改善我国胃癌患者生存率的卫生政策研究-从疾病认知到预后管理

我国是胃癌高发国家，发病例数和死亡例数分别占全球的42.6%和45.0%。在过去10年中，我国胃癌的发病率略有下降，但生存率并未得到改善。本课题计划从民众胃癌认知、基层医生诊疗模式、患者就医延误、临床并发症与治疗、术后追踪管理这五个模块找出我国胃癌生存率较低的原因。模块一：调查2060名城市、农村地区40岁及以上健康常住居民对胃癌的认知水平；模块二：调查1000名基层医生在面对疑似胃癌患者时的诊疗水平；模块三：调查1100名胃癌患者从发病到治疗所耗费的时间、就医延误存在的现状与原因，及其与生存率有关；模块四：计算1000名胃癌患者并发症指 数得分，调查治疗方案、并发症同胃癌生存率的关联；模块五：社区随机干预试验，旨在建立一个基于社区卫生服务中心的癌症患者综合管理模式，检验其降低患者1-2年生存率的效果。总而言之，本课题欲从患者-医生-医疗体系这三大环节探索出一套符合我国国情的卫生管理模式。

Gastric cancer is the one of the most commonly diagnosed cancer in China, which representing 42.6% of total new cases and 45.0% of total deaths per year worldwidely. In the past decade, although incidence has been decreased slightly, mortality rate remain unchanged. The current project aimed to explore potential effective health policy to improve survival rate based on five modules: 1) Population awareness and beliefs about cancer; 2) Beliefs, behaviours and systems in primary care; 3) Root cause of treatment delay; 4) Treatment and comorbidity; 5) Healthcare service for postoperative gastric cancer patients. Module 1 will use questionnaire to investigate 2060 health participants from both urban and rural areas regarding their awareness and beliefs about gastric cancer. Module 2 will use online survey to investigate beliefs, behaviours of 1000 doctors in primary care when they are treating suspicious cancer patients. Module 3 will investigate 1100 cases of gastric cancer on their treatment intervals, treatment delay and their associations with survival rate. Module 4 will calculate both the Charlson and Elixhauser complication score for 1000 cases and gastric cancer, and to explore there associations with prognosis. Module 5 will conduct a community-hospital based field trial, to evaluate if the disease management program could improve 1-year, and 2-year survival rate. In summary, the current study aims to systematically explore the potential reasons for the poor prognosis of gastrointestinal cancer in China, and furthermore to generate effective health policy to improve survival in the near future.