身心障礙者罹患大腸直腸癌延遲治療情形及死亡風險

Risks of treatment delay and mortality in individuals with disability and colorectal cancer

10.6288/TJPH.202310_42(5).112054

龔佩珍(Pei-Tseng Kung)；龔娟玉(Chuan-Yu Kung)；王舜睦(Shun-Mu Wang)；邱莉婷(Li-Ting Chiu)；黃秀玲(Hsiu-Ling Huang)

身心障礙者 ； 健保資料庫 ； 大腸直腸癌 ； 延遲治療 ； 死亡風險 ； disabled people ； National Health Insurance Research Database ； colorectal cancer ； delayed treatment ； mortality risk

台灣公共衛生雜誌

42卷5期（2023 / 10 / 30）

506 - 518

繁體中文;英文

目標：大腸直腸癌為我國最常見癌症。本研究探討身心障礙者罹患大腸直腸癌延遲治療情形及死亡風險。方法：為回溯性世代研究，利用癌症登記檔資料擷取2008～2015年新登記為大腸直腸癌者，串聯內政部身心障礙者資料及衛福部健保資料庫，篩選出研究對象計11,967人，追蹤至2016年年底，觀察其延遲治療情形及死亡風險。除了描述性統計及雙變項分析外，利用羅吉斯迴歸分析探討是否延遲治療之相關因素，以Cox model探討是否延遲之相對死亡風險。結果：共計有2,840人延遲治療（佔23.73%），年齡越大、共病嚴重度越高、有其他重大傷病者，延遲治療比率越高（p＜0.05）。罹癌以第2期延遲治療比率最高（佔36.53%），其延遲治療風險較第1期高1.31倍。有延遲治療者每千人年死亡率較高（（千分之21.19） vs. （千分之19.50）），死亡風險亦較高（HR：1.09）。結論：在全民健保制度下，身心障者罹患大腸直腸癌延遲治療比率高達23.73%，顯示該族群民眾受限於障礙，會影響其接受治療可近性。本研究結果可供相關單位在癌症防治及身心障礙者健康照護政策擬定之參考。

Objectives: Colorectal cancer (CRC) is the most prevalent cancer in Taiwan. In this study, we evaluated the incidence rates of treatment delay and mortality among individuals with disability and CRC. Methods: This retrospective cohort study was conducted using data from patients with CRC who were registered in the Taiwan Cancer Registry between 2008 and 2015. The obtained data were cross-referenced with the disability registry data from Taiwan's Ministry of the Interior and National Health Insurance Research Database. The included patients were followed up until the end of 2016. Descriptive statistics were used and bivariate, logistic regression, and Cox proportional-hazards analyses were performed to identify factors and risks associated with treatment delay and mortality. Results: This study included 11,967 patients; of them, 2,840 patients (23.73%) experienced treatment delay. Older age, elevated Charlson Comorbidity Index scores, and the presence of other catastrophic illnesses were associated with treatment delay (all p < .05). The incidence rate of treatment delay was the highest in individuals with stage 2 CRC (36.53%), with the risk being 1.31 times higher than that in patients with stage 1 CRC. Compared with patients who did not experience treatment delay, those who experienced treatment delay had an elevated mortality rate ((19.50 per mille) vs. (21.19 per mille), respectively) and an increased (by 1.09 times) mortality risk. Conclusions: According to the universal health insurance system, the incidence rate of treatment delay is high (23.73%) among individuals with disability and CRC. This suggests that disability and other pertinent factors impede the access to timely treatment in this patient population. Our findings may guide health-care policies for individuals with disability and facilitate effective initiatives toward cancer prevention.

1. 董和銳, HJ(2003)。身心障礙之概念架構與社會意涵。身心障礙研究季刊，1，32-42。
   連結：
2. 鄭仁翔, JH,陳宛琪, WC,郭年真, RN(2022)。醫院評鑑等級與醫療品質相關性之探討—以醫療品質資訊公開指標為例。台灣衛誌，41，398-410。
   連結：
3. 賴慧貞, HJ,李淑芬, SF,劉益坊, YF,張崑敏,何清治, CC,洪錦墩, CT(2022)。台灣腦中風病患類型與死亡之相關危險因子研究。醫學與健康期刊，11，1-12。
   連結：
4. Center, MM,Jemal, A,Smith, RA,Ward, E(2009).Worldwide variations in colorectal cancer.CA Cancer J Clin,59,366-378.
5. Chen, CY,Hu, JM,Shen, CJ(2020).Increased incidence of colorectal cancer with obstructive sleep apnea: a nationwide population-based cohort study.Sleep Med,66,15-20.
6. Chen, HW,Wu, WT,Wang, JH,Lin, CL,Hsu, CY,Yeh, KT(2023).Epidural steroid injections and the risk of osteoporosis in lumbar spondylosis patients: a nationwide population-based cohort study.Pain Physician,26,307-316.
7. Deroche, CB,Holland, MM,McDermott, S(2015).Development of a tool to describe overall health, social independence and activity limitation of adolescents and young adults with disability.Res Dev Disabil,38,288-300.
8. Deyo, RA,Cherkin, DC,Ciol, MA(1992).Adaptinga clinical comorbidity index for use with ICD-9-CM administrative databases.J Clin Epidemiol,45,613-619.
9. Gore, JL,Lai, J,Setodji, CM,Litwin, MS,Saigal, CS(2009).Mortality increases when radical cystectomy is delayed more than 12 weeks: results from a Surveillance, Epidemiology, and End Results–Medicare analysis.Cancer,115,988-996.
10. Hedestig, O,Sandman, PO,Widmark, A(2003).Living with untreated localized prostate cancer: a qualitative analysis of patient narratives.Cancer Nurs,26,55-60.
11. Huang, HL,Kung, CY,Wang, SM(2021).Effects of body mass index and pay-for-performance program on risk of death in patients with type 2 Diabetes: a nationwide cohort study.Int J Environ Res Public Health,27,4648.
12. Jung, SY,Sereika, SM,Linkov, F,Brufsky, A,Weissfeld, JL,Rosenzweig, M(2011).The effect of delays in treatment for breast cancer metastasis on survival.Breast Cancer Res Treat,130,953-964.
13. Lee, YH,Kung, PT,Wang, YH,Kuo, WY,Kao, SL,Tsai, WC(2019).Effect of length of time from diagnosis to treatment on colorectal cancer survival: a population based study.PLoS One,14,e0210465.
14. Mystakidou, K,Parpa, E,Tsilika, E,Pathiaki, M,Galanos, A,Vlahos, L(2007).Depression, hopelessness, and sleep in cancer patients’ desire for death.Int J Psychiatry Med,37,201-211.
15. Patja, K,Eero, P,Iivanainen, M(2001).Cancer incidence among people with intellectual disability.J Intellect Disabil Res,45,300-307.
16. Richards, M,Smith, P,Ramirez, A,Fentiman, I,Rubens, R(1999).The influence on survival of delay in the presentation and treatment of symptomatic breast cancer.Br J Cancer,79,858-864.
17. Schulz, M(2009).Coping psychologically with amputation.Vasa,38,72-74.
18. Shubha, R(2007).Psychosocial issues in end-of life care.J Psychosoc Nurs Ment Health Serv,45,24-29.
19. Siegel, RL,Miller, KD,Fedewa, SA(2017).Colorectal cancer statistics, 2017.CA Cancer J Clin,67,177-193.
20. Siegel, RL,Miller, KD,Goding Sauer, A(2020).Colorectal cancer statistics, 2020..CA Cancer J Clin,20,145-164.
21. Steele, CB,Townsend, JS,Courtney Long, EA,Young, M(2013).Prevalence of cancer screening among adults with disabilities, United States, 2013.Prev Chronic Dis,14,E09.
22. Wang, N,Cao, F,Liu, F(2015).The effec tof socioeconomic status on health-care delay and treatment of esophageal cancer.J Transl Med,13,241.
23. WHO. Cancer. Available at: https://www.who.int/cancer/en/. Accessed May 10, 2023.
24. WHO. Disability. Available at: https://www.who.int/topics/disabilities/en/. Accessed April 15, 2023.
25. Wisdom, JP,McGee, MG,Horner-Johnson, W,Michael, YL,Adams, E,Berlin, M(2010).Health disparities between women with and without disabilities: a review of the research.Soc Work Public Health,25,368-386.
26. Witham, G,Haigh, C(2018).A narrative literature review examining cancer treatment issues for patients living with intellectual disabilities.Eur J Oncol Nurs,36,9-15.
27. 王冠中, KC(2014)。台中=Taichung，中山醫學大學醫療產業科技管理學系=Department of Health Policy and Management, Chung Shan Medical University。
28. 行政院性別平等會=Gender Equality Committee of the Executive Yuan。行政院性別平等會：重要性別統計資料庫—全民健康保險實質納保率。https://www.gender.ey.gov.tw/GECDB/Stat_Statistics_DetailData.aspx?sn。https://www.gender.ey.gov.tw/GECDB/Stat_Statistics_DetailData.aspx?sn=u4ceyDJ9iGzBYUGlJC0z7w%40%40
29. 財團法人醫院評鑑暨醫療品質策進會：2016~2022年醫院評鑑及教學醫院評鑑（含兒童醫院）合格名單查詢。https://service.jct.org.tw/TJCHA_CERT/ha.aspx。引用2023/08/15。Joint Commission of Taiwan. List of hospitals and teaching hospitals (including children’s hospitals) passing accreditation in 2016-2022. Available at: https://service.jct.org.tw/TJCHA_CERT/ha.aspx. Accessed August 15, 2023. [In Chinese]
30. 衛生福利部：衛生福利統計專區。https://dep.mohw.gov.tw/DOS/lp-4472-113.html。引用2023/04/20。
31. 衛生福利部國民健康署： 2020 年癌症登記報告。https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=269&pid=16434。引用2023/04/15。Health Promotion Administration, Ministry of Health and Welfare, R.O.C. (Taiwan). Cancer registry annual report, 2020 Taiwan. Available at: https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=269&pid=16434. Accessed April 15, 2023. [In Chinese]
32. 衛生福利部統計處：殘障人數統計。https://dep.mohw.gov.tw/DOS/cp-2976-13815-113.html。引用2023/04/15。Department of Statistics, Ministry of Health and Welfare, R.O.C. (Taiwan). Number of people with disabilities. Available at: https://dep.mohw.gov.tw/DOS/cp-2976-13815-113.html. Accessed April 15, 2023. [In Chinese]
33. 羅傑明, CM(2021)。南投=Nantou，國立暨南國際大學高階經營管理碩士學位學程=Executive Master Program of Business Administration Cross-Strait Program, National Chi Nan University。