Use of Chinese Medicine Among Patients with Liver Cancer in Taiwan

Abstract

Dear Editor:

Use of complementary and alternative medicine (CAM) among patients with cancer is popular.^1
–3 Liver cancer is a major cause of cancer mortality worldwide.^4,5 However, data of CAM use by patients with liver cancer are limited. Traditional Chinese Medicine (TCM) is one of the most popular CAMs worldwide. Since 70% of new liver cancer cases occurred in Asia and CM is popular in this area, it is important to explore the utilization of CM among patients with liver cancer.

Taiwan implemented universal national health insurance (NHI) since 1995, providing Western medicine (WM) and Chinese medicine (CM) for all inhabitants. Claims of NHI were released for research. To protect privacy, the data of patient identities and institutions have been scrambled cryptographically by NHI. We conducted a cross-section retrospective study using claims of the year 2007 from NHI Research Database. For CM care, NHI only covered outpatient services in 2007. Therefore, only cancer-related utilization of CM and WM ambulatory services was analyzed in this study. Patients who had visited ambulatory services with a diagnosis of liver cancer (International Classification of Diseases, Ninth Revision, Clinical modification codes: 155 and 155.0) were selected. A total of 40,581 patients with liver cancer who used cancer-related ambulatory services were identified. The database software ASIQ 12.5.7 (Sybase Inc., Dublin, USA) was used for data linkage and processing. The data were analyzed using SPSS for Windows Version 13.0 (SPSS Inc., Chicago, IL).

Our study found that 3.9% patients with liver cancer used cancer-related CM outpatient services at least once in 2007. A total of 1585 CM users had 11,223 cancer-related CM visits (average 7.1). The demographics are presented in Table 1. A higher portion of CM users were male, middle aged, low income, and were living in Southern Taiwan. Almost all CM users (95.1%) also used WM ambulatory services. Nearly half of CM users (59.4%) had less than 6 visits, 19.5% had 6–11 visits, and 21.1% had more than 11 visits. Most CM users visited hospitals (66.7%) rather than clinics (33.3%). The most frequently used CM therapies were Chinese herbal medication (95.7%), followed by acupuncture (1.6%) and traumatology manipulative therapies (1.6%). The details of expenditure are shown in Table 2. CM accounted for 2.6% visits and 0.7% expenditure of ambulatory services for liver cancer. The average cost per visit was $20.6 in CM and $78.9 in WM. The average expenditure per user was $146 in CM and $853 in WM.

Table 1.

Demographics of Patients with Liver Cancer Who Used Ambulatory Services in 2007

	Western medicine		Chinese medicine
Characteristic	Total	%	Total	%
Patient no.	40,503^a		1585^a
Gender
Female	13,067	32	432	27
Male	27,436	68	1153	73
Median age (years)	63.2		62.9
<45	4941	12	159	10
45–64	17,131	42	731	46
≥65	18,431	46	695	44
Insured amount ($/month)
<526	17,619	44	708	45
526–1059	17,408	43	653	41
≥1060	5476	14	224	14
Region
Northern Taiwan	17141	42	542	34
Central Taiwan	6617	16	130	8
Southern Taiwan	15,652	39	876	55
Eastern Taiwan & offshore islands	1093	3	37	2

1507 patients used both Western and Chinese medicine.

Table 2.

Expenditure of Ambulatory Service by Patients with Liver Cancer (U.S.$)

		Western medicine			Chinese medicine
Characteristic		Total	%	Average (per visit)	Total	%	Average (per visit)
Medical expense	Fees for consultation, treatment, and medical supply	20,154,647	58	46.0	8602	4	0.8
	Diagnosis fees	2,556,963	7	5.8	90,556	39	8.1
	Drug fees	11,328,476	33	25.9	126,867	55	11.3
	Dispensing service fees	518,207	1	1.2	5453	2	0.5
	Total amount	34,558,294	100	78.9	231,477	100	20.6
Payment	Partial payment by patient	472,243	1	1.1	3527	2	0.3
	Payment by insurance	34,094,163	99	77.9	227,950	98	20.3
	Total amount	34,558,294	100	78.9	231,477	100	20.6

In conclusion, only a small portion of patients with liver cancer used cancer-related CM under national health insurance. Western medicine is still the mainstream. The majority of CM users also used WM. CM appears to play more as a complementary rather than an alternative role in the care of liver cancer. The use of non-cancer-related and out-of-pocket services of CM needs further investigation.

Footnotes

Acknowledgments

This study is based in part on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health and managed by National Health Research Institutes. The interpretations and conclusions contained herein do not represent those of the Bureau of National Health Insurance, Department of Health, or National Health Research Institutes.

Disclosure Statement

No competing financial interests exist.

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