衛生福利部醫病共享決策平台
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決策輔助工具摘要表

我有子宮頸癌,有什麼治療選擇?該選擇放射治療或是手術治療呢? 最新更新日期:2019年11月26日
科別 內科,婦產科
主題類別 10. 腫瘤
決策類型 治療
關鍵字 子宮頸(Cervical cancer)、分期(stage)、放射治療(Radiotherapy)、手術(Surgery)。
適用病人條件 病人年滿20歲以上罹患子宮頸癌,期別介於IB到IIA的病人
可供選擇決策方案 手術治療,放射治療±熱療
使用場所 診間、病房
執行者 醫師
開發團隊、機構 新光醫療財團法人新光吳火獅紀念醫院※本決策輔助工具由國民健康署部分經費補助
團隊成員
版本
輔助工具研發過程說明 一、 界定範圍:
子宮頸癌患者,經切片病理證實為癌症,並於影像證實分期介於IB到IIA的病人。隨著醫學治療技術及放射治療方法的革新,國際癌症治療指引以大數據之學術論文為佐證,經由國際各治療團隊定期開並更新。依據最新的文獻指出:罹患子宮頸癌,期別介於IB到IIA的患者,放射治療及手術治療之成效相當(包含存活率、復發率),然而其併發症卻截然不同,尤須與病人進行治療前之清楚告知,知情且同意治療方案。
二、使用者需求調查:
(1) 開發前意見徵求:與數名回診之子宮頸癌患者討論,以親身經歷討論初次診斷之心理衝擊、後續治療之成效、所需協助以及所在意的事情及副作用。並透過文獻收集,了解此決策輔助工具的病人、家屬在做決策時時經常遭遇之問題,在去除不治療之消極選項後,了解哪些事情會影響病人做出決策、病人關心醫療選項的優缺點。並與臨床治療科別之醫師請益病人常問問題及迷思,臨床上執行醫務時與病人溝通上之阻礙等。
(2) 經由文獻查詢,彙整此決策輔助工具的使用者在做決策時的需求
(3) 調查對象:子宮頸癌,經本院單純手術治療患者2 員,經放射治療患者2
員,經雙重治療者1 員;本院婦癌科醫師2 員,腫瘤治療科醫師1 員,癌症
個管師1 員,經電話訪問及個別會談後,進行彙整。
三、證據檢索及整合:
P :Cervical cancer with clinical stage between IB to IIA
I :Radical hysterectomy
C :Compared to Radiotherapy
O :Survival and morbidity
重要結論:
子宮頸癌患者,經臨床診斷分期為IB到IIA,期接受放射治療及手術治療之總體存活率及復發率並無顯著差異。

四、測試與修訂:
Alpha測試:由醫品中心發起,召集本院婦癌科主治醫師、放射科主治醫師、婦癌科個案管理師及經治療後之病友試讀,並給予我們回饋,以期有改善之空間。
Beta測試:目前已有一位婦產科醫師、病房專科護理師及病人代表進行Beta測試,後續會持續針對未接觸過此份PDA研發的醫護人員及未治療之子宮頸癌病人進行本醫療決策輔助工具的使用及審視,評估此份決策輔助工具的可行性。最終希望能夠設計出一套決策工具,適用於全台灣各醫療院所婦癌治療科,能夠實質幫助該族群之病人及醫療團隊進行溝通及醫療決策。
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Taketani, Y. (2005). Comparison between conventional surgery and radiotherapy for FIGO stage I–II cervical carcinoma: a retrospective Japanese study. Gynecologic oncology, 97(3), 834-839. (5) Doll, K., Donnelly, E., Helenowksi, I., Rosenbloom, L., Small, W., Schink, J., & Lurain, J. (2011). Treatment of stage IB1 cervix cancer: comparison of radical hysterectomy and radiation. Gynecologic Oncology, 123(2), 444. (6) Chassagne, D., Gerbaulet, A., & Cosset, J. M. (1979). Diagnostic value of vaginal mouldings in uterine cancer (author's transl). Journal de radiologie, 60(5), 371-373. (7) Delgado, G., Bundy, B., Zaino, R., Sevin, B. U., Creasman, W. T., & Major, F. (1990). Prospective surgical-pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecologic oncology, 38(3), 352-357. (8) Wagner, A. E., Pappas, L., Ghia, A. J., & Gaffney, D. K. (2013). Impact of tumor size on survival in cancer of the cervix and validation of stage IIA1 and IIA2 subdivisions. Gynecologic oncology, 129(3), 517-521. (9) Horn, L. C., Bilek, K., Fischer, U., Einenkel, J., & Hentschel, B. (2014). A cut-off value of 2 cm in tumor size is of prognostic value in surgically treated FIGO stage IB cervical cancer. Gynecologic oncology, 134(1), 42-46. (10) Angioli, R., Plotti, F., Montera, R., Aloisi, A., Luvero, D., Capriglione, S., ... & Benedetti-Panici, P. (2012). Neoadjuvant chemotherapy plus radical surgery followed by chemotherapy in locally advanced cervical cancer. Gynecologic oncology, 127(2), 290-296. (11) Landoni, F., Sartori, E., Maggino, T., Zola, P., Zanagnolo, V., Cosio, S., ... & Gadducci, A. (2014). Is there a role for postoperative treatment in patients with stage Ib2–IIb cervical cancer treated with neo-adjuvant chemotherapy and radical surgery? An Italian multicenter retrospective study. Gynecologic oncology, 132(3), 611-617. (12) Wagner, A., Jhingran, A., & Gaffney, D. (2013). Intensity modulated radiotherapy in gynecologic cancers: hope, hype or hyperbole?. Gynecologic oncology, 130(1), 229-236. (13) Huang, Y. T., Wang, C. C., Tsai, C. S., Lai, C. H., Chang, T. C., Chou, H. H., ... & Hong, J. H. (2011). Long-term outcome and prognostic factors for adenocarcinoma/adenosquamous carcinoma of cervix after definitive radiotherapy. International Journal of Radiation Oncology* Biology* Physics, 80(2), 429-436.
(14) Rose, P. G. (2012). Are the differences in treatment outcome for adenocarcinoma of the cervix different enough to change the treatment paradigm?. Gynecologic oncology, 125(2), 285-286. (15) Chen, Y. L., Ho, C. M., Chen, C. A., Chiang, Y. C., Huang, C. Y., Hsieh, C. Y., & Cheng, W. F. (2011). Impact of various treatment modalities on the outcome of stage IB1–IIA cervical adenocarcinoma. International Journal of Gynecology & Obstetrics, 112(2), 135-139. (16) Eifel, P. J., Burke, T. W., Morris, M., & Smith, T. L. (1995). Adenocarcinoma as an independent risk factor for disease recurrence in patients with stage IB cervical carcinoma. Gynecologic oncology, 59(1), 38-44. (17) Peters III, W. A., Liu, P. Y., Barrett, R. J., Stock, R. J., Monk, B. J., Berek, J. S., ... & Alberts, D. S. (2000). Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. Obstetrical & Gynecological Survey, 55(8), 491-492. (18) Baalbergen, A., Veenstra, Y., Stalpers, L. L., & Ansink, A. C. (2010). Primary surgery versus primary radiation therapy with or without chemotherapy for early adenocarcinoma of the uterine cervix. The Cochrane database of systematic reviews, (1), CD006248.
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