| Summary: | 碩士 === 國立成功大學 === 公共衛生研究所 === 101 === Objectives: Using the National Health Insurance claim data of the same population, this study aimed to investigate characteristics of patients of early operated breast cancer, factors to Influence on the selection of the breast reconstruction, and the relationships between various operative methods and subsequent risks of anxiety and depression.
Methods: This study employed the breast cancer (ICD-9-CM: 174 or A-code: A113) ambulatory care visit data to set up the study cohort of breast cancer patient with early operation from 2000 to 2008 (n=36,377). Based on the inpatient claim data, we further classified the study cohort into three groups according to different operative methods, i.e., mastectomy alone (n=34,900), along with early reconstruction (n=1,080), and along with delayed reconstruction (n=397). We analyzed the characteristics of patients in relation to the choic of the operative methods. We also calculated the respective cumulative incidence rate and incidence density of anxiety and depression (ICD-9-CM: 296、298、300、311or V79.0) for the three study groups. Cox multivariate regression model was employed to estimate the relative risk estimates of anxiety and depression in relation to different operative methods. Additionally, ordinal logistic regression was used to calculate the relative risk estimates of ambulatory care visit frequency in relation to different operative methods.
Results: Our study noted that age, insurance preimium level, urbanization level, and post-surgery chemotherapy and radiotherapy were significantly associated with choice of operative methods in breast cancer patients with early stages. After up to 11 years of follow-up, the breast cancer patient with mastectomy alone, along with early reconstruction, and along with delayed reconstruction showed a cumulative incidence rate of 36.90%, 41.56%, and 33.89%, respectively; and a incidence density of 547.81 per 1,000 person-years and 634.92 per 1,000 person-years (combining groups of early and delay reconstruction), respectibvely. The Cox regression analysis indicated that compared to those with mastectomy alone, patients with early and delayed reconstructions experienced a hazard ratio (HR) of 1.06 (95% confidence interval (CI)=0.93-1.21) and 1.17 (95% CI=0.96-1.42), respectively for the occurrence of anxiety/depression. Additionally, a significantly higher HR was also noted for older ages, lower urbanization, secondary cancer post breast cancer surgery, higher ambulatioy care frequency, and suffering from certain chronic illnesses. The ordinal logistic regression analysis also reported no significant influences of operative methods on frequency of ambulatory care visit for anxiety/depression. The odds ratio (OR) of higher frequencies of ambulatory care visit for anxiety/depression for patients with early and delayed reconstruction was estimated at 1.02 (95% CI=0.88-1.18) and 1.21 (95% CI=0.91-1.51), respectively. The factors associated with an increased OR of higher frequencies of ambulatory care visit for anxiety/depression included older ages, lower urbanization, secondary cancer post breast cancer surgery, and with certain chronic illnesses such as hypertenstion, chronic obstructive pulmonary disease, rheumatoid arthritis, ischemia heart disease, and stroke.
. Operative methods had no infleunce on the psychosocial change.
Conclusion: This study found a low prevalence of reconstruction in operated breast cancer patients with early stages in Taiwan. Soco-economic variables and co-morbidities were associated with patient’s choice of reconstruction. We also noted that the incidence of and frequency of ambulatory care visit for anxiety/depression did not vary in patients with differet operative methods.
|
|---|
