胃癌病人拒絕手術的原因與存活率分析

Refusal of Surgery in Gastric Cancer: Reasons and Effect on Survival

胃癌是台灣最常見的癌症死亡原因之一。依據健康署台灣癌症登記數據分析，接受治療的病人在第一年存活率超過80%，而拒絕接受治療的存活率只有50%。本研究分析胃癌病人拒絕治療之原因，進而作為癌症預防政策的規劃和參考。本研究採回溯性研究，統計某一南台灣醫院自2009年至2014年，所有接受胃癌病人，共104位，並分析其拒絕治療之原因。研究結果顯示，104位胃癌病人中，有17位病人中斷或拒絕手術（16.3%）。其中，15位為男性（88.2%），8位70歲以上（47.1%），10位教育程度≦6年（58.8%），和4位獨居（23.5%）。分析中斷或拒絕治療的原因為5位病人擔心疾病造成家庭的負擔（29.4%）。研究發現，“年齡＂和“支持系統＂是影響病人治療遵從性和拒絕手術（P=.001）的原因。“年齡＂的解釋率為0.51（95%CI0.42-0.83; P＜.001），“支持系統＂的解釋率為0.43（95%CI0.31-0.56; P＜.001）。研究顯示，接受治療的病人，其存活率優於拒絕治療的病人。研究結果建議，醫療團隊應建立以病人為中心的多專科團隊醫療模式，為病人提供相關的財務和心理支持，促進正確的醫療行為，使病人能及早接受治療，協助降低失落感，進而促進癌症照護之品質。

Gastric cancer is one of the most common causes of cancer death in Taiwan. According to an analysis of the Taiwan Cancer Registry Database conducted by the Health Promotion Administration, patients undergoing treatment have a survival rate over 80% during the first year, while the rate for patients not undergoing treatment is only 50%. This study analyzed the treatment compliance of gastric cancer patients and their reasons for treatment refusal in hopes of understanding why cancer patients in Taiwan refuse to receive treatment. This study can serve as a national reference during the planning and promotion of cancer prevention policies. The participants in this study were 104 gastric cancer patients who received treatment at a teaching hospital in southern Taiwan from 2009 to 2014. Analysis was performed on the participants' reasons for treatment interruption and refusal. Results showed that of the 104 gastric cancer patients, 17 interrupted or refused surgery (16.3%). Analysis showed that 15 patients were male (88.2%), 8 were over the age of 70 (47.1%), 10 receive education ≤6 years (58.8%), and 4 lived alone (23.5%). With regards to the causes of interrupting or refusing treatment, 5 patients were worried about increasing the burden on their family (29.4%). This study found that a ＂age＂ and ＂support system＂ were the cause for patients' treatment compliance, interruption, and refusal of surgery (p=.001). The age explanation is found to be 0.51 (95% CI 0.42-0.83; p＜.001) and support source explanation 0.43 (95% CI 0.31-0.56; p＜.001). The results also indicated that in terms of survival rates, the compliance group was superior to the refusal group. It is suggested that medical teams establish a patient-centered multidisciplinary team care model to provide patients with information regarding financial and psychological support and promote correct medical seeking perspectives so that patients can receive early treatment, so patients’ feelings of being lost can be reduced, and so the quality of cancer care can be improved.