COVID-19疫情對台灣癌症篩檢、診斷與預後的影響：來自疫情影響輕微國家的觀察觀點

Abstract

COVID-19疫情自2019年底爆發以來，對全球醫療體系造成了前所未有的衝擊。疫情導致各國醫療資源重分配，並對癌症防治產生了深遠的影響。雖然已有國際研究探討疫情對癌症篩檢及診斷的影響，但這些研究多集中於疫情嚴重且醫療體系遭遇崩潰的國家。台灣則於疫情初期成功控制病毒傳播，並且醫療體系未遭遇大規模崩潰，因此可為了解在疫情輕微影響下癌症防治系統的反應提供獨特的觀察場域。本研究使用來自台灣的癌症篩檢資料庫、癌症登記資料庫以及死亡資料庫。選取四項國家篩檢政策所涵蓋的癌症（女性乳癌、子宮頸癌、結直腸癌與口腔癌）、台灣前16大癌症整體、及四個特定癌症（肺癌、肝癌、攝護腺癌、子宮體癌），並分析癌症篩檢、診斷、晚期比率與致死率等七項指標。研究時間範圍為2018年1月1日至2022年12月25日，共260週。分析方法包括核平滑技術和拔靴法進行信賴區間估算，並利用曼-惠特尼U檢定進行統計顯著性比較。本研究發現，即使台灣醫療體系在COVID-19疫情期間維持穩定，癌症防治流程仍受到明顯衝擊。篩檢與診斷人數在疫情高峰期顯著下降，並且陽性比率、確診比率、晚期比率、及確診後致死率上升，反映出高風險或症狀明顯的患者仍較可能就醫，而低風險或無症狀者則延遲或中斷篩檢。農曆新年期間也觀察到癌症篩檢與診斷量的下降，以及晚期比率和致死率的上升。此外，制度設計中的激勵機制及節慶效應亦對癌症防治服務造成長期影響。本研究顯示，即使醫療體系維持運作，COVID-19疫情引發的行為改變及制度節奏調整，仍對癌症防治造成顯著影響，表現為篩檢與診斷人數驟減、陽性與晚期比率上升，以及確診後致死率惡化。此外，制度設計與節慶效應也顯示出對防治流程的潛在擾動。此結果不僅為台灣癌症防治提供了重要的見解，也為全球疫情期間如何保持癌症防治服務提供了寶貴的策略參考。

Since the outbreak of the COVID-19 pandemic at the end of 2019, it has caused unprecedented disruptions to global healthcare systems. The pandemic has led to the reallocation of healthcare resources and had a profound impact on cancer prevention and treatment. While studies conducted in many countries have explored the effects of the pandemic on cancer screening and diagnosis, these studies have mostly focused on countries with severe outbreaks and healthcare system collapses. In contrast, Taiwan successfully controlled the spread of the virus early in the pandemic and did not experience widespread healthcare system collapse. Therefore, Taiwan offers a unique observational setting to understand the response of the cancer prevention and treatment system under a mild pandemic impact.This study used data from Taiwan’s National Cancer Screening Database, Cancer Registry, and the Death Statistics Database. It focused on four cancers covered by national screening policies (female breast cancer, cervical cancer, colorectal cancer, and oral cancer), the top 16 cancers and four specific caners (lung cancer, liver cancer, prostate cancer, and corpus uteri cancer) in Taiwan. Seven indicators were analyzed, including cancer screening, diagnosis, late-stage rate, and fatality rate. The study period spanned from January 1, 2018, to December 25, 2022, covering 260 weeks. The analysis methods included kernel smoothing and bootstrapping for confidence interval estimation, and the Mann-Whitney U test for statistical significance comparisons.The study found that, even though Taiwan’s healthcare system remained stable during the COVID-19 pandemic, cancer prevention and treatment processes were still significantly impacted. The number of screenings and diagnoses dropped significantly during the peak of the pandemic, while positive rates, detection rates, late-stage rates, and fatality rates all increased. This reflects that high-risk or symptomatic patients were more likely to seek medical care, while low-risk or asymptomatic individuals were more likely to delay or interrupt screening and diagnosis. During the Lunar New Year, a similar decline in cancer screenings and diagnoses was observed, along with increased late-stage rates and fatality. Additionally, the incentive mechanisms within the healthcare system and the holiday effect also had long-term impacts on cancer prevention services.This study shows that, even when the healthcare system remains operational, the behavioral changes and adjustments in institutional rhythms caused by the COVID-19 pandemic significantly impacted cancer prevention and treatment. These impacts manifested as a dramatic reduction in screenings and diagnoses, increased positive and late-stage rates, and worsened post-diagnosis fatality. Furthermore, the design of the healthcare system and the holiday effect also revealed potential disruptions to the treatment process. These findings not only provide important insights into cancer prevention in Taiwan but also offer valuable strategic guidance for maintaining cancer prevention services globally during pandemics or other public health crises.