臺灣博碩士論文加值系統

背景：國外研究顯示癌症患者合併精神疾病較容易經歷延遲診斷或治療，然此兩者的關係需要更多的實證研究支持。
目的：探討癌症病患是否會因合併精神疾病，致癌症延遲診斷或治療。
方法：採回溯性世代研究，以2011年確診為肺、肝、結直腸、乳癌、口腔及子宮頸癌新發個案有治療者為對象，利用全民健保門、住診及癌症登記檔進行分析；以傾向分數配對精神疾病與非精神疾病組；另將精神疾病細分為焦慮、老年期診斷、物質濫用、嚴重精神疾患與其他種類精神疾患。以癌症期別第三期以上定義為延遲診斷，診斷到開始治療≥ 4週為延遲治療；控制變項包括病患、疾病與醫院特質，採條件式邏輯斯迴歸進行分析。
結果：癌症治療患者延遲診斷率，合併精神疾病者為48.2%、非精神疾病者為44.3%，兩者無統計上顯著差異(AOR=0.97, 95%CI=0.84-1.11)；合併精神疾病者延遲治療率為58.7%、非精神疾病者為59.7%，亦無統計上顯著差異(AOR=0.94, 95%CI=0.83-1.06)；不同類型精神病分層分析，亦未達統計上顯著差異。
結論：國民健康署積極與醫療院所推動四癌篩檢與癌症醫療品質提升計畫，使癌症治療患者合併精神疾病無較高延遲診斷與治療風險；然如何減少延遲診斷與治療國內仍有努力的空間。

Background: Evidence suggests that cancer patients with psychiatric disorders may be more likely to experience delay cancer diagnosis and treatment. The association between psychiatric disorders and delayed diagnosis and treatment in patients with cancer has not been studied.
Objectives: This study aimed to discuss whether the pre-existing psychiatric disorders led to delayed cancer diagnosis and treatment among cancer patients.
Methods: A population-based retrospective cohort study was conducted using Taiwan National Health Insurance database and Taiwan Cancer Registry. The study subjects were patients who newly diagnosed and received treatment with lung, liver, colorectal, breast, oral and cervical cancer by 2011. Using propensity score to divide the study subjects into two groups, people with psychiatric disorders and people without psychiatric disorders. And we further subdivided the psychiatric disorders into six categories: anxiety disorder, dementia and other organic psychosis, substance abuse and dependence disorder, severe mental disorder and other mental health disorder. Stage III or IV were identified as delayed diagnosis, and the period from definite diagnosis to the start of treatment that ≥ 4 weeks were identified as delayed treatment. Conditional logistic regression was used to analysis after controlling the demographic, hospital and disease characteristics.
Results: Among cancer with treatment patient, the rate of delayed diagnosis of people with psychiatric disorders was 48.2%, and people without psychiatric disorders was 44.3%. The risk of delayed diagnosis was not significant between two groups (AOR=0.97, 95%CI=0.84-1.11). Moreover, the rate of delayed treatment of people with psychiatric disorders was 58.7%, and people without psychiatric disorders was 59.7%. The risk of delayed treatment was not significant between two groups (AOR=0.94, 95%CI=0.83-1.06).
Conclusions: We still need to make efforts to reduce cancer delayed diagnosis and delayed treatment with psychiatric patients.

目錄
中文摘要....i
Abstract....ii
目錄....iv
表目錄....v
圖目錄....v
第一章 緒論....1
第一節 研究背景與動機....1
第二節 研究目的....3
第三節 研究問題....3
第四節 研究重要性....3
第二章 文獻探討....4
第一節 精神疾病之簡介....4
第二節 癌症延遲診斷與治療....6
第三節 精神疾病對癌症延遲診斷與治療之影響....12
第四節 其他影響精神疾病與癌症延遲診斷與治療之因素....17
第三章 材料與方法....21
第一節 研究設計與架構....21
第二節 研究假說....22
第三節 研究對象....23
第四節 研究變項及其測量....24
第五節 研究資料來源及處理流程....30
第六節 統計分析....33
第四章 研究結果....34
第一節 合併精神疾病之癌症患者基本特質分析....34
第二節 合併精神疾病有無與癌症延遲診斷與治療之分佈....37
第三節 合併精神疾病有無對癌症延遲診斷對治療風險之影響....42
第四節 合併不同種類精神疾病對癌症延遲診斷與治療之影響....50
第五章 討論....106
第一節 合併精神疾病對於癌症延遲診斷之情形....106
第二節 合併精神疾病對於癌症延遲治療之情形....109
第三節 研究限制....111
第六章 結論與建議....112
第一節 結論....112
第二節 建議....113
中文文獻....114
英文文獻....115

表目錄
表2-3-1、個人、醫療提供者及系統性延遲時間表....9
表2-4-1、影響精神疾病與癌症期別延遲診斷之其他因素....19
表2-4-2、影響精神疾病與癌症延遲治療之其他因素....20
表3-4-1、DSM IV與ICD-9-CM之精神疾患分類代碼對照表....26
表4-1-1、癌症治療患者有精神疾病與無精神疾病之基本特質比較....36
表4-2-1、癌症治療患者有精神疾病者與無精神疾病者延遲診斷與治療之分佈....41
表4-3-1、癌症治療患者合併精神疾病有無對癌症延遲診斷之風險....45
表4-3-2、癌症治療患者有精神疾病者與無精神疾病者延遲治療之風險....49
表4-4-1、癌症治療患者有焦慮疾患者與無焦慮疾患者延遲診斷與治療之分佈....50
表4-4-2、癌症治療患者有焦慮疾患者與無焦慮疾患者延遲診斷之風險....53
表4-4-3、癌症治療患者有焦慮疾患者與無焦慮疾患者延遲治療之風險....57
表4-4-4、癌症治療患者老年期診斷者與無老年期診斷者延遲診斷與治療之分佈....61
表4-4-5、癌症治療患者老年期診斷者與無老年期診斷者延遲診斷之風險....64
表4-4-6、癌症治療患者有老年期診斷者與無老年期診斷者延遲治療之風險....68
表4-4-7、癌症治療患者有物質濫用與依賴與無物質濫用與依賴者延遲診斷與治療之分佈....72
表4-4-8、癌症治療患者有物質濫用與依賴與無物質濫用與依賴者延遲診斷之風險....75
表4-4-9、癌症治療患者有物質濫用與依賴與無物質濫用與依賴者延遲治療之風險....79
表4-4-10、癌症治療患者有嚴重精神疾患者與無嚴重精神疾患延遲診斷與治療之分佈....83
表4-4-11、癌症治療患者有嚴重精神疾患者與無嚴重精神疾患者延遲診斷之風險....86
表4-4-12、癌症治療患者有嚴重精神疾患者與無嚴重精神疾患者延遲治療之風險.…...90
表4-4-13、癌症治療患者有其他種類精神疾患者與無其他種類精神疾患者延遲診斷與治療之分佈....94
表4-4-14、癌症治療患者有其他種類精神疾患者與無其他種類精神疾患者延遲診斷之風險....97
表4-4-15、癌症治療患者有其他種類精神疾患者與無其他種類精神疾患者延遲治療之風險....101
表4-4-16、癌症治療患者合併不同精神疾病種類延遲診斷校正前後之風險....105
表4-4-17、癌症治療患者合併不同精神疾病種類延遲治療校正前後之風險....105

圖目錄
圖3-1-1 研究架構圖....21
圖3-2-1 資料處理流程圖....32

中文文獻
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