食道癌病人醫療資源耗用與預後情形分析

研究目的：本研究旨在探討食道癌病人分別在不同病人特質、癌症分期、病灶處與治療情形下其醫療資源耗用與預後情形。研究材料與方法：本研究採立意取樣（Purposive sampling）之方式，個案為民國89年4月1日至民國93年12月31日於南部某醫學中心胃腸內科確診為食道癌之患者，共計86名。資料蒐集由二方面著手，首先使用結構式病歷表格，將研究所需資訊抄寫於題項中；另一為民國89年4月1日至民國93年12月31日食道癌病患於住院治療期間之費用明細檔，將86名食道癌病人之病歷檔案與醫院費用明細檔做比對，並作彙整與串檔，確立每名食道癌病人均有基本資料、癌症分期、病灶處、首次住院臨床症狀、治療方式、住出院日期、住院天數、各項費用明細與總醫療費用等。複迴歸模式預測影響醫療資源耗用因子；危害迴歸模式將病人特質、癌症分期、病灶處與治療情形等作考量，以瞭解那一變項為影響預後情況之較重要因子。研究結果：在醫療資源耗用部份，住院次數方面其疾病復發現象為有復發者住院次數較無復發者增加0.82次（P＜0.05）；住院日數方面其癌症分期第Ⅵ期者較第Ⅰ期者增加29.76日，病灶處為食道中段者其住院日數較食道上段者減少21.23日，治療方式上以單一化療者之住院日數最低，較外科手術減少25.29日，達（P＜0.05）；初次住院費用在61歲以上者其費用較50歲以下者減少166,425元，癌症分期為第Ⅱ與Ⅵ期者較第Ⅰ期者分別增加254,852元與280,517元（P＜0.05）；總醫療費用其初診年齡為61歲以上者其費用較50歲以下者減少178,084元，癌症分期為第Ⅵ者其費用較第Ⅰ期者增加295,221元，病灶處於食道中段者其總醫療費用較食道上段者減少195,540元，化學放射療法和單一化療或放療其總醫療費用均低於外科手術（P＜0.05）。在預後情形部份，以COX regression analysis食道癌病人存活情形，在控制其他變項後，病灶處於食道中段者其死亡的危險性較食道上段者降低15.07倍，有無其他癌症部份，非單一癌症者其死亡的危險性較單一癌症者增加62.69倍，療效評估為穩定疾病者其死亡的危險性較部份反應者減少0.05倍，治療方式為外科手術與輔助療法者其死亡的危險性較外科手術降低0.21倍；以COX regression analysis食道癌病人死亡情形，在控制其他變項後，療效評估為惡化者其死亡危險比是部份反應者的0.32倍。結論：病人特質、癌症分期、病灶處與治療情形是影響醫療資源耗用之因子。食道中段、非單一癌症、穩定疾病和外科手術與輔助療法為影響病人存活之因子，而疾病惡化為影響病人死亡之因子。

關鍵字

食道癌；醫療資源耗用；預後情形

並列摘要

Purpose: The main purpose of this study is to explore the medical resources utilization and prognosis among esophageal cancer patient in different patient characteristics, Tumor Node Metastasis (TNM) stage, location, and treatment condition. Materials and Methods: This is a purposive sampling study. The 86 patients who were diagnosed as esophageal cancer were selected our subjects from April 1st, 2000 to December 31st, 2004 in one medical center. The Data conducted from two parts, one was collected from standardize chart review form; other inpatient data including personal profile, TNM stage, location, first hospitalized symptom, treatment type, length of stay, beds, charged items, and total charges. Multiple regression and Cox regression models were employed to identify the associated factor about medical resources utilization and prognosis. Result: A part of medical utilization, the frequency of disease recurrence for inpatient was 0.82 more than non-recurrence (P≦0.05); the stage Ⅳ of the inpatient days was 29.76 more than the stage Ⅰ, the middle of the location was 21.23 less than the upper, chemotherapy of the treatment was 25.29 less than the surgery (P≦0.05); the first inpatient fees for over 61 years old was NT＄166,425 less than under 50, the stage Ⅱ and Ⅳ of the first inpatient fees were NT＄254,852 and NT＄280,517 more than the stage Ⅰ(P≦0.05), respectively; the total fees for over 61 years old was NT$ 178,084 less than under 50, the total fees for the stage Ⅳ was NT$ 295,221 less than the stage Ⅰ, the middle of the location was NT$ 195,540 less than the upper, CCRT and chemotherapy or radiotherapy were less than surgery（P≦0.05）. A part of the prognosis, the COX regression analysis survival condition middle of the location was risk 15.07 less than the upper, non-single cancer was risk 62.69 more than single cancer, stable disease was risk 0.05 less than local response, surgery and neoadjuvant treatment was risk 0.21 less than surgery. The COX regression analysis death worsen condition was risk 0.32 more than local response. Conclusion: Generally, the patient characteristics, TNM stage, location, and treatment condition were effective factors of medical resources utilization. Middle of location, non-single cancer, stable disease, surgery and neoadjuvant treatment were effective survival factors. Disease worsen condition was effective death factor.