建構中西醫合作治療癌症研究平台(2-1)

陳方佩
行政院國軍退除役官兵輔導委員會臺北榮民總醫院
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。
為擴大中醫臨床服務，提昇治療品質，增進中醫與現代醫學互動及合作，制定中西醫合作照護計畫。本計劃以治療癌症為主要目標，並提出中西醫整合治療癌症的門診與會診平台及共同照護路徑，以期達到最具成本效益的中西醫合作治療照護常規模式。
這是ㄧ個兩年期的計劃，計畫中包含了臨床、教學與研究。臨床實務方面，為了改善現行中西醫聯合門診主要以中醫或西醫單獨看診的缺點，本計劃提出中西醫整合門診的概念，乃是以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(辨証論治)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。教學方面，本計劃將提供中醫教學與中醫護理的教育課程，參與的人將包含西醫各科部、護理部、藥劑部、社工，及病友會等。研究方面，針對即將開展的中西醫整合癌症門診，先行向人體試驗委員會提出申請，將納入病人做包括生理與心理方面的療效評估，與可能副作用的探討。第ㄧ年我們以建構中西醫整合癌症門診為主。第二年則以建構中西醫整合會診(住院)平台為主。
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。因此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。
關鍵字：癌症、中醫、整合醫療、實證

Platform establishment of integrative Chinese-Western medical treatment for cancer patients (2-1)

Fang-Pey Chen
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.
In both first and second year, there are 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 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 provided 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.
關鍵字：cancer, Chinese medicine, integrative medicine, evidence-based