Effects of Multidisciplinary Care on Survival of Oral Cavity Cancer Patients - A Propensity-Matched Approach

• Main Authors: Yueh-Hsin Wang, 王悅馨
• Other Authors: Wen-Chen Tsai
• Format: Others
• Language: zh-TW
• Published: 2011
• Online Access: http://ndltd.ncl.edu.tw/handle/13484176314781067331

碩士 === 中國醫藥大學 === 醫務管理學系碩士班 === 99 === Background: There were 640,000 oral cavity cancer patients per year in the world. According to the investigation of Oral Cancer Foundation, 37,000 oral cavity cancer patients were diagnosed and 8,000 of them died due to oral cavity cancer per year in the U.S. Only half of new oral cavity cancer patients could survive more than 5 years. In Taiwan, the oral cavity cancer had the highest growth rate and the average age of oral cavity cancer patients was the youngest in top ten leading cancers. The incidence and death rate increased 4 times and 2.3 time within 20 years, respectively. Previous studies showed that multidisciplinary team care could improve the treatment quality and increase survival for cancer patients. Multidisciplinary team care has been implemented in Taiwan since 2003. Study Purpose: This research used matched-pair based on propensity of participating in multidisciplinary team care to compare the survival of oral cavity cancer patients whether they were treated with multidisciplinary team care or not, and to find the relative factors that influenced patients’ survival. Method: The study population was 19,513 new oral cavity cancer patients from 2004 to 2007 in Taiwan. Matching based on propensity of receiving multidisciplinary care was used and the matching ratio was 1 to 2. This study included 3,099 oral cavity cancer patients who were enrolled in multidisciplinary team care and 6,198 oral cavity cancer patients who weren’t enrolled. These 9,297 patients were observed until 2008 to see their survival status. Cox proportional hazards model was applied to find the relative risks of death. Results: Relative risk of death was lower for patients with multidisciplinary care than that for patients without multidisciplinary care (HR= 0.84; 95% CI: 0.78 to 0.89). Male had higher death risk than that of female (HR= 1.16; 95% CI: 0.78 to 0.89). People with older age, lower premium-based salary, or higher severity of comorbidity had higher death risk. Patient got treatment in regional hospital had lower death risk than that of in medical center (HR= 0.90; 95% CI: 0.83-0.98). The death risk for patients who received treatments in public hospitals was 1.24 times (95% CI: 1.13 to 1.36) than that of patients in private hospitals. Patients treated in hospitals or by attending physicians with higher service volumes had lower relative risk of death (HR= 0.89 and 0.78 respectively). Conclusions: The relative risk of death was lower for patients who were enrolled in multidisciplinary team care. Multidisciplinary team care not only could increase the quality of health care services, but also could increase the survival rate for oral cavity cancer patients.