大腸直腸癌是台灣第二常見的癌症，並位列2022年癌症相關死亡原因中的第三位。2020年起新冠肺炎全球流行，該癌症的防治也受到潛在延後診斷與延後治療的挑戰。本研究探討台灣新冠肺炎疫情對大腸直腸癌患者的診斷、治療時程、醫療費用及預後的影響。研究對象為台灣南部某醫學中心2017年至2022年首次診斷為大腸直腸癌（非轉移癌）的患者作為研究對象。藉以觀察不同新冠肺炎疫情階段，大腸直腸癌的檢出人數、治療時程、醫療花費以及存活率是否會受影響。
研究結果顯示，不同疫情階段的大腸直腸癌初檢出每月人數、期別分佈、及患者人口學與臨床變項上並無顯著差異，同時疫情也未顯著影響大腸直腸癌患者的初次治療時程。然而台灣自新冠肺炎Omicron 病毒株流行起，患者的平均醫療花費顯著增加，對晚期大腸直腸癌患者的存活率也顯著降低。本研究結果顯示新冠肺炎的流行對大腸直腸癌患者醫療成本與病人存活情形有顯著相關，以此強調了疫情期間及後續對癌症患者持續醫療服務的重要性，並建議未來面對相關公共衛生危機時，應制定更靈活的應對措施，以減少對非疫情相關疾病的負面影響。

Colorectal cancer (CRC) is the second most common cancer in Taiwan and ranked third among cancer-related causes of death in 2022. Since the global outbreak of COVID-19 in 2020, the prevention and treatment of colorectal cancer have faced challenges, particularly in terms of delayed diagnosis and treatment. This study investigated the impact of the COVID-19 pandemic on the diagnosis, treatment timeline, medical expenses, and prognosis of colorectal cancer patients in Taiwan. The study focused on patients from a medical center in southern Taiwan who were first diagnosed with non-metastatic colorectal cancer between 2017 and 2022. The objective is to observe whether the number of detected cases, treatment timelines, medical costs, and survival rates were affected during different phases of the COVID-19 pandemic.

The results showed that there were no significant changes in the monthly number of newly detected colorectal cancer cases, stage distribution, or demographic and clinical variables of patients across different pandemic phases. Furthermore, the pandemic did not significantly affect the timeline of initial treatments for colorectal cancer patients. However, compared with the pre-COVID-19 period, the CRC patients had a significant increase in direct medical costs on average with a lower rate of 2-year survival since the Omicron variant started in Taiwan. It revealed the association of the COVID-19 pandemic with the medical costs and survival outcomes for colorectal cancer patients. This study underscores the importance of maintaining continuous medical services for cancer patients during and after the pandemic. The study also recommends that more flexible measures should be established to mitigate the negative impacts on non-pandemic-related diseases during future public health crises.

目錄
論文審定書 i
誌謝 ii
中文摘要 iv
abstract v
圖次 ix
表次 x
第一章 緒論 1
第一節 研究背景 1
第二節 研究動機 1
第三節 研究目的 2
第二章 文獻探討 3
第一節 大腸直腸癌流行病學探討 3
第二節 新冠肺炎疫情探討 8
第三節 新冠肺炎對就醫行為與醫療照護的影響 11
第四節 總結 13
第三章 研究方法 15
第一節 研究架構 15
第二節 研究假說 16
第三節 資料來源與研究變項 17
第四節 資料處理與研究對象篩選 19
第五節 統計方法分析 32
第四章 研究結果 38
第一節 研究個案臨床及人口學變項於不同COVID19疫情階段之比較 38
第二節 大腸直腸癌其治療時程與COVID19程度影響分析 43
第三節 COVID19時期大腸直腸癌患者醫療服務花費分析 48
第四節 COVID19時期大腸直腸癌患者存活率分析 54
第五章 討論 70
第一節 研究假說結果 70
第二節 研究結果探討 74
第三節 研究應用 77
第四節 研究限制 78
第六章 結論 79
第一節 總結 79
第二節 研究貢獻 80
第三節 未來研究建議 81
參考文獻 82

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