癌症多專科診療對癌症病患存活時間之影響分析

The Impact of Multidisciplinary Cancer Treatment on Survival Time for Cancer Patient

張裕凱(Yu-Kai Chang)

指導教授 ： 龔佩珍

亞洲大學/健康學院/健康管理研究所/碩士(2010年)

摘要

目的：健保局於2003年4月新增給付「癌症治療計劃諮詢規劃費」，強調以多專科診療的型態進行治療，但實施至今尚未有針對癌症病患的存活率及存活時間進行評估，故本研究欲探討癌症治療計劃諮詢規劃費後，是否有癌症多專科診療的介入，會在不同癌症上的存活率及存活時間有所差異。

方法：本研究利用國家衛生研究院1997年至2007年之癌症特定主題檔進行分析，並以2004年肺癌、肝癌及結腸直腸癌新發現癌症病患作為本研究對象，分析其有無接受癌症多專科診療、癌症治療方式、性別、最初罹病年齡、癌症別、主要就醫之醫院權屬別、主要就醫之醫院層級別及存活情形等變項之描述性統計值，並利用Kaplan-Meier Survival Curves分析本研究對象的存活率及存活時間，進而以Log-Rank Test比較有無接受癌症多專科診療之存活率差異，最後以Cox Proportional Regression Model探討影響存活情形之相關因素。

結果：2004年肺癌、肝癌及結腸直腸癌新發現癌症病患共有33,220位，其中未接受癌症多專科診療者有31,183位，接受者有2,037位。癌症病患的存活率經由Log-Rank Test檢定後發現接受癌症多專科診療的病患存活率高於未接受者；再進一步以性別區分，並與「全國新發現癌症病患存活率」相比，發現接受癌症治療計劃諮詢規劃費的病患存活率高於全國，未接受者的存活率低於全國。而影響癌症病患存活情形的因素包含了有無接受癌症多專科診療、癌症治療方式、性別、最初罹病年齡、癌症別、主要就醫之醫院權屬別、主要就醫之醫院層級別。

結論：癌症治療計劃諮詢規劃費的實施對於癌症病患存活情形是有幫助的，但申報比例甚低，衛生主管機關與健保單位應加強宣導癌症治療計劃諮詢規劃費相關政策，使得醫療機構更能積極推動癌症多專科診療的治療模式，對於癌症病患存活情形將更有助益。

關鍵字

癌症多專科診療 ； 癌症治療計劃諮詢規劃費 ； 存活時間 ； 存活率

並列摘要

Objective: Bureau of National Health Insurance(NHI) added Cancer patient treatment planning and Consultation in April, 2003, and emphasized health providers to offer cancer treatment for cancer patient by multidisciplinary care.
Since 2003, Cancer patient treatment planning and Consultation has not yet been targeted for cancer patients to assess the survival rate and survival time, so this study want to investigate whether involvement of multidisciplinary care, and to understand the differences of survival rate and survival time from cancer.

Method: Using the Cancer Dataset of NHI Research Database from 1997 to 2007 by National Health Research Institutes(NHRI), and defining the new cancer patients of lung cancer, liver cancer, colorectal cancer of 2004 who are participants of this study. To describe variables that include whether to receive multidisciplinary care, cancer treatment, gender, age of diagnosed with cancer, cancer type, ownership of major hospital, level of major hospital. Using Kaplan-Meier Survival Curves to get survival rate and survival time, Log-Rank Test to compare the difference between cancer patient whether to receive multidisciplinary care, and using Cox Proportional Regression Model to understand the factors affect survival.

Result: In this study, 31,183 participants haven’t received the multidisciplinary care and 2,037 participants have received. According to Log-Rank Test, we found rate of survival of receiver higher than not receiver. To distinguish between gender, compared survival rate with survival rate of new cancer patient in Taiwan, we found rate of survival of receiver higher than new cancer patient in Taiwan, and not receiver lower than new cancer patient in Taiwan. The impact factors of survival included whether to receive multidisciplinary care, cancer treatment, gender, age of diagnosed with cancer, cancer type, ownership of major hospital, level of major hospital.

Conclusions: Cancer patient treatment planning and Consultation is helpful for survival of cancer patients, and Department of Health and NHI should be to spread the policy strengthening because having low rate of declare. If health provider to actively promote the multidisciplinary care, survival for cancer patients will be more useful.

並列關鍵字

Multidisciplinary care ； Cancer patient treatment planning and Consultation ； Survival time ； Survival rate

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