治療方式。而第三階段延遲天數影響因子則為，年齡、期別、治療方式。
結論與建議
性別、年齡、投保金額、前一年門診次數、期別、治療方式，皆會影響病患延遲治療天數。第二、三階段延遲天數多為7天以下。研究結果顯示結直腸癌患者的平均醫療費用會隨著前一年門診次數越多、期別越晚以及選擇化放療之治療方式而增加。第二、三級延遲治療天數越長，病患死亡風險比則會越高。

關鍵字

結直腸癌 ； 延遲治療 ； 存活情況 ； 醫療資源利用

並列摘要

Objectives:
Colorectal cancer (Colorectal Cancer, CRC) is the third most common cancer of the world. Since 1996, CRC was the third consecutive cancer causes of death in our country. Based on past literature, mostly to study of colorectal patients with the clinical treatment, prevention, screened cases, rarely to explore the treatment of colorectal cancer patients with delay which influencing factors. Therefore, this study Objective to explore the colorectal cancer patients with treatment delay, of the factors may be associated and cost-effectiveness, survival and medical resources in.

Methods:
This is a retrospective observation design study. The population conducted from the registered Taiwan National Health Insurance database, the subjects were 2008 patients of newly diagnosed with colorectal cancer, total 9569 population, this study were divided into three stage of treatment delay, according to the three- level patients to explore. The first level treatment delay refers between patients has symptoms to first contact healthcare professional, the second level treatment delay refers between patients diagnosed to first time to medical treatment, the third level treatment delay refers between patients diagnosed to start of treatment. All statistical analyses were performed using the SPSS20.0 statistical software. We used Descriptive test, chi-square test, independent samples t-test, variance test, multiple regression analysis, Kaplan-Meier survival analysis, Cox regression analysis.

Results:
Study results showed the patients have 9,569 peoples, average age is 65 years old, the man has higher percentage than women. Low insured, high urbanization, AJCC stage 4, patients have higher dead percentage. Sex, the previous year’s clinics, AJCC stage and treatment types were significant influence the second phase delay days. Age, AJCC stage and treatment types were significant influence the third phase delay days.

Conclusion:
Sex, age, insured, previous year’s clinics, AJCC stage, treatment types were significant influence the patients delay days. Delay days were below 7 days in the second and the third delay. Results showed colorectal cancer patients have higher previous year’s clinics, AJCC stage 4 and treatment use chemoradiotherapy were had higher medical costs. Longer delays days were had higher risk in death.

並列關鍵字

colorectal cancer ； delay treatment ； survival ； health care resource utilization

參考文獻

2. 王冠中.(2014).台灣五大癌症與延遲治療之相關因素與探討

8. 趙昭欽. (2010). 腸保健康~ 淺談大腸癌. 秀傳季刊, 25(2), 1-3.

9. 薛肇文. 大腸癌的防治. 聲洋防癌之聲 春季號

13. 劉介宇、洪永泰、莊義利、陳怡如、翁文舜、劉季鑫、涼賡義(2006)。台灣地區鄉鎮市區發展類型應用於大型健康調查抽樣設計之研究。健康管理學刊；4(1)：1-22。

32. Yeh CC, Hsieh LL, Tang R, et al. Risk factors for colorectal cancer in Taiwan: a hospital-based case-control study. J Formos Med Assoc 102: 305-312, 2003.