Tumor markers and the frequencies of image inspections could affect medical cost and outcomes after breast cancer surgery

• Main Authors: Wen-Hui Su, 蘇文慧
• Other Authors: Hon-Yi Shi
• Format: Others
• Language: zh-TW
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/9vn9d6

碩士 === 高雄醫學大學 === 醫務管理暨醫療資訊學系碩士在職專班 === 106 === Purpose This study will aim researching for the tendencies of tumor markers examination and the frequencies of breast mammography and breast ultrasound could affect medical cost and treatment efficiency after breast cancer treatments. There are two purposes of this research: (1) to realize the long-term trend of impacts and features on the demography, clinical experiences and the efficiencies of breast cancer treatment in terms of tumor markers and mammography. (2) to explore the impacts on the frequencies of tumor markers inspections and mammography for breast cancer patients, and the crucial factors of the impacts. Method This research applies to retrospective secondary data analysis study among the database of National Health Insurance from January 1997 to December 2008; total samples are 2,393 with women breast cancer post-operation (ICD-9 174) for the duration of 5 years. SPSS 22.0 is applied to describe and access the frequencies of tumor markers inspections on the efficiencies of post-op treatment. T-test, Chi-square test, logistic regression and linear multiple regression analysis were also applied to analyzed the data and verified the assumption of this research. Results The five-year survival rate and the disease-free survival rate for the patients who had 5 or more than 5 times of mammography is higher than those who had less then 5 times of mammography (96.5% v.s 84.3%, p=0.009); (98.2% v.s 94.9%, p=0.006). And the five-year survival rate and the disease-free survival rate or the patients who had 9 or more than 9 times of mammography is higher than those who had less then 8 times of mammography (95.4% v.s 84.6%, p=0.005); (97.0% v.s 94.8%, p=0.006). The most effective post-op observation tracking is by conducting mammography once a year or breast ultrasound once for every 6 months. The more of these tumor markers the worse for the survival rate (p<0.05). According to the statistics of Cox regression of CA15-3, the more racking actions being conduct, the lower the survival rate does. This conclusion could be related to the late stages of cancer, who uses more tumor marker tracer than others, which means it is economically inefficient. Conclusion and Recommendations This research has concluded that periodically mammography for post-op breast cancer patients would be helpful in terms of early detection of breast cancer recurrence. The most recommended method is to conduct a mammography or breast ultrasound once a year in a duration of 5 years. It is assumed that tumor markers (CEA & CA15-3) might not have the same medical efficiency as the above-mentioned. Due to medical information asymmetry, even though the Taiwan National Health Insurance system and the catastrophic illness policy has been conducted; cases of medical disputes are still significant currently. This study aims to build up common standards and further, to lower unnecessary medical cost, improve treatment quality to increase survival rate in general.