陳方佩 台北榮民總醫院
隨著西方醫學科技的進步，明確診斷與治療的方針已經成為全世界上癌症防治上的共識 (NCCN 癌症治療共識)。但是癌症病患因治療期間所產生的副作用，已經嚴重地影響到病患的生活品質，也造成全球補充替代療法(complimentary and alternative medicine, CAM)或整合醫學盛行的趨勢。然而由於文化國情的不同，在台灣中醫並不是補充另類療法，而是有教育制度及法規的正式醫療。如何結合現代醫學與傳統中醫的菁華，應用於癌症的治療，是一重要且極待解決的課題。
這是ㄧ個兩年期計劃的第二年，在第一年執行成果中，包含了臨床、教學與研究。臨床實務方面，我們已經提出中西醫整合門診的概念，乃是中醫與西醫共同看診的平台，面對同一癌症病人，經過辨病(診斷)之後，分別經過中醫(辯症論治)及西醫(診斷治療)的雙向溝通，提出共同治療的共識與治療方針。利用資訊室整合中醫與西醫門診的代碼 (0AE為中西整合治療癌症門診)，病人掛號此特別門診後，由西醫經由診斷步驟(SOA)確認疾病及ICD-9 疾病代碼，此步驟為診斷(西醫)或中醫(辨病)的主要依據。之後經由中醫的辨症(辨証)或西醫的鑑別診斷，兩人或依序討論出治療共識，並分別開列治療方針與處方。教學方面，半年來我們定期舉辦中醫對癌症治療有幫助的相關課程。研究方面，從2012年8月至2012年11月27日，至台北榮總中醫癌症特別門診及中西醫聯合門診之病人共有2,334人次，其中癌症病人約為1,641人次。同期間本研究共收案40人（其中乳癌28人、大腸癌4人、肺癌6人、卵巢癌1人、舌癌1人）。其中28位乳癌受試者於使用中藥前、使用後一個月追蹤檢驗血清中女性相關的荷爾蒙，例如女性荷爾蒙(E2)及卵巢刺激素(FSH)，結果顯示中藥使用後一個月檢驗女性荷爾蒙(E2)會略為降低，但卵巢刺激素(FSH)與使用中藥前差不多。在生活品質方面，由於計畫收案時間過於短暫，影響使用本平台後的分析結果，仍需進一?追蹤。
延續第一年的經驗與成果，於第二年我們將第一年在門診建立的平台，應用於住院會診的平台。其目的將於第二年達成病人住院期間的中西整合治療癌症的會診作業與規劃。為了提供良好的中醫與西醫配合的癌症治療策略，過去幾年，我們已經著手癌症整合醫療臨床實務的討論與執行，且具初步結果，發現中西整合治療乳癌病人，經過針灸的治療，不僅在症狀的程度上有改善，在心理上也有極大的助益。
隨著時代的進步，癌症病患對治療期中所需要的支持與幫助，都有極高的期待與盼望。有了第一年的執行經驗與成果，我們相信只要經過科學驗証的整合醫療方法，都應該被納入正規的醫療體系。本計劃所提的中心思想，乃是藉著中醫與與現代醫學互補，找到具有實證(evidence-based)，又對病人較無傷害(favorable benefit/risk ratio) 的癌症治療方針，以期在未來能對癌症病人找到最具成本效益的中西醫合作治療照護的常規模式。
關鍵詞： 癌症，中醫，整合醫療，實證
Platform establishment of integrative Chinese-Western medical treatment for cancer patients(2-2)
FANG-PEI CHEN Taipei Veterans General Hospital
There is consensus that cancer treatment in modern medicine or Western medicine follows the generally accepted NCCN guideline. However, cancer patients seek complementary & alternative medicine (CAM) to relieve their discomfort or mental stress induced by modern medicine. Nevertheless, traditional Chinese medicine (TCM), by definition, is not CAM in Taiwan. How to integrate TCM and modern medicine in treatment of caner patients remains a challenging problem and an important issue in Taiwan. The aims of this 2-year project are to establish a platform for integrated TCM and Western medicine (ICWM, denoted as IM) in treatment of cancer patients. In the first year, the aim is to establish a platform for IM cancer treatment for out-patient clinics, while in the second year, it is to establish a platform for IM cancer treatment for in-patient service by consultation. This is the 2nd year of this project. In the 1st year project, Several tackforces have been conducted, namely, clinical-, teaching-, and academic ones. On clinical aspect, a platform for both TCM and modern medicine doctors to care a cancer patient will be established, which is based on a common language from patient’s chief complaints and a definite diagnosis provided by an international ICD-9 code, followed by treatment plans proposed by each specialists. On teaching aspect, education programs in TCM will provide for those medical and paramedical personnel. On research aspect, there were 2,334 consecutive patients followed from Aug. 2012 to Nov. 2012. Among these patients, 1,641 were cancer patients. After inform consent, 39 patients were included and longitudinally followed by questionnaire for quality of life and serum E2 and FSH levels. Due to time limited, the parameters assessed are of no statistical significance. More patients and longer duration are needed to complete the study. In the 2nd year project, the platform that has been well established at the end of 1st year will be applied in hospitalized patients. Since we have experiences on handling this platform, it is expected that an integrated Western medicine and TCM will work together to treat cancer patients. Three directions in this proposal, namely, clinical-, teaching-, and academic ones. On clinical aspect, a platform for both TCM and modern medicine doctors to care hospitalized cancer patients will be established, which is based on a common language from patient’s chief complaints and a definite diagnosis provided by an international ICD-9 code, followed by treatment plans proposed by each specialists. On teaching aspect, education programs in TCM will provide for those medical and paramedical personnel. On research aspect, a clinical observation study under the approval of IRB will be conducted to evaluate the benefit and adverse effects of IM treatment in cancer patients. The results of this 2-year project will provide an impact on TCM and modern medicine doctores and also provide an evidence-based health care for those patients with different cancers in Taiwan.
