研究背景:
惡性腫瘤(癌症)長達37年佔據台灣十大死因排名第一名，對於罹癌患者而言，除了在漫長的醫藥治療外，心理上的支持及社會功能協助也很重要，對於罹癌患者的「身心社」三環上的照護，是缺一不可的。透過心理及社會支持對治療有正向的幫助，使其可以更積極的接受正統醫藥治療，獲得痊癒的機會。根據國民健康署資料顯示，有18%的患者在初確診罹癌後的3個月內未接受治療，因為對醫療資訊的不對稱或不知道該如何尋求外界的協助等原因，使自己因而長期處在高度壓力下，產生了治療的阻力，甚至是引發心理疾病，也沒有足夠的社會經濟資源、營養等醫療以外需求的支持，讓治療過程變得更加困難甚至停止療程。
癌症資源中心是一個以各醫院為單位的服務窗口，服務對象為所有癌症病患及家屬，透過提供他們癌症照護相關的衛生教育資訊、社會資源轉介、病友團體互助會及康復用品的提供等資源，使患者在接受正統醫藥治療之餘，能不因日常生活的壓力而放棄治療，然而癌症資源中心這樣的服務在國內行之數年，但其成效仍有待客觀的評估。
研究目的:
探討個人屬性、社會經濟地位、是否願意接受癌症相關治療等變項是否為罹患頭頸癌或食道癌之患者使用癌症資源中心服務的相關因子，了解有使用癌症資源中心的患者特性後，再進一步分析影響患者存活分析的相關因素。
研究方法:
本研究採用回溯性分析研究。資料來源為在南部某醫學中心初診斷罹患頭頸癌及食道癌患者癌登資料、癌症個管師以及癌症資源中心服務紀錄內容，蒐集2012年1月1日至2019年12月31日共8年患者為研究對象。依患者是否有使用癌症資源中心服務，分為實驗組及對照組共2個組別，對照組係依實驗組之性別、年齡及罹癌期別經傾向分數配對以1:1比例產生。採用卡方檢定、t檢定、邏輯式迴歸及Cox Proportional Hazards Model探討患者使用癌症資源中心的意願及存活分析。
研究結果:
本研究共分析2442位罹患頭頸癌或食道癌患者使用癌症資源中心使用意願及有無使用該中心對患者的存活影響。在使用意願方面，年紀越輕者、有宗教信仰、職業為藍領者或無職業者、教育程度越低者會有較高的意願使用癌症資源中心服務。在死亡風險方面，若以整體期別患者做分析，職業別、教育程度不同者在有無使用癌症資源中心上大多沒有直接的相關性。若以各期別觀察，有使用癌症資源中心的第I期患者相較於無使用者有顯著較低的死亡風險。進一步將癌症資源中心提供的服務項目細分，在有使用衛生教育及營養品服務者中，僅在第I期有顯著較低的死亡風險，顯示癌症資源中心於患者罹癌初期適時提供資源的重要性。

Background
Malignant Tumor (cancer) had been the first Leading Causes of Death in Taiwan for 37 straight years. Patients diagnosed with cancer not only require long-term medical treatment, psychological supports and social-functioned assistances also take an important role in patient treatment, which are recognized as the treatment of “entity, psychology, society” triple-circle. Through psychological and social supports, patients are be positively affected to undergo standard treatments and increase the chance for them to recovery. According to the research of Taiwan Health Promotion Administration, 18% of patients did not receive treatment within 3 months after the initial diagnosis of cancer due to a lack of medical information or not knowing how to seek assistance. As a result, they might have themselves under long-term pressure, emerging resistance to treatment, and even causing mental illness. Without sufficient socio-economic resources, nutrition, or other medical supports, patients' treatment process becomes more difficult or even have to suspend the treatment.
Objective:
This study aims to evaluate whether personal attributes, socio-economic status, willingness to receive cancer-related treatments are related to the usage intention of cancer resource center services in head and neck cancer and esophageal cancer patients, and to analyze factors affecting patient survival duration.
Method:
The data of this study were obtained from the database of a Medical Center in Southern Taiwan, combining records of cancer registry, cancer case managers, and cancer resource center. The database target the patients who are newly diagnosed with head and neck cancers or esophageal cancer dated from January 1, 2012, to December 31, 2019. Research samples are divided into two groups: the experimental group and the control group according to whether the patients use the cancer resource center services. The control group is generated according to the gender, age, and cancer stage of the experimental group and matched with a 1:1 ratio. Chi-square test, T-est, Regression analysis, and Cox Proportional Hazards Model were used to explore the usage intention of Cancer resource center and patients survival analysis in the study.
Result:
In this study, a total of 2442 patients with head and neck cancer or esophageal cancer were enrolled. In terms of usage intention, the younger, religious, blue-collar or unemployed, and low education levels have a significantly higher willingness to use the cancer resource center services. In terms of the risk of death, the analysis result of the overall stage of patients shows no direct correlation between the use of the cancer resource center and p with different occupations and education levels. Observed by each stage, stage I patients who used the cancer resource center have a significantly lower risk of death than patients without using. In terms of different services provided by the cancer resource center, among those who use health education and nutrition services, only stage I have a significantly lower risk of death, which shows the importance of the cancer resource center to provide resources in the early stages of cancer.

論文審定書 i
致謝 ii
中文摘要 iii
Abstract v
目錄 vii
圖目錄 ix
表目錄 x
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 4
第二章 文獻探討 5
第一節 頭頸癌及食道癌定義 5
第二節 癌症資源中心 10
第三節 罹癌患者是否使用癌症資源中心之相關因子 13
第四節 罹癌患者使用癌症資源中心對其存活情況之相關因素 17
第五節 癌症資源中心服務項目對罹癌患者存活情況之相關因素 20
第六節 小結 24
第三章 研究設計與方法 25
第一節 研究架構 25
第二節 研究假設 26
第三節 資料來源與研究對象 28
第四節 研究變項與操作型定義 30
第五節 統計分析 32
第四章 研究結果 34
第一節 研究對象之基本資料分析 34
第二節 傾向分數配對後之資料分析 38
第三節 各變項對使用癌症資源中心之邏輯式迴歸分析 43
第四節 罹癌患者使用癌症資源中心情形之存活分析 45
第五章 研究討論及結論 55
第一節 研究假設驗證 55
第二節 研究討論 56
第六章 研究限制及貢獻 58
第一節 研究限制 58
第二節 研究建議 59
參考文獻 61
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二、英文文獻 63
附錄一、IRB同意書 72

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