運用健保資料庫探討台灣乳癌病患中藥使用之安全與療效

陳俊良
長庚醫療財團法人林口長庚紀念醫院
癌症為台灣地區十大死因之首，乳癌是女性癌症發生率第1位，對國人健康危害極大。國外研究顯示，乳癌病患尋求另類療法的需求很大，63%-83%乳癌病患曾使用另類療法，中草藥最常使用。近來研究也發現，某些中草藥可能與西藥產生交互作用，甚至刺激乳癌細胞生長，其使用的安全值得重視。國內某區域醫院以70位乳癌病患研究，55.7%乳癌病患使用「另類療法」，而各式另類療法中，以使用中草藥居冠(56.4%)。可見台灣也面臨同樣的問題，但台灣尚無針對本土乳癌病患使用「另類療法」的大規模調查，對乳癌病患常用的中草藥也缺乏系統研究，這些中草藥的療效與安全，是一個臨床重要問題。
台灣自1995年開辦全民健保，提供西醫與中醫服務，健保的資料以全民健保研究資料庫的形式提供學術研究，分析健保資料可以提供可靠的中西藥使用記錄。因此本研究將分析健保資料庫以獲得乳癌病患之中西藥使用記錄，探討這些中藥的安全與療效，分析中藥與抗癌藥物在健保資料庫併用之頻率，以及中西藥併用對乳癌存活率之影響。
本計畫以評估中藥的安全性為主，運用國民健康局全民健保資料庫2003-2004乳癌病患資料探討乳癌病患最常服用的中藥處方及單味中藥。分析中藥與抗癌藥物在健保資料庫的併用。分析健保資料庫以獲得乳癌病患之中西藥使用記錄，探討這些中藥的安全與療效，分析中藥與抗癌藥物在健保資料庫併用之頻率，以及中西藥併用對乳癌存活率之影響。乳癌病患最常使用的中醫師處方前10名及最常使用的前10名單味中藥， 分析中藥與抗癌藥物在健保資料庫併用之頻率乳癌病患接受化學治療或標靶藥物治療或Tamoxifen治療時合併中藥使用的種類，頻率及中西藥併用之成本效益評估。並篩選2003-2004林口長庚紀念醫院癌症中心乳癌病患癌症登錄資料分為2組，乳癌病患曾服用林口長庚紀念醫院中醫門診中藥處方治療之個案為研究組，以無服用中藥者為對照組，探討林口長庚紀念醫院癌症中心乳癌病患服用中藥之種類，頻率以及中西藥併用之頻率及種類，比較乳癌病患有無服用中藥作為輔助及替代療法5年存活率之比較。並與全民健保資料庫 Data做比較。
關鍵字：乳癌 另類療法 中醫 中草藥 藥物交互作用

Investigation of safety and efficacy of Chinese herbal medicine used among breast cancer patients in Taiwan from National Health Insurance Researsh Database

Use of complementary and alternative medicine (CAM) has increased in recent decades. A survey of a regional hospital in Taiwan demonstrated 55.7% breast cancer patients used CAM after cancer diagnosis. Among CAM users, CHM was the most popular. Drug-herb interactions are an important concern in the treatment of cancer. They can affect drug dosage, which is important for optimizing the anti-tumor effect of treatments and minimizing their toxicity to normal tissue. Most CHM products are used for centuries in Chinese population and are generally safe if CHM products are used under the traditional rules. Due to the possibility of herb-drug interactions, it is important to know which CHM is most frequently used by cancer patients and how their effects on cancer treatment. However, there is limited information on this issue.
We will use National Health Insurance Research Database to explore CHM use among breast cancer. The drug-herb interaction of these most commonly used CHM with Western medications . This study will be focus on the interactions of CHM and hormonal therapeutic drugs, such as Tamoxifen.
The project to assess the safety of Traditional Chinese Medicine-based, using the National Health Council, the 2003-2004 National Health Insurance Database of breast cancer information breast cancer patients taking the medicine prescription and the most common single herb. Analysis of anticancer drugs in Traditional Chinese Medicine and health care databases and use. Analysis of National Health Insurance database for medicine use among breast cancer patients, records of safety and efficacy of these medicines, anticancer drugs of Traditional Chinese Medicine and health care database and use the frequency, and western medicine and use the effect on breast cancer survival. The most commonly used Chinese medicine for breast cancer patients prescribed the top 10 list of most commonly used herbs, analysis of Traditional Chinese Medicine and anti-cancer drug used in the insurance database and the frequency of breast cancer patients receiving chemotherapy or targeted drug therapy or Tamoxifen combined use of Chinese Medicine treatment type, frequency and western medicine and use of cost-benefit assessment. And Chang Gung Memorial Hospital, 2003-2004 Screening Cancer Center breast cancer patients divided into 2 groups of cancer registry data, breast cancer patients who had taken the Chang Gung Memorial Hospital of Traditional Chinese medicine prescribed for the treatment of the case-patient study group to not take Chinese medicine as control group to explore the Linkou Chang Gung Memorial Hospital Cancer Center, the types of breast cancer patients taking Traditional Chinese Medicine, Western medicine and the frequency and types used to compare breast cancer patients with or without taking the medicine as a complementary and alternative therapies Comparison of 5-year survival rate. And with the National Health Insurance Database Data comparison.
關鍵字：Breast cancer ; Traditional Chinese Medicine ; Herb-drug interaction