醫師的遵循行為可促進病患的存活嗎？以臺灣非小細胞肺癌病患為例_

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題名：	醫師的遵循行為可促進病患的存活嗎？以臺灣非小細胞肺癌病患為例
書刊名：	臺灣公共衛生雜誌
作者：	陳錫杰／蘇慧芳／李中一／賴美淑／謝碧晴
作者(外文)：	Chen, His-chieh／Su, Hui-fang／Li, Chung-yi／Lai, Mei-shu／Hsieh, Pi-ching
出版日期：	2010
卷期：	29:2
頁次：	頁118-130
主題關鍵詞：	非小細胞肺癌；一年存活；遵循治療指引；臺灣癌症診療資料庫；Non-small cell lung cancer；NSCLC；One year survival；Guideline adherence；Taiwan cancer data base
原始連結：	連回原系統網址
相關次數：	被引用次數:期刊(3) 博士論文(0) 專書(0) 專書論文(0) 排除自我引用:3 共同引用:0 點閱:33

目標：探討在控制病患特性、醫院及醫師特性後，非小細胞肺癌病患接受遵循指引治療，對一年存活情形之影響。方法：此回溯性世代追蹤研究，資料源自2004年台灣癌症診療資料庫、2002到2004年健保資料庫，及2004到2005年死因登記檔。Kaplan-Meier繪製存活曲線，Cox涉險模型進行風險校正，分析病患接受遵循指引治療對存活情形的影響。結果：57%的病患為第四期，66.6%接受遵循指引治療。不同期別，遵循指引者皆比未遵循者有較好的一年存活率(51.1% vs. 22.1%)。校正後，遵循指引治療者在診斷後一年內死亡的風險比未遵循者低(HR＝0.44; 95% CI＝0.41-0.48)。期別與遵循指引與否有顯著的交互作用。期別早期且遵循指引者，診斷後一年內死亡的風險，比期別晚期者為低。結論：醫師能遵循治療指引提供照護，能顯著提升病患一年的存活情形，特別是期別較為早期者，其診斷後一年內死亡的風險較低。故早期診斷非小細胞肺癌並促進治療指引共識之建立及落實執行是控制疾病的有效策略。

以文找文

Objectives: To explore the relationship between adherence to treatment guidelines and one-year survival of all stages of non-small cell lung cancer (NSCLC) patients after adjustment for the characteristics of patients, hospitals and physicians. Methods: Population-based data were retrieved from the Taiwan Cancer Data Base (TCDB) in 2004, National Health Insurance Research Database (NHIRD) in 2002-2004 and Taiwan’s Death Registries in 2004-2005. This was a retrospective cohort study and Kaplan-Meier analysis was used to construct survival curves. A multivariate Cox proportional hazard model was employed to estimate the hazard ratio (HR). Results: Fifty-seven percent of NSCLC patients were at cancer stage IV. Overall, 66.6% of NSCLC patients in the study cohort were compliant with treatment guidelines. The patients who received treatments in adherence to guidelines had a higher one-year survival rate than those who did not adhere (51.1% vs. 22.1%), even in various stages of cancer. Multivariate analysis showed that the patients who received treatments in adherence to guidelines had a lower risk of one-year mortality (HR=0.44; 95% CI=0.41-0.48). A significant interaction effect between cancer stage and guideline adherence was found. The early-stage cancer patients who adhered to guidelines had a lower risk of one-year mortality then those diagnosed with late-stage cancer. Conclusions: Physician adherence to treatment guidelines is associated with one-year survival of NSCLC patients regardless of the stage of the cancer. Such a favorable effect is particularly noteworthy for patients diagnosed at an early-stage. Early diagnosis and promotion of the adoption of guidelines for treatment are effective strategies for NSCLC control.

以文找文

期刊論文
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研究報告
1.	賴美淑、邱秀渝、唐秀治、鍾國彪、謝碧晴(2006)。癌症中心品質提升評估整合型研究計畫(第三年)期末報告。台北。延伸查詢

圖書
1.	台灣癌症臨床研究合作組織肺癌研究委員會(2004)。肺癌臨床指引。台北。延伸查詢
2.	National Comprehensive Cancer Network(2008)。Clinical practice guideline in oncology。

其他
1.	行政院衛生署(2007)。衛生統計系列(一)死因統計。延伸查詢

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