影響台灣癌症登記資料庫的正確性及相關因素

Abstract

背景 儘管台灣癌症登記資料庫(Taiwan Cancer Registry，TCR)蒐集癌症期別與治療的資料已長達十年以上，但就癌症期別及治療方式的摘錄正確性尚未有相關的評估研究，研究目的為實地再閱醫院病歷以評估癌症期別及癌症治療方式的摘錄正確性，並進一步檢定醫療服務機構及專業癌症登記摘錄者經驗對癌症期別及治療方式摘錄品質的影響。 方法 此為回溯性實地再閱病歷的研究，共選取14家醫院，隨機抽樣392位癌症病人，比較由資深癌症登記摘錄者至醫院實地再閱原始病歷與台灣癌症資料庫申報資料的摘錄正確性，並依據醫院當年度的癌症病人數分成高低服務量二組及專業癌症登記摘錄者考取基礎級證照至進階級證照之間隔分為5年內及超過5年(含)二組，採用kappa統計量測量一致性，進一步採用多變項回歸分析醫療服務機構及專業癌症摘錄者經驗對癌症期別及治療方式等對癌症登記摘錄正確性的影響。 結果 癌症別以咽癌、食道癌、直腸癌、乳癌以及攝護腺癌在臨床與病理期別的摘錄正確性都很高，而卵巢癌的摘錄正確性偏低，大腸直腸癌、肺癌及卵巢癌在手術治療方式、化學藥物治療處方及放射線治療範圍的摘錄正確性都很高，而淋巴癌在手術治療方式、化學藥物治療處方及放射線治療範圍的摘錄正確性都偏低。控制了專業癌症登記摘錄者經驗後，發現低癌症申報量醫院在臨床期別的摘錄正確性偏低，控制了醫院癌症病人數量的高低後，發現專業癌症登記摘錄者「考取基礎級證照後超過五年才考取進階級證照者」，在「癌症期別」及「手術治療方式」的摘錄正確性偏低。 結論 癌症登記資料庫在癌症期別及治療方式的摘錄品質，除了癌症別間特性有差異外，也受到醫院癌症病人數量的影響，進一步檢定發現專業癌症登記摘錄者經驗影響更甚，尤其在「臨床期別」及「手術治療方式」的摘錄正確性偏低，建議加速考取進階級的癌症登記資格，以及投入更多專科化的癌症期別教育訓練，政府也應該更積極推動醫院與醫學會落實手術記錄及放射線治療摘要等結構化的條列式記錄方式。

Background: Although staging and treatment information has been collected through the cancer registry system in Taiwan for more than 10 years, but its quality of coding in cancer staging and treatment data has not been discussed. This study assessed the accuracy rate for staging and the first course of treatment by site visit at medical institutes and the influence of the nature of medical institute and the experience of cancer registrars on staging and treatment data accuracy. Methods: In this retrospective chart review study, 392 randomly selected medical records from 14 hospitals were re-abstracted by experienced abstractors; the senior cancer registrar reviewers had compared each original chart with data from the TCR to assess accuracy rate for staging and treatment. The hospitals were classified into two groups on the basis of the number of cancer patients. Furthermore, qualified cancer registrars who had progressed from basic to advanced licenses were classified as (≧5 years) and (<5 years). The kappa (κ) statistic method and multiple regression analysis were used to compare among the medical institutes and qualified cancer registrars. Results: The accuracy rate was high in pharynx, esophageal, rectal, breast, and prostate cancers, and low in ovarian and other cancers for clinical and pathological staging. For the first course of its treatment, the accuracy rate was high (≥96%) for colorectal cancer, lung cancer, and ovarian cancer but low (<85%) for any type of lymphoma. After adjustment for the experience of the qualified cancer registrar, low-caseload hospitals had a significantly lower clinical staging accuracy rate than that of high-caseload hospitals. When stratifying by staging and surgery type after adjustment for hospital caseload, a high accuracy rate was found for cancer registrars who had progressed from basic to advanced licenses within 5 years of graduating. A high workload for a registrar nonsignificantly reduced the accuracy rates for chemotherapy and radiotherapy. Conclusions: The reliability of staging data in the TCR is affected not only by the cancer type but also by the number of patients treated in hospital. Moreover, the experience of cancer registrar strongly influences accuracy rate, especially in clinical staging and surgery type. We recommend that cancer registrars with basic licenses upgrade to advanced licenses as soon as possible. Furthermore, continuous education regarding cancer site specific abstracting skills and rules should be emphasized. Medical record collaboration should establish documentation for the checklist of radiation oncology and surgical operation records in hospitals.