The Relationship of Guideline Adherence and One Year Survival in Patients: An Example of Non-small Cell Lung Cancer (NSCLC).

• Main Authors: Chen, Hsi-Chieh, 陳錫杰
• Other Authors: Hsieh, Pi-Ching Ph. D.
• Format: Others
• Language: zh-TW
• Published: 2009
• Online Access: http://ndltd.ncl.edu.tw/handle/41161169151099308721

碩士 === 國立台北護理學院 === 醫護管理研究所 === 97 === Background: In Taiwan, lung cancer is the leading cause of cancer death since 2004. Depending on the cancer stage, the recommended treatments of lung cancer include surgery, radiotherapy or chemotherapy, or a combination of one or all of these. There was consencus in minimally recommended treatments on non-small cell lung cancer (NSCLC) in worldwide. However, the impact of physician adherence to clinical guideline on survival of patient with NSCLC was unknown. Objectives: To explore the relationship of guideline adherence and various stage NSCLC patient’s one-year survival in adjusting characteristics of patients, hospitals and physicians. Methods: The population-based data were retrieved from Taiwan Cancer Data Base (TCDB) in 2004, National Health Insurance Reasearch Database (NHIRD) in 2002-2004 and Taiwan’s Death Registries in 2004-2005. A retrospective cohort study was conducted. The study cohort consisted of newly diagnosed NSCLC patients registered in TCBD in 2004. Kaplan-Meier analysis was used to construct survival curves. Multivariate Cox proportional hazard model was employed to estimate the hazard ratio (HR). Results: Fifty-seven percentage of NSCLC paitents were stage IV. Overall, 66.6% of NSCLC paitents were compliance with treatment guidleline in the study cohort. The patients received treatments by guideline adherence had higher one-year survival rate than those non-guideline adherence (51.1% vs 22.1%), even in various cancer stage. Multivariate analysis showed the patients received treatments by guideline adherence had lower risk of one-year mortality (HR=0.44; 95% CI=0.41-0.48). A significant interaction effect between cancer stage and guideline adherence was found. The patients with early cancer stge received treatments by guideline adherence had especially lower risk of one-year mortality then those with late cancer stage. Conclusions: Compliance with treatment guideline is associated with one-year survival of patients with NSCLC patients irrespective of cancer stage. Such favourable effect is particularly noteworthy for the patients diagnosed in early cancer stage. Promoting the adoption of guideline for treatment is an effective strategy for disease control. Key words: non-small cell lung cancer (NSCLC), one year survival, guideline adherence, Taiwan Cancer Data Base