中國傳統醫藥是全球最使用替代療法最普遍的一種，台灣的全民健保涵蓋了中醫的醫療給付，肝癌和肺癌是台灣最常見的兩個癌症。本研究之目的是採用健保局資料庫百萬人檔的資料，分析從1996-2007年肝癌患者使用中醫型態，而肺癌病人則依據手術狀態分層，分析從1996-2010年的中醫利用型態。
肝癌採用橫斷面的研究，肺癌則是回顧性追蹤性研究。使用1996-2010年縱向健保資料庫2005年(LHID2005)的資料,包含住院和門診的數據，進行分析。門診的資料包含病患的基本資料(如性別、生日、年齡等)，就醫的日期，國際疾病分類代碼(ICD-9 codes),治療的程序(如診斷或處方用藥)及費用的給付等。本研究只針對中醫的門診照護進行分析。
研究結果發現: 共6358個肝癌門診病人，1240人使用了中醫的醫療服務，中醫的利用率為19.5%;年齡小於50歲、女性、公教人員、私人機構員工及居住在台灣中區的肝癌病人有較高的中醫使用率; 而年齡大於70歲以上、農夫、漁夫及台北地區的肝癌病人中醫使用率較低。肺癌方面，共7677個(有手術和沒有手術)肺癌病人，6939位沒有手術的肺癌病人，中醫的利用率為26.3%，738位有手術的肺癌病人為31.2%;沒有手術的肺癌病人70歲以上和男性、工會和農夫與漁夫的肺癌病人，有較低的中醫利用率;在被診斷為肺癌的前一年有較高的中醫使用率。投保金額在2萬~低於4萬之間、居住於都市化程度2和4，有較高的中醫使用率;而有手術的肺癌病人，診斷肺癌前一年有使用中醫者和投保金額在大於6萬以上有較高的中醫利用率。
肺癌和肺癌病人使用中醫治療相當普遍，中醫門診利用在整個研究期間都維持相當高。本研究的結果可提供公共衛生政策制定者醫療規劃時參考依據。

Traditional Chinese medicine (TCM) is one of the most popular traditional medicine modalities worldwide. TCM is even covered by the National Health Insurance Program in Taiwan. Liver and lung cancers are the top two most common cancers in Taiwan. This study aimed to analyze the TCM utilization patterns of patients with liver cancer from 1996–2007 and lung cancer stratified by surgery status from 1996-2010 using a population-based random sample of one million insured patients.
A cross-sectional study was conducted for liver cancer and a retrospective cohort study for lung cancer. The inpatient and outpatient claim datasets from 1996 to 2010 obtained from the Longitudinal Health Insurance Database 2005 (LHID2005) were used. The outpatient datasets contained the encounter form-based dates of visit, three items from the International Classification of Diseases (Ninth Revision, Clinical Modification codes), billed amount, and paid amount. Only ambulatory care was analyzed.
For liver cancer, a total of 6358 liver cancer patients utilized ambulatory care. Among them, 1240 (19.50%) availed of TCM outpatient services. After multivariable adjustment, the likelihood of TCM users was lower in participants aged 70 years and older (odds ratio, OR = 0.79, 95% confidence interval, CI: 0.64–0.97), males (OR = 0.60, CI: 0.52–0.68), residents of Taipei (OR = 0.75, CI: 0.58–0.96) as well as farmers and fishermen (OR = 0.71, CI: 0.54–0.94), but was higher in residents of central Taiwan (OR = 1.99, CI: 1.56–2.54). For lung cancer, among 7,677 lung cancer patients, 1,826 (26.32%) and 230 (31.17%) availed of TCM outpatient services for lung cancer patients without and with surgery, respectively. For lung cancer patients without surgery, the likelihood of TCM users was lower in participants aged 70 years and older (odds ratio, OR = 0.60, 95% confidence interval, CI: 0.49–0.73), males (0.86, 0.75–0.98), members of occupational (0.69, 0.51-0.93), and farmers and fishermen (0.72, 0.53–0.97), but was higher in residents who had TCM use one year prior to lung cancer diagnosis (4.55, 4.00-5.17), patients with insured amount of 20,000-39,999 NT dollars (1.34, 1.12-1.60), residents of urban levels of 2 (1.35, 1.03-1.77) and 4 (1.47, 1.14-1.91), and residents of Central (1.55, 1.21–1.97) and Kao-Ping (1.32, 1.02–1.71) after multivariable adjustment. For lung cancer patients with surgery, the likelihood of TCM users was higher in residents who had TCM use one year prior to lung cancer diagnosis (4.07, 2.74-6.04), patients with insured amount of ≧60,000 NT dollars (3.18, 1.18-8.56).
TCM was widely used by the patients with liver cancer and lung cancers. The findings of this study should be useful for health policy makers as well as researchers considering the integration of TCM and Western medicine.

Keywords: traditional medicine/therapies, liver cancer, lung cancer

目錄

Chapter I Introduction 1
1.1 General background information 1
1.2 Research objectives 2
1.3 Organization of the dissertation 2
Chapter II Literature Review 4
2.1 Epidemiology 4
2.1.1 Epidemiology of Liver Cancer 4
2.1.2 Epidemiology of Lung Cancer 4
2.2 Treatment combined with TCM for liver cancer 5
2.3 Treatment combined with TCM for lung cancer 6
2.4 Utilization pattern of TCM for Cancer 8
Chapter III Methods 10
3.1 Conceptual Framework of the Study 10
3.1.1 Conceptual framework for utilization pattern of TCM in liver cancer patients 10
3.1.2 Conceptual framework for utilization pattern of TCM in lung cancer patients 10
3.2 Methods for TCM use in patients with liver cancer 12
3.2.1 Data sources 12
3.2.2 Study subjects 12
3.2.3 Variables for expenditure and coexisting diseases 13
3.2.4 Statistical analysis 13
3.3 Methods for TCM use in patients with lung cancer 14
3.3.1 Data sources 14
3.3.2. Study subjects 15
3.3.3. Variables for expenditures and coexisting diseases. 16
3.3.4. Sociodemographic factors and urbanization levels of residential area. 16
3.3.5. Statistical analysis. 17
Chapter IV Results 18
4.1 The results of TCM use for patients with liver cancer 18
4.1.1 Prevalence of TCM use over time 18
4.1.2 Factors associated with TCM use 18
4.1.3 Medical institutes 19
4.1.4 Existing diseases 21
4.1.5 Expenditures 24
4.2 The results of TCM use for patients with lung cancer 25
4.2.1 Factors associated with TCM use. 25
4.2.2 Medical institutes 28
4.2.3 Coexisting diseases. 28
4.2.4 Expenditures 30
4.2.5 Overall survival times 32
Chapter V Discussion and Conclusions 35
5.1 Discussion and Conclusions for TCM use in patients with liver cancer 35
5.1.1 Discussion 35
5.1.2 Conclusion 39
5.2 Discussion and Conclusions for TCM use in patients with lung cancer 40
5.2.1 Discussion 40
5.2.2 Conclusions 43
5.3 Strengths and limitations 44
Refencens 45
Chinese abstract 52
Acknowledgements 54
LIST OF FIGURES

Figure 3.1 Conceptual framework for utilization pattern of TCM for liver cancer patients 11
Figure 3.2 Conceptual framework for utilization pattern of TCM for lung cancer patients 11
Figure 4.1 Proportion of TCM use by liver cancer patients during the years 1996-2007 19

LIST OF TABLE

Table 4.1. Liver cancer patient characteristics during 1996-200720
Table 4.2. Liver cancer outpatient service providers during the period 1996-200722
Table 4.3. Top 5 disease codes among liver cancer patients during the years 1996-2007 for all outpatient visits and outpatient visits specifically for liver cancer23
Table 4.4. Expenditures for outpatient services for liver cancer patients (NT$) during the period 1996-200726
Table 4.5. Sociodemographic factors of patients with lung cancer27
Table 4.6. Lung cancer outpatient service providers during the period 1996-201029
Table 4.7. Top 5 disease codes among lung cancer patients during the years 1996-2010 for all outpatient visits one-year before and after lung cancer diagnosis31
Table 4.8. Expenditures for outpatient services for lung cancer patients (NT$) during the period 1996-2010 one-year before and after lung cancer diagnosis33
Table 4.9. Univariate and multivariate Cox''s analyses of TCM use for overall mortality stratified by surgery status. (n=7,677)34