目的：本研究旨在評估影響大腸癌患者對於化學治療與標靶治療的知識、態度、行為的相關因素。
方法：本研究採用橫斷性研究設計，以立意取樣方式透過問卷調查方式收集高雄某區域教學醫院單一位大腸直腸外科主治醫師所收治的大腸癌病人資料。問卷經五位專家效度分析，總體內容效度指標(CVI)達93.8%，並於2013年9月間收集22位大腸癌患者進行問卷前測，所得總體問卷信度Cronbanch α值為0.946。正式問卷調查於2013年10月21日至2014年2月28日間進行，共計收集到173位有效樣本，使用的統計分析方法包括t檢定、變異數分析及線性複迴歸分析。
結果：總體樣本173人中，男性113人(65.3%)、女性60人(34.7%)，平均年齡為60.9歲（標準差11.1歲），對於化學治療或標靶治療知識面9個題累積平均總分為28.45分(標準差8.46分)、態度面9個子題累積平均總分為35.46分(標準差5.31分)、行為面10個子題累積平均總分為40.78(標準差6.19分)，各個面向單變項分析達顯著相關的因素才納入複迴歸分析。與知識面分數的顯著影響因素包括年齡、教育程度、婚姻狀況、家庭年收入、與孫子女同住、與親友同住、資訊來源為電視、資訊來源為網路，總體解釋力達54.2%；與態度面分數的顯著影響因素包括知識、資訊來源為護理師或腫瘤個管師、資訊來源為報章雜誌，總體解釋力達53.1%；與行為面分數的顯著影響因素包括態度、教育程度、與兒女同住，總體解釋力達55.1%。
結論：本研究所納入迴歸分析的自變項所展現出對於知識、態度及行為的變異都在五成左右的中度解釋力。建議醫療機構針對大腸癌患者，首要應做好完整的知情同意程序並加強化療或標靶治療的相關衛教情形，透過提升大腸癌患者的的知識面，來建立對於化療或標靶治療的良好態度，從而使患者能積極面對疾病後續的完整治療療程。
關鍵詞：大腸癌、化學治療、標靶治療、知識、態度、行為

Objective: The purpose of this study was to evaluate the influences of colon cancer patients’ knowledge, attitude, and behavior in relation to chemotherapy and target therapy.
Methods: This was a cross-sectional study. Judgment sampling was used to survey the colon cancer patients of one colorectal surgeon at a regional teaching hospital in Kaohsiung. The validity of the questionnaire used in this study to obtain information from the patients was examined by 5 experts. The total content validity index (CVI) was 93.8%. In September 2013, 22 colon cancer patients were invited to take a pretest. The total Cronbach’s α was 0.946. The formal survey was administered from October 21, 2013 to February 28, 2014, and 173 valid questionnaires were collected. The methods used to analyze the questionnaire results included a t test, analysis of variance (ANOVA), and multiple linear regression analysis.
Results: Among the 173 participants who returned valid questionnaires, 65.3% were male and 34.7% were female; the average age was 60.9 years (standard deviation (SD) = 11.1 y). The average accumulated score for the 9 questions on knowledge of chemotherapy and target therapy was 28.45 (SD = 8.46). The average accumulated score for the 9 questions on attitude toward chemotherapy and target therapy was 35.46 (SD = 5.31). The average accumulated score for the 10 questions on behavior during chemotherapy and target therapy was 40.78 (SD = 6.19). If the result of univariate analysis was significant, multiple linear regression was performed. Knowledge was significantly correlated with age, education, marital status, family income, living with grandchildren, living with relatives, television as a source of information, and the Internet as a source of information (R2 = 0.542). Attitude was significantly correlated with knowledge, nurses and case managers as sources of information, and newspapers and magazines as sources of information (R2 = 0.531). Behavior was significantly correlated with attitude, education, and living with sons or daughters (R2 = 0.551).
Conclusion: In this study, the independent variable explained the variance in knowledge, attitude, and behavior, which was approximately 50%. Therefore, medical institutions should establish complete procedures for obtaining informed consent, and health education that addresses chemotherapy and target therapy should be provided for colon cancer patients. By increasing the level of knowledge of colon cancer patients, medical institutions could assist these patients in developing and maintaining a healthy attitude during chemotherapy and target therapy, and also motivate patients to adopt a positive attitude toward the entire disease therapy process.
Keywords: colon cancer, chemotherapy, target therapy, knowledge, attitude, behavior

頁數
內文目錄-------------------------------------------------------------------------------- i
表次-------------------------------------------------------------------------------------- ii
圖次-------------------------------------------------------------------------------------- iii
中文摘要-------------------------------------------------------------------------------- iv
英文摘要-------------------------------------------------------------------------------- v
第一章 緒論--------------------------------------------------------------------------- 1
第一節 研究背景及動機--------------------------------------------------------- 1
第二節 研究目的------------------------------------------------------------------ 5
第二章 文獻探討-------------------------------------------------------------------- 6
第一節 大腸癌簡介--------------------------------------------------------------- 6
第二節 大腸癌在台灣的流行概況與醫療資源使用量------------------ 16
第三節 大腸癌的化學治療與標靶治療-------------------------------------- 25
第四節 影響大腸癌患者接受化學治療與標靶治療的決策------------ 47
第三章 材料與方法----------------------------------------------------------------- 52
第一節 研究設計與研究架構-------------------------------------------------- 52
第二節 研究對象與問卷信效度----------------------------------------------- 53
第三節 研究變項操作型定義-------------------------------------------------- 63
第四節 資料處理及統計分析-------------------------------------------------- 65
第四章 研究結果------------------------------------------------------------------- 67
第一節 基本特徵分析----------------------------------------------------------- 67
第二節 化療與標靶治療知識、態度、行為單變項相關因素分析- 77
第三節 化療與標靶治療知識、態度、行為複迴歸分析-------------- 84
第五章 討論------------------------------------------------------------------------- 94
第一節 化學治療或標靶治療知識面影響因素--------------------------- 94
第二節 化學治療或標靶治療態度面影響因素--------------------------- 100
第三節 化學治療或標靶治療行為面影響因素--------------------------- 105
第四節 結論----------------------------------------------------------------------- 109
參考文獻------------------------------------------------------------------------------ 111
附錄一 專家效度問卷------------------------------------------------------------ 125
附錄二 前測問卷------------------------------------------------------------------- 131
附錄三 正式研究調查問卷------------------------------------------------------- 136
附錄四 IRB核准函------------------------------------------------------------------ 140

一、 中文部分
TCOG大腸癌工作群編撰小組，大腸癌臨床診療指引，財團法人國家衛生研究院癌症研究所台灣癌症臨床研究合作組織：苗栗，2010。
中央健康保險署，用藥品項查詢系統，2014，April 25【線上資料】來源：http://www.nhi.gov.tw/query/query1.aspx?menu=18&menu_id=683&webdata_id=3468&WD_ID=756
中央健康保險署，藥品給付規定-第9節 抗癌瘤藥物，2013，August 5【線上資料】，來源：http://www.nhi.gov.tw/webdata/webdata.aspx?menu=20&menu_id= 710&WD_ID=812&webdata_id=2919
中央健康保險局，健保新增給付腸癌標靶藥物，2011，November 25【線上資料】，來源：http://www.nhi.gov.tw/epaper/ItemDetail.aspx?DataID=2732&IsWebData= 0&ItemTypeID=7&PapersID=233&PicID=
王緯書，大腸直腸癌化學治療之近況，臨床醫學期刊，1999；43(5)：317-20。
李祥、賴世偉、黃金財，大腸直腸癌，基礎醫學，2001；16：192-8。
李瑞美、顧乃平，癌症病人對化學治療引起腸胃道副作用的知識、自我照顧行為及相關因素之探討，護理雜誌 1990；37（2）：9-20。
林楨國，家族性大腸瘜肉症，2014，Apri 14【線上資料】，來源：http://hospital.kingnet. com.tw/library/diagnose.html?lid=9241&engchar=f
國民健康局，大腸癌核心測量指標與存活率分析，101年度癌症診療品質標竿學習報告，2012。
陳玉珍、陳瑤琪、康靜芬，大腸直腸癌病患對化學治療等待注射及滿意度之改善方案，腫瘤護理雜誌，2004；4（1）：23-34。
陳秋蓉，Clerodane diterpenoid 16-hydroxycleroda-3,13-dien-15,16-olide化合物對大腸癌細胞的作用，國立中山大學生物醫學研究所未出版碩士論文，2008。
陳建仁，流行病學：原理與方法（初版），聯經：台北，1999。
曾嘉慶、李嘉龍、吳啓華，大腸直腸腫瘤的篩檢與追蹤：文獻回顧與最新指引，內科學誌 2009；20(6)：506-13。
劉易承、宋鴻樟、謝玲玲、唐瑞平、葉志清，大腸直腸癌之風險預測模式與風險指標，臺灣公共衛生雜誌 2008；27（1）：1-12。
衛生福利部國民健康署，大腸癌防治概況，2013，June 21【線上資料】，來源：http://www.hpa.gov.tw/BHPNet/Web/HealthTopic/TopicArticle.aspx?No=200907210002&parentid=200802140005
衛生福利部國民健康署，民國91年至100年癌症登記報告，2014，April 14【線上資料】，來源：http://www.hpa.gov.tw/BHPNet/Web/Stat/StatisticsShow.aspx? No=200911300001
衛生福利部統計處，全民健康保險醫療統計年報，十五大癌症第三位結腸、直腸和肛門癌-按戶籍縣市別統計（2004-2012），2014，January 28 【線上資料】，來源：http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no =4730

二、 英文部分
Aleksandrova K, Nimptsch K, Pischon T. Obesity and colorectal cancer. Front Biosci (Elite Ed). 2013;5:61-77. Review.
Almurshed KS. Colorectal cancer: case-control study of sociodemographic, lifestyle and anthropometric parameters in Riyadh. East Mediterr Health J. 2009;15(4):817-26.
American Cancer Society: Cancer facts and figures 2013. Atlanta, Ga: American Cancer Society, 2013. Available online. Last accessed January 10, 2014. http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-036845.pdf
American Joint Committee on Cancer. Colon and rectum. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 143-64.
André T, Boni C, Mounedji-Boudiaf L, Navarro M, Tabernero J, Hickish T, Topham C, Zaninelli M, Clingan P, Bridgewater J, Tabah-Fisch I, de Gramont A; Multicenter International Study of Oxaliplatin/5-Fluorouracil/Leucovorin in the Adjuvant Treatment of Colon Cancer (MOSAIC) Investigators. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med. 2004;350(23):2343-51.
Arkenau HT, Bermann A, Rettig K, Strohmeyer G, Porschen R; Arbeitsgemeinschaft Gastrointestinale Onkologie.5-Fluorouracil plus leucovorin is an effective adjuvant chemotherapy in curatively resected stage IIIcolon cancer: long-term follow-up results of the adjCCA-01 trial. Ann Oncol. 2003;14(3):395-9.
Arndt V, Merx H, Stegmaier C, Ziegler H, Brenner H. Quality of life in patients with colorectal cancer 1 year after diagnosis compared with the general population: a population-based study. J Clin Oncol. 2004;22(23):4829-36.
Arora NK, McHorney CA. Patient preferences for medical decision making: who really wants to participate? Med Care. 2000;38(3):335-41.
Aubry C, Spyckerelle Y, Bon N, Deschamps JP. Public knowledge and attitude towards colorectal cancer. Gastroenterol Clin Biol. 1989;13(6-7):596-601.
Baghianimoghadam MH, Ardakani MF, Akhoundi M, Mortazavizadeh MR, Fallahzadeh MH, Baghianimoghadam B. Effect of education on knowledge, attitude and behavioral intention in family relative with colorectal cancer patients based on theory of planned behavior. Asian Pac J Cancer Prev. 2012;13(12):5995-8.
Barzelloni ML, Mogavero A, Carnicelli P, Izzo R, Crivaro V. Experimental prospective cognitive study on the evaluation of connection of fatigue perception and depression among caregivers and team treating cancer patients receiving oral chemotherapy to systemic chemotherapy. Equi-Car 10 study. G Ital Med Lav Ergon. 2012;34(2 Suppl B):B29-37. Italian.
Basu A, Datta S, Roy C. Knowledge and attitude towards cancer: the need for health education. J Indian Med Assoc. 2010;108(5):305-6, 308.
Bazzoli F, Fossi S, Sottili S, Pozzato P, Zagari RM, Morelli MC, Taroni F, Roda E. The risk of adenomatous polyps in asymptomatic first-degree relatives of persons with colon cancer. Gastroenterology. 1995;109(3):783-8.
Ben-Ishay O, Brauner E, Peled Z, Othman A, Person B, Kluger Y. Diagnosis of colon cancer differs in younger versus older patients despite similar complaints. Isr Med Assoc J. 2013;15(6):284-7.
Bernhard J, Hürny C, Maibach R, Herrmann R, Laffer U. Quality of life as subjective experience: reframing of perception in patients with colon cancer undergoing radical resection with or without adjuvant chemotherapy. Swiss Group for Clinical Cancer Research (SAKK). Ann Oncol. 1999;10(7):775-82.
Birt DF, Phillips GJ. Diet, genes, and microbes: complexities of colon cancer prevention. Toxicol Pathol. 2014;42(1):182-8.
Bongaerts BW, de Goeij AF, Wouters KA, van Engeland M, Gottschalk RW, Van Schooten FJ, Goldbohm RA, van den Brandt PA, Weijenberg MP. Alcohol consumption, alcohol dehydrogenase 1C (ADH1C) genotype, and risk of colorectal cancerin the Netherlands Cohort Study on diet and cancer. Alcohol. 2011;45(3):217-25.
Botteri E, Iodice S, Bagnardi V, Raimondi S, Lowenfels AB, Maisonneuve P. Smoking and colorectal cancer: a meta-analysis. JAMA. 2008;300(23):2765-78.
Broomé U, Bergquist A. Primary sclerosing cholangitis, inflammatory bowel disease, and colon cancer. Semin Liver Dis. 2006;26(1):31-41. Review.
Burrer CV, Bauer SM. Insights into genetic testing for colon cancer: the nurse practitioner role. Clin Excell Nurse Pract. 2000;4(6):349-55.
Cappell MS. The pathophysiology, clinical presentation, and diagnosis of colon cancer and adenomatous polyps. Med Clin North Am. 2005;89(1):1-42, vii. Review.
Cappellani A, Zanghì A, Di Vita M, Cavallaro A, Piccolo G, Veroux P, Lo Menzo E, Cavallaro V, de Paoli P, Veroux M, Berretta M. Strong correlation between diet and development of colorectal cancer. Front Biosci (Landmark Ed). 2013;18:190-8. Review.
Carney PA, Lee-Lin F, Mongoue-Tchokote S, Mori M, Leung H, Lau C, Le TD, Lieberman DA. Improving colorectal cancer screening in Asian Americans: Results of a randomized intervention study. Cancer. 2014 Mar 4. doi: 10.1002/cncr.28640. [Epub ahead of print]
Cassidy J, Clarke S, Díaz-Rubio E, Scheithauer W, Figer A, Wong R, Koski S, Lichinitser M, Yang TS, Rivera F, Couture F, Sirzén F, Saltz L. Randomized phase III study of capecitabine plus oxaliplatin compared with fluorouracil/folinic acid plus oxaliplatin as first-line therapy for metastatic colorectal cancer. J Clin Oncol. 2008;26(12):2006-12.
Cavalli-Björkman N, Lambe M, Eaker S, Sandin F, Glimelius B. Differences according to educational level in the management and survival of colorectal cancer in Sweden. Eur J Cancer. 2011;47(9):1398-406.
Céilleachair AÓ, Costello L, Finn C, Timmons A, Fitzpatrick P, Kapur K, Staines A, Sharp L. Inter-relationships between the economic and emotional consequences of colorectal cancer for patients and their families: a qualitative study. BMC Gastroenterol. 2012;12:62.
Cho KR, Vogelstein B. Suppressor gene alterations in the colorectal adenoma- carcinoma sequence. J Cell Biochem Suppl. 1992;16G:137-41.
Chow WH, Devesa SS, Blot WJ. Colon cancer incidence: recent trends in the United States. Cancer Causes Control. 1991;2(6):419-25.
Craven O, Hughes CA, Burton A, Saunders MP, Molassiotis A. Is a nurse-led telephone intervention a viable alternative to nurse-led home care and standard care for patients receiving oral capecitabine? Results from a large prospective audit in patients with colorectal cancer. Eur J Cancer Care (Engl). 2013; 22(3):413-9.
Cross AJ, Ferrucci LM, Risch A, Graubard BI, Ward MH, Park Y, Hollenbeck AR, Schatzkin A, Sinha R. A large prospective study of meat consumption and colorectal cancer risk: an investigation of potential mechanisms underlying this association. Cancer Res. 2010;70(6):2406-14.
Cunningham D, Humblet Y, Siena S, Khayat D, Bleiberg H, Santoro A, Bets D, Mueser M, Harstrick A, Verslype C, Chau I, Van Cutsem E. Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. N Engl J Med. 2004;351(4):337-45.
Degner LF, Sloan JA. Decision making during serious illness: what role do patients really want to play? J Clin Epidemiol. 1992;45(9):941-50.
Delcò F, Egger R, Bauerfeind P, Beglinger C. Hospital health care resource utilization and costs of colorectal cancer during the first 3-year period following diagnosis in Switzerland. Aliment Pharmacol Ther. 2005;21(5):615-22.
Deng SX, Gao J, An W, Yin J, Cai QC, Yang H, Li ZS. Colorectal cancer screening behavior and willingness: an outpatient survey in China. World J Gastroenterol. 2011;17(26):3133-9.
Edge SB, Byrd DR, Compton CC, et al., eds. Colon and rectum. In: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 143-64.
Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127(12):2893-917.
Flynn KE, Smith MA, Vanness D. A typology of preferences for participation in healthcare decision making. Soc Sci Med. 2006;63(5):1158-69.
Ford ES. Body mass index and colon cancer in a national sample of adult US men and women. Am J Epidemiol. 1999;150(4):390-8.
Ford JS, Coups EJ, Hay JL. Knowledge of colon cancer screening in a national probability sample in the United States. J Health Commun. 2006;11 Suppl 1:19-35.
Francois F, Elysée G, Shah S, Gany F. Colon cancer knowledge and attitudes in an immigrant Haitian community. J Immigr Minor Health. 2009;11(4):319-25.
Frezza EE, Wachtel MS, Chiriva-Internati M. Influence of obesity on the risk of developing colon cancer. Gut. 2006;55(2):285-91.
Fuchs CS, Marshall J, Mitchell E, Wierzbicki R, Ganju V, Jeffery M, Schulz J, Richards D, Soufi-Mahjoubi R, Wang B, Barrueco J. Randomized, controlled trial of irinotecan plus infusional, bolus, or oral fluoropyrimidines in first-line treatment of metastatic colorectal cancer: results from the BICC-C Study. J Clin Oncol. 2007;25(30):4779-86.
Fuchs CS, Giovannucci EL, Colditz GA, Hunter DJ, Speizer FE, Willett WC. A prospective study of family history and the risk of colorectal cancer. N Engl J Med. 1994;331(25):1669-74.
Ger LP, Ho ST, Chiang HH, Chen WW. Cancer patients' knowledge of their diagnoses. J Formos Med Assoc. 1996;95(8):605-11.
Gerner EW, Ignatenko NA, Lance P, Hurley LH. A comprehensive strategy to combat colon cancer targeting the adenomatous polyposis colitumor suppressor gene. Ann N Y Acad Sci. 2005;1059:97-105. Review.
Gilbar O. The attitude of the doctor to the refusal of the cancer patient to accept chemotherapy. Med Law. 1989;8(5):527-34.
Goel S, Huang J, Klampfer L. K-Ras, Intestinal Homeostasis and Colon Cancer. Curr Clin Pharmacol. 2013. [Epub ahead of print]
Goerner M, Riemer-Hommel P. Economic impact of alternative adjuvant chemotherapy regimens for stage III colon cancer. Onkologie. 2009; 32(11):647-52.
Grossman S, Milos ML, Tekawa IS, Jewell NP. Colonoscopic screening of persons with suspected risk factors for colon cancer: II. Past history of colorectal neoplasms. Gastroenterology. 1989;96(2 Pt 1):299-306.
Hashimoto H, Fukuhara S. The influence of locus of control on preferences for information and decision making. Patient Educ Couns. 2004;55(2):236-40.
Hochster HS, Hart LL, Ramanathan RK, Childs BH, Hainsworth JD, Cohn AL, Wong L, Fehrenbacher L, Abubakr Y, Saif MW, Schwartzberg L, Hedrick E. Safety and efficacy of oxaliplatin and fluoropyrimidine regimens with or without bevacizumab as first-line treatment of metastatic colorectal cancer: results of the TREE Study. J Clin Oncol. 2008;26(21):3523-9.
Hoff PM, Ansari R, Batist G, Cox J, Kocha W, Kuperminc M, Maroun J, Walde D, Weaver C, Harrison E, Burger HU, Osterwalder B, Wong AO, Wong R. Comparison of oral capecitabine versus intravenous fluorouracil plus leucovorin as first-line treatment in 605 patients with metastatic colorectal cancer: results of a randomized phase III study. J Clin Oncol. 2001;19(8):2282-92.
Hou L, Ji BT, Blair A, Dai Q, Gao YT, Chow WH. Commuting physical activity and risk of colon cancer in Shanghai, China. Am J Epidemiol. 2004;160(9):860-7.
Hurria A, Somlo G, Ahles T. Renaming "chemobrain". Cancer Invest. 2007;25(6): 373-7. Review.
Jansen SJ, Otten W, Baas-Thijssen MC, van de Velde CJ, Nortier JW, Stiggelbout AM. Explaining differences in attitude toward adjuvant chemotherapy between experienced and inexperienced breast cancer patients. J Clin Oncol. 2005; 23(27):6623-30.
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69-90.
Joanna K. Physical activety in the prevention of the most frequent chronic disease: an analysis of the recent evidence. Asia Pacific J Cancer Prevention. 2007;8(3):325-33.
Johansen C, Schou G, Soll-Johanning H, Mellemgaard A, Lynge E. Marital status and survival in colorectal cancer. Ugeskr Laeger. 1998;160(5):635-8.
Korsgaard M, Pedersen L, Laurberg S. Delay of diagnosis and treatment of colorectal cancer--a population-based Danish study. Cancer Detect Prev. 2008;32(1):45-51.
Kremer H, Ironson G, Schneiderman N, Hautzinger M. "It's my body': does patient involvement in decision making reduce decisional conflict? Med Decis Making. 2007;27(5):522-32.
Kris MG, Urba SG, Schwartzberg LS. Clinical roundtable monograph. Treatment of chemotherapy-induced nausea and vomiting: a post-MASCC 2010 discussion. Clin Adv Hematol Oncol. 2011;9(1):suppl 1-15.
Kumar SK, Goldberg RM. Adjuvant chemotherapy for colon cancer. Curr Oncol Rep. 2001;3(2):94-101.
Kutner JS, Vu KO, Prindiville SA, Byers TE. Patient age and cancer treatment decisions. Patient and physician views. Cancer Pract. 2000;8(3):114-9.
Laing SS, Bogart A, Chubak J, Fuller S, Green BB. Psychological distress after a positive fecal occult blood test result among members of an integrated healthcare delivery system. Cancer Epidemiol Biomarkers Prev. 2014;23(1):154-9.
Larsson SC, Orsini N, Wolk A. Diabetes mellitus and risk of colorectal cancer: a meta-analysis. J Natl Cancer Inst. 2005;97(22):1679-87.
Lembersky BC, Wieand HS, Petrelli NJ, O'Connell MJ, Colangelo LH, Smith RE, Seay TE, Giguere JK, Marshall ME, Jacobs AD, Colman LK, Soran A, Yothers G, Wolmark N. Oral uracil and tegafur plus leucovorin compared with intravenous fluorouracil and leucovorin in stage II and III carcinoma of the colon: results from National Surgical Adjuvant Breast and Bowel Project Protocol C-06. J Clin Oncol. 2006;24(13):2059-64.
Lemmens VE, van Halteren AH, Janssen-Heijnen ML, Vreugdenhil G, Repelaer van Driel OJ, Coebergh JW. Adjuvant treatment for elderly patients with stage III colon cancer in the southern Netherlands is affected bysocioeconomic status, gender, and comorbidity. Ann Oncol. 2005;16(5):767-72.
Leung WH, Liu CK. Chemotherapy and targeted therapy in colorectal cancer: the current status. J Cancer Res Pract. 2014;30(1):11-20.
Levy BT, Daly JM, Xu Y, Ely JW. Mailed fecal immunochemical tests plus educational materials to improve colon cancer screening rates in Iowa Research Network (IRENE) practices. J Am Board Fam Med. 2012;25(1):73-82.
Lin CC, Lai YL, Lin TC, Chen WS, Jiang JK, Yang SH, Wang HS, Lan YT, Liang WY, Hsu HM, Lin JK, Chang SC. Clinicopathologic features and prognostic analysis of MSI-high colon cancer. Int J Colorectal Dis. 2012;27(3):277-86.
Loss J, Eichhorn C, Nagel E. Knowledge of colorectal cancer prevention in the Bavarian population above 50 years--survey in two districts. Gesundheitswesen. 2005;67(7):455-60.
Lynn MR. Determination and quantification of content validity. Nurs Res. 1986; 35(6):382-5.
Machii R, Saika K. Five-year relative survival rate of colon cancer in the USA, Europe and Japan. Jpn J Clin Oncol. 2014;44(1):105-6.
Macrae FA, Hill DJ, St John DJ, Ambikapathy A, Garner JF. Predicting colon cancer screening behavior from health beliefs. Prev Med. 1984;13(1):115-26.
Maghfoor I. Colorectal cancer. Lancet. 1999;353(9157):1013.
Maiello E, Gebbia V, Giuliani F, Paoletti G, Gebbia N, Borsellino N, Cartenì G, Pezzella G, Manzione L, Romito S, Lopez M, Colucci G; Gruppo Oncologico dell'Italia Meridionale (GOIM). FOLFIRI regimen in advanced colorectal cancer: the experience of the Gruppo Oncologico dell'Italia Meridionale (GOIM). Ann Oncol. 2005;16 Suppl 4:iv56-60.
McFarlane K, Dixon L, Wakeman CJ, Robertson GM, Eglinton TW, Frizelle FA. The process and outcomes of a nurse-led colorectal cancer follow-up clinic. Colorectal Dis. 2012;14(5):e245-9.
Moertel CG, Fleming TR, Macdonald JS, Haller DG, Laurie JA, Tangen CM, Ungerleider JS, Emerson WA, Tormey DC, Glick JH, Veeder MH, Mailliard JA. Fluorouracil plus levamisole as effective adjuvant therapy after resection of stage III colon carcinoma: a final report. Ann Intern Med. 1995;122(5):321-6.
Murff HJ, Spigel DR, Syngal S. Does this patient have a family history of cancer? An evidence-based analysis of the accuracy of family cancer history. JAMA. 2004;292(12):1480-9.
Myers EA, Feingold DL, Forde KA, Arnell T, Jang JH, Whelan RL. Colorectal cancer in patients under 50 years of age: a retrospective analysis of two institutions' experience. World J Gastroenterol. 2013;19(34):5651-7.
Näthke I. Relationship between the role of the adenomatous polyposis coli protein in colon cancer and its contribution to cytoskeletal regulation. Biochem Soc Trans. 2005;33(Pt 4):694-7. Review.
NCCN, National Comprehensive Cancer Network. NCCN guidelines for treatment of cancer by site-colon/rectal cancer. 2014. https://www.nccn.org/store/login/login. aspx?ReturnURL=http://www.nccn.org/professionals/physician_gls/pdf/colon.pdf
NCCN, National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: Colon Cancer, version 4, 2009. http://www.nccn.org
NCI, Nation Cancer Insitute. Colon cancer treatment (PDQ○R): Health Professional Version. 2014. http://www.cancer.gov/cancertopics/pdq/treatment/colon/Health Professional
NCI, Colon cancer treatment (PDQ○R): Cellular Classification of Colon Cancer. 2013a. http://www.cancer.gov/cancertopics/pdq/treatment/colon/HealthProfessional/page2
NCI, Colon cancer treatment (PDQ○R): Treatment Option Overview for Colon Cancer. 2013b. http://www.cancer.gov/cancertopics/pdq/treatment/colon/Health Professional/page4
Norum J. Adjuvant chemotherapy in Dukes' B and C colorectal cancer has only a minor influence on psychologicaldistress. Support Care Cancer. 1997;5(4):318- 21.
O'Boyle K. The role of the Deleted Colon Cancer (DCC) gene in colorectal and gastric cancer. Cancer Invest. 2003;21(3):484-5.
O'Brien MJ, Winawer SJ, Zauber AG, Gottlieb LS, Sternberg SS, Diaz B, Dickersin GR, Ewing S, Geller S, Kasimian D, et al. The National Polyp Study. Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas. Gastroenterology. 1990;98(2):371-9.
O'Connell JB, Maggard MA, Ko CY. Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging. J Natl Cancer Inst. 2004;96(19):1420-5.
Pande M, Lynch PM, hopper JL, Jenkins MA, Gallinger S, Haile RW, LeMarchand L, Lindor NM, Campbell PT, Newcomb PA, Potter JD, Baron JA, Frazier ML, Amos CI. Smoking and colorectal cancer in Lynch syndrome: results from the Colon Cancer Family Registry and the University of Texas M.D. Anderson Cancer Center. Clin Cancer Res. 2010;16(4):1331-9.
Pericleous M, Mandair D, Caplin ME. Diet and supplements and their impact on colorectal cancer. J Gastrointest Oncol. 2013;4(4):409-23.
Petrasch S, Schmiegel W. Adjuvant therapy of colon carcinoma: results of two Intergroup Studies (INT-0035 and INT-0089), a study by the German Cancer Aid 17-1A Study Group and the IMPACT Study. Z Gastroenterol. 1997;35(1):49-52.
Porschen R, Bermann A, Löffler T, Haack G, Rettig K, Anger Y, Strohmeyer G; Arbeitsgemeinschaft Gastrointestinale Onkologie. Fluorouracil plus leucovorin as effective adjuvant chemotherapy in curatively resected stage III colon cancer: results of the trial adjCCA-01. J Clin Oncol. 2001 Mar 15;19(6):1787-94.
Powe BD, Finnie R, Ko J. Enhancing knowledge of colorectal cancer among African Americans: why are we waiting until age 50? Gastroenterol Nurs. 2006; 29(1):42-9.
Quasar Collaborative Group, Gray R, Barnwell J, McConkey C, Hills RK, Williams NS, Kerr DJ. Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study. Lancet. 2007;370(9604):2020-9.
Ransohoff DF, Lang CA. Screening for colorectal cancer. N Engl J Med. 1991;325(1):37-41.
Riggs JE. Aging, genomic entropy and carcinogenesis: implications derived from longitudinal age-specific colon cancermortality rate dynamics. Mech Ageing Dev. 1993;72(3):165-81.
Robb-Nicholson C. By the way, doctor. I keep hearing that aspirin can help prevent colon cancer, but I have no idea how much I should take. Can you help? I've had adenomatous polyps in the past. Harv Womens Health Watch. 2010;18(4):8.
Ryan-Harshman M, Aldoori W. Diet and colorectal cancer: Review of the evidence. Can Fam Physician. 2007;53(11):1913-20.
Saclarides TJ, Szeluga D, Staren ED: Neuroendocrine cancers of the colon and rectum. Results of a ten-year experience. Dis Colon Rectum. 1994;37(7):635-42.
Sajid MS, Shakir AJ, Baig MK. Information on the Internet about colorectal cancer: patient attitude and potential toward Web browsing. A prospective observational study. Can J Surg. 2011;54(5):339-43.
Sarasqueta AF, Forte G, Corver WE, de Miranda NF, Ruano D, van Eijk R, Oosting J, Tollenaar RA, van Wezel T, Morreau H. Integral analysis of p53 and its value as prognostic factor in sporadic colon cancer. BMC Cancer. 2013;13:277.
Sausville EA, Elsayed Y, Monga M, Kim G. Signal transduction--directed cancer treatments. Annu Rev Pharmacol Toxicol. 2003;43:199-231.
Schagen SB, Das E, van Dam FS. The influence of priming and pre-existing knowledge of chemotherapy-associated cognitive complaints on the reporting of such complaints in breast cancer patients. Psychooncology. 2009;18(6):674-8.
Shankaran V, Jolly S, Blough D, Ramsey SD. Risk factors for financial hardship in patients receiving adjuvant chemotherapy for colon cancer: a population-based exploratory analysis. J Clin Oncol. 2012;30(14):1608-14.
Shibata D, Reale MA, Lavin P, Silverman M, Fearon ER, Steele G Jr, Jessup JM, Loda M, Summerhayes IC. The DCC protein and prognosis in colorectal cancer. N Engl J Med. 1996;335(23):1727-32.
Shivapurkar N, Huang L, Ruggeri B, Swalsky PA, Bakker A, Finkelstein S, Frost A, Silverberg S. K-ras and p53 mutations in aberrant crypt foci and colonic tumors from colon cancer patients. Cancer Lett. 1997;115(1):39-46.
Slattery ML, Boucher KM, Caan BJ, Potter JD, Ma KN. Eating patterns and risk of colon cancer. Am J Epidemiol. 1998;148(1):4-16.
Smith RA, von Eschenbach AC, Wender R, Levin B, Byers T, Rothenberger D, Brooks D, Creasman W, Cohen C, Runowicz C, Saslow D, Cokkinides V, Eyre H; ACS Prostate Cancer Advisory Committee, ACS Colorectal Cancer Advisory Committee, ACS Endometrial Cancer Advisory Committee. American Cancer Society guidelines for the early detection of cancer: update of early detection guidelines for prostate, colorectal, and endometrial cancers. Also: update 2001--testing for early lung cancer detection. CA Cancer J Clin. 2001;51(1):38-75; quiz 77-80.
Sutherland HJ, da Cunha R, Lockwood GA, Till JE. What attitudes and beliefs underlie patients' decisions about participating in chemotherapy trials? Med Decis Making. 1998;18(1):61-9.
Steckelberg A, Hülfenhaus C, Haastert B, Mühlhauser I. Effect of evidence based risk information on "informed choice" in colorectal cancer screening: randomised controlled trial. BMJ. 2011;342:d3193.
Steele SR, Park GE, Johnson EK, Martin MJ, Stojadinovic A, Maykel JA, Causey MW. The impact of age on colorectal cancer incidence, treatment, and outcomes in an equal-access health care system. Dis Colon Rectum. 2014;57(3):303-10.
Terhaar sive Droste JS, Oort FA, van der Hulst RW, Coupé VM, Craanen ME, Meijer GA, Morsink LM, Visser O, van Wanrooij RL, Mulder CJ. Does delay in diagnosing colorectal cancer in symptomatic patients affect tumor stage and survival? A population-based observational study. BMC Cancer. 2010;10:332.
Terzić J, Grivennikov S, Karin E, Karin M. Inflammation and colon cancer. Gastroenterology. 2010;138(6):2101-2114.e5.
Thorlacius H, Toth E. Role of chromoendoscopy in colon cancer surveillance in inflammatory bowel disease. Inflamm Bowel Dis. 2007;13(7):911-7. Review.
Thorson AG, Knezetic JA, Lynch HT. A century of progress in hereditary nonpolyposis colorectal cancer (Lynch syndrome). Dis Colon Rectum. 1999;42(1):1-9.
Tournigand C, André T, Achille E, Lledo G, Flesh M, Mery-Mignard D, Quinaux E, Couteau C, Buyse M, Ganem G, Landi B, Colin P, Louvet C, de Gramont A. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol. 2004;22(2):229-37.
Tsunoda A, Nakao K, Hiratsuka K, Tsunoda Y, Kusano M. Prospective analysis of quality of life in the first year after colorectal cancer surgery. Acta Oncol. 2007;46(1):77-82.
Twelves C, Wong A, Nowacki MP, Abt M, Burris H 3rd, Carrato A, Cassidy J, Cervantes A, Fagerberg J, Georgoulias V, Husseini F, Jodrell D, Koralewski P, Kröning H, Maroun J, Marschner N, McKendrick J, Pawlicki M, Rosso R, Schüller J, Seitz JF, Stabuc B, Tujakowski J, Van Hazel G, Zaluski J, Scheithauer W. Capecitabine as adjuvant treatment for stage III colon cancer. N Engl J Med. 2005;352(26):2696-704.
Vadaparampil ST, Quinn G, Malo TL, Alvarez A, Miree CA, Shibata D. Knowledge about hereditary colorectal cancer among colorectal cancer survivors. Genet Test Mol Biomarkers. 2010;14(5):603-9.
Van Cutsem E, Köhne CH, Hitre E, Zaluski J, Chang Chien CR, Makhson A, D'Haens G, Pintér T, Lim R, Bodoky G, Roh JK, Folprecht G, Ruff P, Stroh C,Tejpar S, Schlichting M, Nippgen J, Rougier P. Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer. N Engl J Med. 2009;360(14):1408-17.
Van Cutsem E, Twelves C, Cassidy J, Allman D, Bajetta E, Boyer M, Bugat R, Findlay M, Frings S, Jahn M, McKendrick J, Osterwalder B, Perez-Manga G, Rosso R, Rougier P, Schmiegel WH, Seitz JF, Thompson P, Vieitez JM, Weitzel C, Harper P; Xeloda Colorectal Cancer Study Group. Oral capecitabine compared with intravenous fluorouracil plus leucovorin in patients with metastatic colorectal cancer: results of a large phase III study. J Clin Oncol. 2001;19(21):4097-106.
Vikram B. The DCC protein and colon cancer. N Engl J Med. 1997;336(20):1456; author reply 1456-7.
Viswanath K, Breen N, Meissner H, Moser RP, Hesse B, Steele WR, Rakowski W. Cancer knowledge and disparities in the information age. J Health Commun. 2006;11 Suppl 1:1-17.
Wang L, Wilson SE, Stewart DB, Hollenbeak CS. Marital status and colon cancer outcomes in US Surveillance, Epidemiology and End Results registries: does marriage affect cancer survival by gender and stage? Cancer Epidemiol. 2011;35(5):417-22.
Wark PA, Wu K, van 't Veer P, Fuchs CF, Giovannucci EL. Family history of colorectal cancer: a determinant of advanced adenoma stage or adenoma multiplicity? Int J Cancer. 2009;125(2):413-20.
WHO and I.A.f.R.o. Cancer. Colorectal cancer incidence, mortality and prevalence worldwide in 2008.
Wilkinson AV, Vasudevan V, Honn SE, Spitz MR, Chamberlain RM. Sociodemographic characteristics, health beliefs, and the accuracy of cancer knowledge. J Cancer Educ. 2009;24(1):58-64.
Yardley C, Glover C, Allen-Mersh TG. Demographic factors associated with knowledge of colorectal cancer symptoms in a UK population-based survey. Ann R Coll Surg Engl. 2000;82(3):205-9.
Yeh CC, Hsieh LL, Tang R, Chang-Chieh CR. Risk factors for colorectal cancer in Taiwan: a hospital‐based case‐control study. J Formos Med Assoc. 2003;102(5):305-12.
Yuhara H, Steinmaus C, Cohen SE, Corley DA, Tei Y, Buffler PA. Is diabetes mellitus an independent risk factor for colon cancer and rectal cancer? Am J Gastroenterol. 2011;106(11):1911-21; quiz 1922.
Zajac LE, Klein WM, McCaul KD. Absolute and comparative risk perceptions as predictors of cancer worry: moderating effects of gender and psychological distress. J Health Commun. 2006;11 Suppl 1:37-49.