合併精神疾病對癌症延遲診斷與治療之相關性

Associations of psychiatric disorders with delay in diagnosis and treatment of cancer

目標：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，台灣是否也存 在這樣的情形？本研究欲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：整體而言，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。

Objectives: Evidence suggests that cancer patients with psychiatric disorders may be more likely to experience a delay in cancer diagnosis and treatment. The association between psychiatric disorders and delayed diagnosis and treatment in patients with cancer has not been studied well in Taiwan. The aim of this study was to determine if pre-existing psychiatric disorders led to delayed diagnosis and treatment among patients with cancer. Methods: A population-based retrospective cohort study was conducted with the use of the Taiwan National Health Insurance database and the Taiwan Cancer Registry. The study subjects were patients who were newly diagnosed and received treatment for lung, liver, colorectal, breast, oral or cervical cancer before 2011. Propensity scores were used to divide the study subjects into two groups with and without psychiatric disorders. Psychiatric disorders were further subdivided into five categories: anxiety disorders, dementia and other organic psychoses, substance abuse and dependence disorders, severe mental disorders, and other mental health disorders. Stage III or IV cancer was identified as a delayed diagnosis, and a period from definite diagnosis to the start of treatment greater than four weeks was identified as delayed treatment. Conditional logistic regression was used for analysis after controlling for demographic, hospital and disease characteristics. Results: Among patients treated for cancer, the rate of delayed diagnosis for people with psychiatric disorders was 48.2%, and for people without psychiatric disorders, it was 44.3%. The risk of delayed diagnosis was not significantly significant between groups (AOR=0.97, 95%CI=0.84-1.11). Moreover, the rate of delayed treatment for people with psychiatric disorders was 58.7%; for people without psychiatric disorders, it was 59.7%. The risk of delayed treatment was not significantly different between the groups (AOR=0.94, 95%CI=0.83-1.06). Conclusions: We still need to make an effort to reduce the delay in diagnosis and treatment of cancer in psychiatric patients.