최종보고서[기관고유연구사업]

2015 년 월 일

과제책임자 : (인)

국 립 암 센 터 원 장 귀 하

과제고유번호 1310250연 구 분 야

(코 드 )

지 원

프 로 그 램목적과제

공개가능여부

(공개, 비공

개)

공개

연 구 사 업 명 국 립 암 센 터 기 관 고 유 연 구 사 업

연 구 과 제 명 한국 암 성과 연구의 체계화

과 제 책 임 자 성명 소속 직위

세 부 과 제

구분 과제명과제책임자

성명 소속(직위) 전공

(1세부) 지속적인 암 관리 성과연구 이덕형국가암관리

사업(본부장)

예방의학

(2세부) 암 종별 치료 패턴에 따른 치료 성과연

구이은숙

연구소

(소장)외과

총 연 구 기 간

2013년 1월~2015년

12월

(총 3년)

해당단계

참 여

연구원 수

총: 명

내부: 명

외부: 명

해당단계

연 구 개 발 비

연구비: 천원

민간: 천원

계: 천원

총 연구기간

참 여

연구원 수

총: 명

내부: 명

외부: 명

총 연구개발비

연구비: 천원

민간: 천원

계: 천원

연 구 기 간 및

연 구 비

(단 위 :천 원 )

구분 연구기간 계 국립암센터기업부담금

소계 현금 현물

계2013.01.01∼

2015.12.31404,000 404,000

제1차2013.01.01∼

2013.12.31100,000 100,000

제2차2014.01.01∼

2014.12.31160,000 160,000

제3차2015.01.01∼

2015.12.31144,000 144,000

참여기업 참여기업명 :

국제공동연구상대국명: 상대국 연구기관명:

위 탁 연 구연구기관명: 연구책임자:

요약(연구개발성과를 중심으로 개조식으로 작성하되, 500자 이내로 작성합니다)

Ⅰ. 총괄과제

< 국문 요약문 >

연구의

목적 및 내용

국가 단위 암 관리체계 구축을 통한 암 예방부터 생존과 사망까지의 암 진료서비

스의 질과 효율성 제고 및 국가암관리사업 활성화의 근거에 입각한 정책 평가 및

제언

○ ‘한국 암 성과 연구’ 데이터베이스 구축

- 국립암센터‧건강보험공단 공동 연구 협약 - 성과연구 자료 자료구축

- 자료설명집 제작 및 기초통계 분석

○ 암보장성 강화정책에 따른 의료의 접근성

- 지역친화도 (relevance index) 분석 : 암환자의 암 진단과 첫 치료

(암 관련 수술, 방사선치료, 항암화학치료)의 타 지역 의료기관 이용률

- 요양기관 종별, 암종별에 따른 유병자수, 치료 종류, 진료비 등 변화

- 암환자본인부담 경감 정책에 따른 암 진단시 건강불평등 개선 효과 평가

- 2010년도 전체 암질환의 사회경제적 질병부담

- 흡연에 기안한 암의 조기사망에 따른 질병부담 변화

○ 국가암검진에 대한 포괄적 평가

- 국가암검진 수검에 따른 효과분석

‧ 국가암검진사업의 암종별, 검사방법별 검사결과 확인 ‧ 국가암검진사업의 암종별, 검사방법별 민감도, 특이도, 양성예측도를 이용한 검사의 정확도 분석

‧ 대장암검진 단계별 검사의 효과성 분석 및 1차 검사(분변잠혈검사) 이상소견에 대한 2차 검사 실시여부 및 검사 정확도 분석

‧ 국가암검진 수검자에서 암 발견율

- 국가암검진사업의 평가

‧ 암검진 효과와 질관리 모니터링을 위한 지표 제시 ‧ 암환자에서 국가암검진 수검자와 비수검자의 생존율, 암병기 분석 ‧ 암검진 이상소견에 대한 사후관리의 적정성 평가 ‧ 암발견 및 치료, 사망에 미치는 국가암검진사업 효과에 대한 포괄적 평가와

효과적인 암검진 사업 수행을 위한 정책방향 제시

○ 말기 암환자의 의료 행태 및 사회경제 영향 분석

- 암사망자의 의료이용 행태에 대한 특성 분석

‧ 암사망자의 사망 장소별 의료이용 특성 분석 ‧ 암사망자의 마지막 3개월의 의료이용 행태 분석 ‧ 암사망자의 마지막 의료이용 행태 분석

- 4 -

○ 암 치료의 질 관련 성과 분석

- 암 진단 후 적극적 치료여부에 따른 생존

- 암 진단 후 첫 치료까지의 대기기간

- 암 종별 첫 수술 후 30일 사망률과 5년 생존율 분석

○ 암 발생 및 생존 등 예측 모형 개발을 위한 기반 구축

- 건강습관에 따른 원발암과 이차암 발생 및 사망의 위험요인 분석

- 환자의 고지질혈증 치료제별 생존율과 이차암 발생 관련성

○ 발생률 높은 암종별 치료패턴에 따른 진료 성과 분석

- Trends in the Aggressiveness of End-of-Life Care for Korean Pediatric

Cancer Patients Who Died in 2007-2010

- 대장암 수술 전 항암화학방사선치료 후 생존율에 미치는 영향

- 2003~2010년 전립선암 환자의 암 진단전 말기신부전증 유병률에 관한 연구

- 유방암 치료 후 가임여성에서의 임신 빈도 및 임신이 재발에 미치는 영향

연구개발성과

구분 달성치/목표치1) 달성도(%)

SCI 논문 편수 1

IF 합 4.09

기타 성과- 국외 학술대회 포스터 1- 국가 암 데이터베이스 구축- 말기암환자 전문 의료체계 구축에 기여

1) 총연구기간 내 목표연구성과로 기 제출한 값

- 한국 암 성과 연구의 체계화 공동연구 협약

‧ 국립암센터-국민건강보험공단 MOU체결(2013.05.01) ‧ 국립암센터 – 국민건강보험공단 공동연구를 위한 협약 체결(2013,2014) ‧ 국민건강보험공단 – 국립암센터 우수협력기관 감사패 수여(2014.06.30) - ‘말기 암환자의 의료비 및 의료서비스 행태 결과를 호스피스완화의료 활성화

대책’(보건복지부,2010) 에 근거 자료로 활용

- 건강보험공단의 흡연 폐암 환자의 의료비 산출하여 담배소송 근거 자료 활용

- 암환자 본인부담 경감 정책에 따른 암 진단시 건강불평등 개선 효과 평가.

2015 한국보건행정학회 후기학술 대회 포스터 발표 (2015.11.05)

- 암 발생과 치료 단계별 암 진료비 변화(Cancer treatment costs by stage of

disease and treatment modality). 2015 한국보건행정학회 후기학술 대회 포

스터 발표 (2015.11.05)

- Active treatment rates and Related Factors of Active treatment and No

active treatment of Korean Cancer Patients, 2002-2010. 2014 한국보건행

정학회 후기학술 대회 포스터 발표 (2014.11.06)

- Changes in the Death Causes of Adult Cancer Survivors According to

their Survival Period. Cancer Outcomes Conference 2015 포스터 발표

(2015.06.10)

연구개발성과의 ○ 중증질환 보장성 강화 및 국가 암 검진사업 등 진료 환경 변화에 따른 암 진

- 5 -

활용계획

(기대효과)

단 및 치료 진료 패턴의 변화를 파악함으로써 정책의 성과를 측정하고, 추후

의 보건의료 정책 수립에 대한 근거로 활용

○ 국가 암검진사업을 통한 암 예방 및 발생, 치료, 관리, 사망 등의 근거 자료

를 바탕으로 우리나라 실정에 부합하며 실질적으로 적용 가능한 암정책 구축

가능

○ 국가적인 차원에서 암 관련한 효과적인 의료 자원의 배분 및 암 진료의 질 향

상에 기여

○ 각종 진료 지침의 실제 임상 현장에서의 적절성과 효과성을 분석함으로써, 암

진료의 질을 향상시키는 데에도 기여

○ 암 종별로 관련된 수술, 항암제, 방사선 치료 등의 패턴을 분석하고 분석 결

과에 따른 치료 성과를 연구함으로써, 암환자의 생존율 증가를 위한 새로운

치료패턴 개발과 불필요한 치료의 감소로 경제적인 부담을 낮추는 정책 수립

시 근거로 활용

○ 암 생존과 그에 영향을 끼치는 요소들 간의 기존 단면 연구의 한계를 극복하

고, 암종별, 개인별 차이를 반영한 예후 예측 모델을 개발하여 보다 구체적인

생존자관리 지침 제시 가능

○ 객관적이고 표준화된 정책 제언을 통해 암환자뿐만 아니라 나아가 국민의 건

강 증진 및 의료 질 향상에 기여

중심어

(5개 이내)보장성강화 암검진

호스피스

완화관리 암 진료 생존

< 영문 요약문 >

〈 SUMMARY>

Purpose&

Contents

1) Enhancing quality and efficiency in cancer prevention and care service from

survival to death by establishing the national cancer management system

and assessing and proposing policies based on the evidence from the

national cancer control program

2) Quality and efficiency enhancement in cancer prevention and care service

from survival to death by establishing the national cancer management

system and policy assessment and proposal based on the evidence from

the national cancer control program

1. Establish a database on Korea's Cancer outcome studies

- Joint research agreement between the National Cancer Center and NHIS

- Construct data on outcome research

- Publication of coding book and analysis of basic statistics

2. Access to health care in accordance with policies to expand health

insurance benefits for cancer patients

- Analysis of Relevance Index : Cancer patients' use of medical facilities

located in other regions for cancer diagnosis and first

treatment/care(cancer related surgery, radiotherapy, chemotherapy, etc.)

- Changes in prevalence(number of patients), care types, care costs by

medical care institution and cancer types

- Assessment of effectiveness in improving inequality in health by

implementing policies to reduce co-payment of cancer patients

- Socio-economic burden of cancer in 2010

- Change in burden of disease due to early cancer death from smoking

3. Comprehensive assessment on the National Cancer Screening Program

- Analysis of effectiveness of the National Cancer Screening Program

(Colorectal Cancer)

- 7 -

‧ Sensitivity and Specificity of the National Cancer Screening Program ‧ Cancer detection rate, survival rate and stage of the National Cancer

Screening Program participants

‧ Medical costs and survival rate of the National Cancer Program participants and non-participants by pattern of medical care use and

severity

‧ Analysis of effectiveness of colorectal cancer screening by stage ‧ Participation in secondary screening test and its accuracy following

abnormal findings from primary colorectal cancer screening(Fecal

Immunochemical Tests)

- Assessment of the National Cancer Screening Program

‧ Propose indicators for cancer screening effectiveness and quality control monitoring

‧ Assess appropriateness/feasibility of follow-up management after abnormal findings from cancer screening

‧ Propose policy directions for comprehensive evaluation of effectiveness of the National Cancer Screening Program on cancer detection, care and

death, and effective management of cancer screening program

4. Analysis on end-stage cancer patients care behavior and socio-economic

impact

- Analyze characteristics of cancer decedents' medical care use behavior

‧ Analyze characteristics of cancer decedents' medical care use by location of death

‧ Analyze cancer decedents' medical care use behavior during the last three months

‧ Analyze cancer decedents' last medical care use behavior

5. Evaluation of outcomes related to quality of cancer care

- Survival rate following aggressive treatment after cancer diagnosis

- Waiting time between cancer diagnosis to first treatment

- 30-day mortality and 5 year survival rate after first surgery by cancer type

6. Establishing foundation for development of prediction model for cancer

incidence and survival

- 8 -

- Analysis of risk factors associated with primary and secondary cancer

incidence and mortality in terms of health habit

- Relationship between survival rate and secondary cancer incidence in terms

of patients' hyperlipidemia treatment

7. Analysis of cancer care outcomes by care patterns of cancer types with

high incidence rate

- Trends in the Aggressiveness of End-of-Life Care for Korean Pediatric

Cancer Patients Who Died in 2007-2010

- Impact of pre chemoradiotherapy to colorectal cancer surgery on survival

rate

- Study on prevalence of end-stage renal failure among prostate cancer

patients prior to diagnosis in 2003~2010

- Incidence of pregnancy among women of reproductive age after breast

cancer treatment and influence of pregnancy on cancer recurrence

Results

1. Access to health care in accordance with policies to expand health

insurance benefits for cancer patients

- After 2002, in all regions excluding Gwangju Metropolitan City, Busan

Metropolitan City and Seoul Metropolitan Government, regional

self-sufficiency in cancer screening increased. In Jeju, self-sufficiency rate

increased by the largest margin(25.5→72.0). In particular, Jeollanamdo's

self-sufficiency rate recorded a sustained increase(11.8→48.7) since

designating Jeonnam University Hospital as the region's cancer center in

2004

- When the study investigated the annual change in number of medical care

use cases by cancer from 2002~2010, stomach cancer had the highest

number of medical care use cases with exception of 2010, while thyroid

cancer displayed large annual increase until it reached its record in 2010.

Colorectal and breast cancer cases increased by a large margin as well

‧ In terms of medication cost, the average spending on patients was higher than new patients. For injection cost, new patients and patients had

similar level of spending. In care and surgery cost and examination cost,

the average spending on new patients was higher than patients. In all

four kinds, average spending increased sharply in 2006 following

expansion of insurance benefits in 2005

- 9 -

‧ In terms of 2005 and 2009 when policies to expand health insurance benefits for cancer patients were implemented, spending levels of tertiary

hospitals, general hospitals and hospitals increased significantly. Tertiary

hospitals recorded the highest increase. The spendings of clinic center

and public health center increase annually but there was no significant

change.

- In a study which investigated burden of disease due to early cancer death

from smoking from 1990~1999, the cases for both male and female

decreased every year. In particular, lung cancer with the highest burden of

disease due to early death from smoking for male and female, it

increased to the late 1990s then showed a decreasing trend. As nation

wide government intervention began in mid-1990s, the smoking rate

among adults plummeted from 35.1% in 1995 to 25.3% in 2007.

2. Comprehensive assessment on the National Cancer Screening Program

○ Cancer detection rate following test outcomes after colorectal cancer

screening

- From 2004, when the National Cancer Screening(colorectal cancer) was

launched, to 2009, 7,848,461 people in total went through screening

- From 7,848,461 participants, 92.97% had negative finding from FIT, while

7.03% had positive finding

- 0.09% of participants with negative finding from FIT were registered for

colorectal cancer within a year from the date of screening

- From patients with positive FIT findings, 49.30% received secondary

screening

- From patients who received secondary screening, 43.17% chose Double

Contrast Barium Enema, 71.21% went through Colonoscopy. 33.30% of

Double Contrast Barium Enema recipients also took Colonoscopy

- Among people with positive Double Contrast Barium Enema finding,

54.67% were registered with colorectal cancer within a year from

screening. 78.19% of patients with positive colonoscopy findings were

registered with colorectal cancer within a year from screening

- From those who had positive findings from FIT but did not receive

secondary screening, 2.18% were registered with colorectal cancer within

a year from screening

- 10 -

○ Analysis of the National Cancer Screening accuracy(Colorectal cancer)

- Analyzing the accuracy of colorectal cancer screening conducted as a part

of the National Cancer Screening by referring to data from Korea Central

Cancer Registry's cancer registry with cancer registration within a year from

screening as golden standard

- For FIT, sensitivity to screening increased gradually to 76.2% in 2010

- Among people with positive FIT findings, when Double Contrast Barium

Enema was conducted as secondary test, sensitivity to screening increased

continuously to 73.4% in 2010

- When people with positive FIT findings went through colonoscopy as

secondary test, sensitivity to screening rose continuously to 74.0% in 2010

3. Analysis on end-stage cancer patients care behavior and socio-economic

impact

- After diagnosed with end-stage cancer, there was nearly no change to

patients' medical care use behavior and in fact, the number of care users

increased with time

- Spending on medical care increased, as from Health Insurance

Expendituresof all cancer patients, patients with 3 months or less to death

accounted for 701.2 billion won, which is 19.9% of total 3,527 billion

won(’10)

- From medical costs of 701.2 billion won for the last three months before

death, at least 72.3 billion won(10.3%) cannot be considered as adequate

/proper/appropriate spending for end-stage cancer patients

- Analyze characteristics of cancer decedents' medical care use behavior

- Hospice and Palliative Care aims to relieve/manage/care pain and

symptom of patients with limited life expectancy and provide psychological

stability to family members

- When patients use palliative care units, daily medical expenses in tertiary

hospitals and general hospitals where end-stage cancer patients prefer

decrease by 175,154 won and 70,487 won respectively

4. Analysis of outcomes related to quality of cancer care

- Survival rate following aggressive treatment after cancer diagnosis

- 11 -

‧ The Hazard ratio(HR) for patients who did not receive aggressive treatment compared to patients who did was highest for stomach cancer with 2.736,

followed by breast cancer, bladder cancer and kidney cancer. It was the

lowest for colorectal cancer with 1.671.

- Waiting time between cancer diagnosis to first treatment

‧ From total 538,018 subject patients, 37.29%(200,622 patients) received their first aggressive treatment 31 days after cancer diagnosis

‧ The proportion of patients who received first treatment before 31 days after diagnosis was the highest for bladder cancer with 80.43%, and

lowest for pancreatic cancer patients with 43.72%

‧ The Hazard ratio(HR) of patients who did not receive treatment within 31 days was the highest for prostate cancer with 2.00, and lowest for

bladder caner with 0.70

- 30-day mortality and 5 year survival rate after first surgery by cancer type

5. Establishing foundation for development of prediction model for cancer

incidence and survival

- Analysis of risk factors associated with primary and secondary cancer

incidence and mortality in terms of health habit

- Relationship between survival rate and secondary cancer incidence in terms

of patients' hyperlipidemia treatment

6. Analysis of cancer care outcomes by care patterns of cancer types with

high incidence rate

- Trends in the Aggressiveness of End-of-Life Care for Korean Pediatric

Cancer Patients Who Died in 2007-2010

- Impact of pre chemoradiotherapy to colorectal cancer surgery on survival -

Study on prevalence of end-stage renal failure among prostate cancer

patients prior to diagnosis in 2003~2010

‧ The number of end-stage renal failure patients prior to prostate cancer diagnosis was the highest with 2,319, followed by 149 dialysis patients

and 13 transplantation patients

‧ Among 2,319 end-stage renal failure patients, 1,702 patients survived and 766 died. The most common cause of death, for 496 patients, was

prostate cancer

- 12 -

- Incidence of pregnancy among women of reproductive age(가임여성) after

breast cancer treatment and influence of pregnancy on cancer recurrence

‧ Among the group of patients who became pregnant after diagnosis, 530 patients were pregnant prior to diagnosis. In the group of patients who did

not become pregnant after diagnosis, 4,783 patients were once pregnant

prior to diagnosis.

‧ From total 33,043 patients, survivors accounted for 92.66%(30,618 patients) while 2,425 patients(7.34%) died. The most common cause of

death, for 2,225 patients, was breast cancer

Expected

Contribution

○ Develop aggressive measures to overcome economic burden by analyzing

economic impact of cancer prevention

○ Assess performance of policies by identifying changes in cancer diagnosis

and care patterns caused by shift in health care environment, such as

expanding benefit coverage on medical care utilization and the national

cancer screening program, and use the results as evidence for future health

care policy design

○ Contribute to developing cancer policies which is applicable and reflect

current circumstances based on evidence from the National Cancer

Screening Program's cancer prevention, incidence, care, mortality data

○ Contribute to enhancing effective distribution of cancer related medical

resources and quality of cancer care at national level

○ Contribute to enhancing quality of cancer care by analyzing appropriacy and

effectiveness of clinical practice guidelines

○ Use outcomes as evidence when developing new care patterns to increase

survival rate of cancer patients and formulating policies that lessens

economic burden of patients through reducing unnecessary treatments by

analyzing patterns such as surgery, anticancer drug, radiation therapy of

different cancer types and investigating outcomes of treatments in

accordance with the results

○ Ultimately ensure people's right to know and assist in building grounds to

enhance cancer patients' health, while using outcomes as base data when

designing plans to efficiently use health resources including limited health

insurance, determine priorities in cancer care policies, and improve quality

of cancer care

○ Overcome limitations of previous cross-sectional studies on cancer survival

and relevant factors, and propose a concrete survivor management

guidelines by developing a prognosis prediction model which reflect

differences between cancer types and individuals

Keywords

strengthen health

insurance coverage

cancer

screening

hospice &

palliative caretreatment survivor

〈 목 차 〉

1. 연구개발과제의개요 ·························································································1

2. 국내외 기술개발 현황 ·····················································································5

3. 연구수행 내용 및 결과 ·················································································18

4. 목표달성도 및 관련분야에의 기여도 ·······················································170

5. 연구결과의 활용계획 등···············································································172

6. 연구과정에서 수집한 해외과학기술정보···················································173

7. 연구개발과제의 대표적 연구실적 ·····························································174

8. 참여연구원 현황 ···························································································175

9. 기타사항 ·········································································································178

10. 참고문헌 ·······································································································178

표 1. 연도별 보장성 강화정책 ···································································································································· 5

표 2. 암유형별 환자 1 인당 사망 1 년 전 진료비 ······························································································· 12

표 3. 체계적인 분석을 위한 단계 ·························································································································· 18

표 4. 공동연구 협약절차 ············································································································································ 19

표 5. 전문가 자문단 구성 ········································································································································ 22

표 6. 데이터 구축연도 ················································································································································ 24

표 7. 검진자료의 개요 ·············································································································································· 24

표 8. 암 환자의 거주 지역 내 암 진단 자체충족률 변화 ·················································································· 26

표 9. 암 환자의 거주 지역 내 첫 치료 자체충족률 변화(갑상선포함 5 대 암) ··········································· 27

표 10. 요양개시연도별 암환자 1 인당 요양급여비용, 보험자부담금, 본인부담금

합계 ·················································································································································································· 29

표 11. 요양개시연도별 암환자 1 인당 평균 항별 금액 ······················································································ 30

표 12. 2002~2012 년 요양기관종별 요양급여비용총액 ····················································································· 34

표 13. 연도별 유급간병인의 일일 평균비용 ········································································································· 35

표 14. 연도별 국가암검진 수검자 수 ····················································································································· 45

표 15. 국가암검진 수검자 전년 대비 증감률 ······································································································· 45

표 16. 최종판정 결과 ················································································································································· 46

표 17. 최종판정 결과 ················································································································································· 47

표 18. 최종판정 결과 ················································································································································· 48

표 19. 국가암검진 이후 암등록이 이루어진 경우의 연도별 빈도 비교(위암) ·············································· 51

표 20. 국가암검진 이후 암등록이 이루어진 경우의 연도별 빈도 비교(간암) ·············································· 52

표 21. 국가암검진 이후 암등록이 이루어진 경우의 연도별 빈도 비교(대장암) ·········································· 53

표 22. 위장조영검사결과에 따른 위암 검진의 정확도 ······················································································· 54

표 23. 위내시경검사결과에 따른 위암 검진의 정확도 ······················································································· 54

표 24. 알파태아단백검사결과에 따른 간암 검진의 정확도 ··············································································· 55

표 25. 간초음파 1 검사결과에 따른 간암 검진의 정확도 ··················································································· 55

표 26. 초음파 2 검사결과에 따른 간암 검진의 정확도 ······················································································· 55

표 27. 알파태아단백검사&간초음파 1 검사결과에 따른 간암 검진의 정확도 ················································ 56

표 28. 알파태아단백검사&간초음파 2 검사결과에 따른 간암 검진의 정확도 ················································ 56

표 29. 분변잠혈검사결과에 따른 대장암검진의 정확도 ····················································································· 57

표 30. 대장이중조영검사 판독소견에 따른 대장암검진의 정확도 ··································································· 57

표 31. 대장내시경검사 판독소견에 따른 대장암검진의 정확도 ······································································· 57

표 32. 중앙암등록자료 암종별 연도별 요약병기상태 확인 ··············································································· 58

표 33. 중앙암등록자료 위암의 연도별 요약병기 확인 ······················································································· 59

표 34. 중앙암등록자료 간암의 연도별 요약병기 확인 ······················································································· 59

표 35. 중앙암등록자료 대장암의 연도별 요약병기 확인 ··················································································· 59

표 36. 중앙암등록자료 유방암의 연도별 요약병기 확인 ··················································································· 60

표 37. 중앙암등록자료 자궁경부암의 연도별 요약병기 확인 ··········································································· 60

표 38. Basic Characteristics of the Study Population ···················································································· 62

표 39. Result of Chi-square Test for Screening Status1 among the Colorectal Cancer Patients 64

표 40. Result of Chi-square Test for Screening Status2 among the Colorectal Cancer Patients ·· 65

표 41. Hazard Ratios and 95% Confidence Intervals for Colorectal Cancer Patients Death by All

Causes Adjusted for Covariate ······························································································································· 66

표 42. Hazard Ratios and 95% Confidence Intervals for Colorectal Cancer Patients Death by

Colorectal Cancer Adjusted for Covariate ··········································································································· 68

표 43. 성별 비 암사망 분석 ····································································································································· 73

표 44. 사망연도별 비 암사망 분석 ························································································································· 74

표 45. 진단연도별 비 암사망 분석 ························································································································· 75

표 46. 진단 연도별 비 암사망 주요 사인 분석 ··································································································· 76

표 47. 지역별 비 암사망 주요 사인 분석 ············································································································· 78

표 48. 진단암과 비 암사망 주요 사인 분석 ········································································································· 80

표 49. 사망 연도별 비동일암 사망자 분석 ··········································································································· 81

표 50. 비동일암 사망자 주요 사망사인 분석 ······································································································· 83

표 51. 진단연도별 비동일암 사망 분석 ················································································································· 84

표 52. 지역별 비동일암 사망 분석 ························································································································· 85

표 53. 연령별 비동일암 사망 분석 ························································································································· 86

표 54. 보험직역별 비동일암 사망 분석 ················································································································· 87

표 55. 연도별 동일암 사망자 현황 분석 ··············································································································· 89

표 56. 지역별 동일암 사망자 현황 분석 ··············································································································· 91

표 57. 연령대별 동일암 사망자 현황 분석 ··········································································································· 92

표 58. 보험직역별 동일암 사망자 현황 분석 ······································································································· 93

표 59. 암 생존자 성별 분석 ····································································································································· 94

표 60. 지역별 암 생존자 현황 분석 ······················································································································· 96

표 61. 연령대별 암 생존자 현황 분석 ··················································································································· 97

표 62. 진단 연도별 암 생존자 현황 분석 ············································································································· 98

표 63. 분석 대상자 ··················································································································································· 99

표 64. 연구에 이용하는 변수 ································································································································· 101

표 65. 말기암환자의 사망 전 특정 의료 이용 현황(‘10 년) ··········································································· 102

표 66. 말기암환자의 사망 전 특정 의료비 지출액(‘10 년) ············································································· 104

표 67. 사망 1 달전 의료기관 종별 입원 일당 진료비 비교(‘10 년) ······························································ 105

표 68. 사망 1 달전 의료기간 종별 완화의료병동 이용시 차액 추정 ···························································· 105

표 69. 사망장소에 따른 인구학적 특성 ··············································································································· 105

표 70. 사망장소에 따른 사회적 특성 ··················································································································· 106

표 71. 암사망자의 의료적 특성 ····························································································································· 107

표 72. 유병기간과 병기 ··········································································································································· 108

표 73. 사망장소에 따른 사망원인 분석 ············································································································· 108

표 74. 사망전 마지막 의료이용 형태 ··················································································································· 109

표 75. 11 개 암 진단 코드 ····································································································································· 111

표 76. 암 진단 후 1 년 동안 적극적 치료를 받은 환자와 받지 않은 환자 (N=892,609) ······················ 114

표 77. 적극적 치료를 받지 않은 환자 (Logistic Regression) ······································································· 116

표 78. Effect of no active treatment on overall mortality ·········································································· 117

표 79. 암 진단 후 첫 치료까지의 대기기간 31 일 전･후 (N=538,018) ······················································ 118표 80. 암 진단 후 첫 치료까지의 대기기간 (Logistic Regression) ··························································· 122

표 81. Effect of wait time on overall mortality ······························································································ 123

표 82. 이차암 발생 빈도(원발암 기준) ················································································································ 125

표 83. Descriptive characteristics of the study population (2002-2010) ··············································· 127

표 84. Age-standardized Incidence Rates of First and Second Primary

Cancer ·········································································································································································· 128

표 85. Hazard Ratio (HR) of Second Primary Cancer by Prediagnosis Body Mass Index in Male

cancer survivors ························································································································································· 128

표 86. Stratified Analysis of Risk of Any Second Primary Cancer by Prediagnosis Body Mass Index

in Male cancer survivors ········································································································································· 128

표 87. Hazard Ratio (HR) of First Cancer by Body Mass Index in Male Cohorts participants ····· 128

표 88. Descriptive characteristics of the study population (2002-2010) ··············································· 135

표 89. Age-standardized Incidence Rates of First and Second Primary

Cancer ·········································································································································································· 136

표 90. Hazard Ratio (HR) of Second Primary Cancer by Prediagnosis Body Mass Index in Female

cancer survivors ························································································································································· 137

표 91. Stratified Analysis of Risk of Any Second Primary Cancer by Prediagnosis Body Mass

Index in female cancer survivors ························································································································· 140

표 92. Hazard Ratio (HR) of First Cancer by Body Mass Index in Female Cohorts participants 142

표 93. 동반질환별 치료 약제 정리 ······················································································································· 144

표 94. 암환자의 고지질혈증 치료제별 투약 현황 (n=1,445,384) ································································ 145

표 95. 남자 암환자의 고지혈증 치료제별 이차암 발생 위험 (Hazard ratio) ············································· 146

표 96. 남자 암환자의 고지혈증 치료제별 사망 위험 (Hazard ratio) ··························································· 147

표 97. 여자 암환자의 고지혈증 치료제별 이차암 발생 위험 (Hazard ratio) ············································· 148

표 98. 여자 암환자의 고지혈증 치료제별 사망 위험 (Hazard ratio) ··························································· 150

표 99. 암종의 치료패턴별 진료성과 연구 주제 ································································································· 151

표 100. Characteristics of Patients by Year of Death (n = 696) ····························································· 153

표 101. Trends in Indicators of Aggressive Care during the 4-Year Study Period (n = 696) ····· 154

표 102. 대장암 수술 전 항암화학방사선치료 기간에 따른 인과적 특성 ····················································· 157

표 103. ESRD 세부 그룹별 환자수 및 암 진단 이전까지의 요양일수 통계량 ·········································· 164

표 104. ESRD 그룹 생존자, 사망자 및 사망사인(N=3945) ········································································· 164

표 105. 변수 정의 ····················································································································································· 165

표 106. Baseline characteristics of the study population(N=33,043) ·················································· 167

표 107. Baseline characteristics of the study population(N=33,043) ·················································· 167

표 108. Outcome of pregnancy(N=1,453) ········································································································ 169

그림 1. 국가 암 검진사업 수검률 (%) ····················································································································· 3

그림 2. 암 보장성 강화정책 초창기(2004-2009 년) ····························································································· 7

그림 3. 암 보장성 강화정책 후반기(2010-2016 년) ····························································································· 7

그림 4. 암환자의 지역별 자체충족률 및 혼란도 ···································································································· 8

그림 5 ·············································································································································································· 9

그림 5. 1999 년 및 2002 년 지역 암환자의 자체충족률 및 변화 ····································································· 9

그림 6. 지역별 암환자의 자체충족도 분포 ············································································································ 10

그림 7. 대구지역 거주환자의 주진단별 의료이용지역표 ·················································································· 11

그림 8. 암유형별 환자 1 인당 초기 진료비 ·········································································································· 12

그림 9. Average monthly medical expenses from 12 months before death by survival time ········ 13

그림 10. 영국 암 치료 대기기간 “아직 최고는 아님” ························································································ 14

그림 11. 영국 암 치료 대기기간 목표 “31 일” ·································································································· 15

그림 12. Prognostic Significance of Tumor Regression After PCRT for Rectal Cancer ······················ 16

그림 13. 전체 연구 흐름도 ······································································································································· 18

그림 14. 국립암센터-국민건강보험공단 공동연구 협약서(2013 년) ······························································ 20

그림 15. 국립암센터-국민건강보험공단 공동연구 협약서(2014 년) ································································ 22

그림 16. 추진체계 ····················································································································································· 24

그림 17. 연구대상자 구축 ······································································································································· 25

그림 18. 2002~2010 년 암종 및 연도별 의료이용 건수 ··················································································· 28

그림 19. 2002~2010 년 암종 및 연도별 신환자 의료이용 건수 ····································································· 29

그림 20. 2003~2010 년 연도별 신환 및 구환 본인부담금 수준 ································································· 29

그림 21. 2003~2010 년 연도별 환자 유형별 본인부담률 ················································································· 30

그림 22. 2003~2010 년 연도별 신환 및 구환 투약료 비교 (단위: 원) ························································ 31

그림 23. 2003~2010 년 연도별 신환 및 구환 주사료 비교 (단위: 원) ························································ 31

그림 24. 2003~2010 년 연도별 신환 및 구환 처치 및 수술료 비교 (단위: 원) ········································ 32

그림 25. 2003~2010 년 연도별 신환 및 구환 검사료 비교 (단위: 원) ························································ 32

그림 26. 2002~2012 년 요양기관종별 요양급여비용총액 변화 ······································································· 34

그림 27. 흡연에 기안한 암의 조기사망에 따른 질병부담 변화 연구방법 4 단계 ········································ 36

그림 28. 암의 조기사망에 따른 생명손실년수 ····································································································· 37

그림 29. 흡연의 기여분율 ········································································································································· 38

그림 30. Current smoking prevalence for males or females(1990-2010) ··············································· 38

그림 31. Relative risk for tobacco smoking and cancer ··············································································· 38

그림 32. 위암 검진 절차 ··········································································································································· 41

그림 33. 간암 검진 절차 ··········································································································································· 41

그림 34. 대장암 검진 절차 ······································································································································· 42

그림 35. 유방암 검진 절차 ······································································································································· 42

그림 36. 자궁경부암 검진 절차 ······························································································································· 42

그림 37. 대장암검진 효과 분석 전략 ··················································································································· 43

그림 38. 대장암 검진 분석 대상자 ························································································································· 44

그림 39. 대장암 검진 이후 검사 결과에 따른 암 발견율 ················································································· 50

그림 40. Study flow diagram ·································································································································· 61

그림 41. Kaplan-Meier Survival Curve about Death by all cause ······························································ 70

그림 42. Kaplan-Meier Survival Curve about Death by Colrectal cancer ················································· 71

그림 43. 연구대상자 추출 및 자료연계 과정 ····································································································· 100

그림 44. 월별 총 의료비 증가 추이 ····················································································································· 103

그림 45. 사망 1 개월 전 암환자의 의료기관 종별 의료비 비중 ···································································· 103

그림 46. 사망 2 주전 의료 이용자 수 및 의료비 ······························································································ 104

그림 47. 암 진단 후 적극적 치료여부에 따른 생존 분석 자료 구축 흐름도 ············································· 110

그림 48. 적극적 치료를 받지 않은 환자의 암종별, 연도별 분포(2002~2010 년) ·································· 112

그림 49. 비급여 반영 후, 적극적 치료를 받지 않은 환자의 암종별, 연도별 분포(2002~2010 년) ·· 113

그림 50. 첫 치료까지의 대기기간 자료 구축 흐름도 ······················································································· 118

그림 51. 이차암 발생 예측 모형 연구 대상자 구축 흐름도 ··········································································· 124

그림 52. Flow chart of patient recruitment for the study (male) ····························································· 126

그림 53. Flow chart of patient recruitment for the study (female) ························································· 134

그림 54. 연구대상자 추출 및 자료연계 과정(소아암) ······················································································ 152

그림 55. Trends for administering chemotherapy as aggressive end-of-life care to Korean

pediatric cancer patients who died 2007-2010. ···························································································· 154

그림 56. Trends for administering new chemotherapy as aggressive end-of-life care to Korean

pediatric cancer patients who died 2007-2010. ···························································································· 154

그림 57. Trends for the administering CPR as aggressive end-of-life care to Korean pediatric

cancer patients who died 2007-2010 ··············································································································· 156

그림 58. 연구 대상 암환자의 구성 ····················································································································· 157

그림 59. Life_tim (unit: month) ·························································································································· 160

그림 60. Life_tim (unit: month) ·························································································································· 162

그림 61. 전립선 연구대상자 자료 구축 흐름도 ······························································································· 164

그림 62. 유방암 연구대상자 추출 및 자료연계 과정 ······················································································· 165

그림 63. 유방암 연구대상자 그룹별 생존자, 사망자 및 사망사인 ······························································ 167

- 1 -

1. 연구개발과제의 개요

1-1. 연구개발 목적

○ 최종목표

- 국가 단위 암 관리체계 구축을 통한 암 예방부터 생존과 사망까지의 암 진료서비스의 질과 효율성

제고 및 국가암관리사업 활성화의 근거에 입각한 정책 평가 및 제언

- 암 진료서비스의 질과 효율성 제고 및 국가암관리사업 활성화의 근거에 입각한 정책 개발을 위한

성과 연구 수행

○ 세부 목표

- 국립암센터-국민건강보험공단 공동연구 협력체 구성

- 암 예방 및 발생부터 치료, 생존자 관리, 사망, 암 관리의 경제적 영향, 암 관리의 10년 추이 예측

을 아우르는 포괄적 한국 암 성과 연구 기반 구축

- 암보장성 강화정책에 따른 의료의 접근성 분석을 통한 효과 평가

- 암발견 및 치료, 사망에 미치는 국가암검진 사업 효과에 대한 포괄적 평가와 효과적인 암검진 사업

수행을 위한 정책방향 제시

- 말기암환자의 사망 유형(진단 동일암, 비동일암, 비암사망) 파악과 한국 암사망자들의 의료 이용

행태 및 사회경제적 현황 분석

- 암 종별 치료 및 관리 패턴에 따른 진료성과에 미치는 영향 연구

‧ 해당 암 관련 수술, 항암제, 방사선 치료 패턴 정리 ‧ 암 치료의 질 관련 성과 분석 ‧ 암 발생 및 생존관련 예측 모형개발을 위한 자료 구축- 암 발생 및 생존 등 예측 모형 개발을 위한 기반 구축

- 발생률 높은 암종별 치료패턴에 따른 진료 성과 분석

1-2. 연구개발의 필요성

가. 암 보장성 강화정책에 따른 의료이용변화

○ 2002년을 기준으로 8년 동안 총 진료환자 수는 평균 6.7% 증가한 데 반해, 암 환자의 진료환

자 수는 평균 46.8% 증가하였고, 암 진료비의 증가율도 총 진료비 증가율에 비해 높음(건강보

험통계연보, 2002-2012)

○ 암은 의료자원의 지출이 큰 질환으로 발생률과 치사율이 지속적으로 증가하며, 소득수준이 낮

을수록 암 진단 후 생존율이 낮게 나타남

○ 의료기관과 의료인의 지역 간 불균등은 보건의료서비스에 대한 지리적 격차를 만들어 의료서비

스에 대한 접근성의 격차를 초래할 수 있어 의료자원 공급의 증가 및 불균형 문제의 발생을 최

소화하고 적정 수준을 유지하기 위해서는 정책적인 개입이 필요함

○ 지역 내 의료기관의 규모가 클수록 지역의 자체 충족도가 높음. 의료기관의 이용은 그 지역의

의료자원의 중요한 요인이며 이것은 정부의 지원이나 보건의료정책 효과로 나타남

- 2 -

○ 암환자의 서울 집중화 문제는 암 치료 대기기간으로 이어져 이는 국가 보건의료체계, 의료자원

과 보건정책 등에 영향을 받음. 특히 암은 신체의 다른 부위로 확산 위험이 있어 암 진단을

받은 환자는 빠른 치료를 받아야 생존율과 예후가 좋기 때문에 치료까지의 대기기간이 중요함

○ 암환자에 대한 건강보험 법정본인부담 인하 시행 후 정책비용 및 편익에 대한 포괄적인 평가의

지표가 필요함

○ 따라서 본 연구를 통해, 암 보장성 강화정책 시행에 따른 의료이용 정도와 암의 경제적 비용변

화 추세를 파악함으로써 추후 시행 될 암 보장성 강화정책의 우선순위를 계획하고 정책 개발

및 수립의 근거자료로 활용하고자 함

○ 흡연의 질병부담을 사회경제적 비용이나, 건강부담의 측면에서 동시에 측정하여, 질병부담의

양상을 포괄적으로 포착한 논문은 찾기 어려우며, 또한 최근의 흡연율 변화와 암 발생의 증가

라는 역학적 변화를 반영한 연구가 필요함

나. 국가암검진 수검에 따른 효과 분석

○ 국민들의 암으로 인한 사망과 부담을 감소시키기 위하여 1999년에 의료급여수급권자를 위암,

유방암, 자궁경부암 등 3종에 대한 검진을 실시하였고, 2002년부터는 대상자를 전 국민으로 확

대하였고, 2003년에 간암검진, 2004년에 대장암 검진이 추가 도입되어 현재 진행 중인 국가 5

대 암검진 프로그램이 완성됨. 2002년부터 진행된 전 국민대상 암검진사업에서 상위소득자는

검진비용의 50%를 본인이 부담하였으나, 2006년에 상위소득자의 본인 부담이 20%로 낮아졌

고, 2010년부터는 상위소득자의 본인 부담이 10%로 감소함

○ 국민건강보험공단의 “암 검진사업의 경제성 평가 연구 동향 및 시사점 연구”에서 지적된 것처

럼 암 검진의 효과성 연구는 RCT를 통한 연구의 실질적 수행이 어렵고 신뢰할 만한 평가 모형

에 기반을 두지 않는 경우가 많아 자료가 부족한 실정임

○ 한국의 중위연령은 1980년 21.8세에서 2010년 37.9세로 16세 정도 상승하였으며 2030년엔

○ 1999년부터 의료급여수급권자를 대상으로 위암, 유방암, 자궁경부암 등 3종에 대한 검진 실시

○ 2002년부터 검진대상을 의료급여수급권자와 건강보험가입자 하위 20%까지 확대

○ 2003년부터 검진대상을 의료급여수급권자와 건강보험가입자 하위 30%까지 확대하고

대상 암종에 간암을 포함

○ 2004년부터 대상 암종에 대장암을 포함

○ 2006년부터 건강보험가입자 하위 50%에 장애인, 도서벽지 거주자 등의 경감된 보험료를

반영하여 국가암검진대상을 확대. 상위소득자 50%에 대해서는 본인 부담금은 암검진 비용

50%에서 20%로 경감

○ 2007년 생애 전환기검진이 되면서 주요생애전환기인 40세, 66세에 암검진 전액 무료

○ 암검진 서식 및 판정 기준 개정

○ 2010년 상위소득자 본인 부담 10%로 경감

- 3 -

48.5세로 10세 정도 더 높아질 것으로 추정되고 있음. 우리나라 국민들의 평균수명 역시 1980

년에 남자 58.6세, 여자 65.5세에서 2010년 남자 77.2세, 여자 84.0세로 급격히 증가함. 암

생존율도 급격히 증가하였는데 1993년-1995년 사이 우리나라 전체 암환자의 5년 상대생존율이

41.2%에 불과하였는데, 2007년에서 2011년 사이 암환자의 5년 상대생존율은 66.3%로 25.1%

가 증가하였다. 이러한 인구 구조의 변화와 암 생존율의 변화에 따라 검진의 수요와 효과에 변

화가 생길 것으로 예상됨. 이러한 변화에 따른 검진의 효과의 변화를 모니터링 할 필요가 있음

○ 인구 구조 및 암발생률과 암 생존율이 변화하고, 암검진 수검률이 향상됨에 따라 검진 항목의

타당성, 검진 후 사후관리 행태, 검진 사업의 효과성 등을 평가하여 향후 보다 효과적이고 효율

적인 국가암검진사업의 방향성 및 근거를 만들어 갈 필요가 있음

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

간암 0 9.6 11 16.2 24.9 27.5 33.8 37.3 42.7 47.1

대장암 0 0 10.5 13.5 15.2 18.1 21 25.6 29.8 33.3

위암 11.5 13.5 15.4 17.4 20.9 25 28.4 33.8 36.6 44.4

유방암 14.7 16.5 18.2 20.8 25.4 29.9 34.8 39.6 42.8 49.4

자궁경부암 15.6 10.4 9 11.8 11.4 11.3 13.8 18 28.5 27.1

전체 12.9 15.2 15.3 17.7 19.8 23.9 27.4 32.2 33.9 39.9

0

10

20

30

40

50

60

그림 1. 국가 암 검진사업 수검률 (%)

출처: 보건복지부(국가 암검진사업 정보시스템)

다. 말기암환자의 사망 전 의료이용행태 및 진료비 지출 추이 분석

○ 말기암환자의 정의에 따르면 기대여명이 6개월로 알려져 있으나, 완화의료기관 이용자 평균 14

일 이내 사망자가 50%이고, 1개월 이내 사망자가 70%임. 또한 호스피스완화기관 평균 재원일

수는 23일이었음

○ 암환자의 진단부터 사망까지 전 단계의 의료비 지출 비중 중 초기와 사망 직전이 높은데 특히,

사망 직전의 불필요한 연명 치료로 인하여 환자의 삶의 질 저하와 의료비 과다 지출로 인한 국

가 보험 재정에도 막대한 손실을 미치게 됨

○ 건강보험공단의 자료를 이용하여 사망한 암환자의 사망 전 진료비를 조사한 결과, 사망 전 1개

월의 진료비가 사망 전 12개월의 진료비 중 31.3%로 가장 높게 나타났으며, 사망 3개월 전까

지는 약 58.3%로 나타나 사망 전 집중적으로 진료비가 지출되는 것으로 나타남

○ 국립암센터에 따르면 말기암환자의 심폐소생술의 경우 일반 병동은 사망 전 1개월에 약 142배

급격히 증가하고 평균비용은 호스피스에 비해서 약 41배 이상의 비용을 지출함

- 4 -

○ 일반 병동 및 호스피스 항생제 투여률 및 평균 투여일이 사망 전 2개월부터 급격히 증가함. 사

망 전 1개월에 호스피스의 항생제 의료비가 일반 병동의 의료비에 비해서 적게 지출되며, 일반

병동 50.8%와 호스피스는 38.2%로 차지하였음. 일반 병동의 항생제 비용은 호스피스의 비용

보다 평균 3배가 높음

○ 집중치료실의 일반 병동의 평균비용은 호스피스의 약 8배 이상 차지하며, 1개월을 기점으로 2

개월 전보다 약 4배의 비용을 증가하였음

○ 일반 병동에서 사망한 환자의 방사선치료 평균비용은 약 55만원으로 호스피스에 비해서 약 2

배 정도 높은 수치임

○ 따라서, 국가에서는 말기암 환자의 의학적 요구를 수용하고 자원의 낭비를 막을 수 있는 대안

으로 말기암 환자의 의료행태 및 진료비 지출 규모를 파악하여 급성기 진료체계에 흡수된 말기

암환자 관리를 바람직한 말기암 환자 진료 체계 개편과 환자 삶의 질 향상 마련을 위한 대안

수립이 요구됨

라. 진단 및 치료 기술의 발전과 함께 암은 최근 생존율이 증가하고 있음

○ 조기에 발견하는 경우에는 완치를 기대할 수 있는 질환이 되고 있음

○ 1993년부터 1995년까지 조사된 5년 생존율은 41.2%에 불과했으나 2003년부터 2007년까지의 암

환자 생존율은 57.1%로 증가함

○ 암환자 생존율 증가와 함께 암 조기검진이 활성화되면서 암을 조기에 발견하는 경우에는 완치

를 기대할 수 있는 질환이 되었음

마. 암의 의심 시점부터 암 환자들이 어떠한 의료 전달 경로를 따르는 지에 관한 연구는 국가

적 차원에서의 암 관리 정책을 수립하는데 큰 도움이 될 것으로 판단됨

바. 암이 의심되고 나서부터 치료를 받기까지, 환자와 가족들은 심한 불안과 스트레스를 받을 수 있

으며, 또한 심각하게 지연되는 경우에는 암이 진행되어 예후를 나쁘게 할 가능성이 있음

사. 암 생존자 관리의 중요성

○ 암 치료 기술이 발전하고 암 조기 발견이 급증하면서 암 생존자가 증가하는 추세임에도 불구하

고 암 환자의 생존율에 영향을 주는 신체적, 정신적, 사회적, 영적 고통 및 2차암, 동반질환 발

생 등 다각적인 문제들로 인한 사회적 손실은 구체적으로 논의되고 있지 않음

○ 암을 극복한 생존자들은 일반인과는 다른 접근법으로 생활습관, 동반질환, 약물 복용 및 2차암

예방을 위한 가이드라인을 제시해야 할 필요성이 강조되고 있음

○ 암 생존율은 생활습관, 동반질환 및 약물 복용 등에 영향을 받는 부분이 상당하며, 또한 2차암

발생 역시 암 진단 후 생존율에 큰 영향을 끼치므로, 암 생존율과 생활습관, 동반질환, 약물복

용, 2차암의 상관관계 분석을 위한 新예측 모형을 개발하여 보다 신뢰할만한 암 생존자 연구가

필요함

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1-3. 연구개발 범위

○ 다면적 생존율 예측 모형 개발을 위한 기반 구축

- 암 생존율과 그에 영향을 끼치는 요소들 간의 기존 단면 연구의 한계를 극복하고, 암종별, 개인별

차이를 반영한 예후 예측 모델을 개발하여 보다 구체적인 생존자관리 지침을 제시하여야 함

- 제2기 암정복 10개년 계획에 따른 암환자의 삶의 질 향상과 건강 증진 강화에 구체적 청사진을

제시하고 암환자 예후 관리의 질을 향상시키기 위한 연구를 진행해야 함

2. 국내외 기술개발 현황

○ 암 질환의 보장성 강화정책

시기 세부 내용

2002 국가암검진 저소득 건강보험가입자(보험료부과기준 하위 20%)로 확대

2003 국가암검진 저소득 건강보험가입자(보험료부과기준 하위 30%)로 확대, 간암 검사 추가

실시

2004.1 외래진료비 본인부담률 50%(진찰료 제외) → 전체 요양급여의 20%(진찰료 포함)

진찰료 제외한 요양급여의 50%→진찰료 포함 요양급여의 20% 부담

한시적 비급여의 급여전환(고액, 중증환자 필요 10개 항목)

대장암 검사 추가 실시

2004.7 6개월 간 300만원 초과액 상환

2005.9 암, 뇌혈관계질환등의 MRI 급여전환(본인부담 10%), 비급여의 급여전환(438항목)

법정본인부담금 인하 (20% → 10%)

항암제 및 기타 약제의 보험급여 확대

2006.1 위암, 유방암, 대장암, 간암 50% → 20%로 경감(자궁경부암은 면제)

간·심장·폐·췌장의 4개 장기적출 및 이식수술 보험급여 실시

2006.6 - 병기설정(진단 포함), 재발평가, 치료효과 판정(병기재설정)에 유용한 경우 진행정도를

진단하기 위한 촬영 1회

- 수술 후 1회

- 항암 치료(항암화학요법 혹은 방사선치료) 중 2회 급여 적용

(장기 추적검사의 경우 추가 적용)

대부분적용이 100% 되지는 않기 때문에 일부 비급여 처리되는 특수 기구들도 있음

식대 급여 전환 (본인부담률 20%)

2007.7 본인부담액 상한선 6개월 간 300만원 → 200만원

2008.1 기존 20% → 50%로 상향 조정(일반, 중증질환, 6세 미만, 자연분만 등 포함)

2009.1 연간 소득 50% 이하 : 200만원/ 소득 50-80% : 300만원/ 상위 20% : 400만원

2009.12 입원 및 외래 본인부담금 인하 (10% → 5%)

2010.1 전액 본인 부담 → 치료/수술에 사용되는 적삭기류 등 급여 전환

2010.10 2개 이상의 2군 항암제(고가 항암제) 병용 투약하는 경우 고가항암제는 보험급여 적용,

저가 항암제는 전액 환자 부담 → 고가, 저가 항암제 모두 보험급여

다발성골수종, 유방암 치료제 급여 확대

2011.4 양성자 방사선 치료 소아암에 급여 적용, 세기변조 방사선 치료 급여 적용

2011.7 폐암 냉동제거술, 전립선암 3세대형 냉동제거술, 신종양 냉동제거술, 신장암 고주파 열

치료술 보험급여

2013.1 -간암치료제(넥사바) 본인부담 경감(기존 50%→5%)

-위암치료제(TS-1) 본인부담 경감(기존 100%→5%)

2013.10 검사 및 수술 후 상태 확인 등에 필수적이거나 건강보험 적용받지 못했던 초음파 검사

(비급여 → 건강보험 급여 적용)

2014.1 유방암, 위암 환자의 치료제 선택을 위해 필요한 유전자검사 급여 확대

표 1. 연도별 보장성 강화정책

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2014.3 직·결장암 치료제 ‘얼비툭스주’, 다발성골수종 치료제 ‘레블리미드캡슐’ 보험 급여

2014.6 암환자의 표적항암제 선택 및 치료경과 확인을 위해 필수적인 유전자검사 8종 건강보험

적용

2014.8 본인부담률 80%

유방암 3개 요법, 직장암 1개 요법, 다발성골수종 2개 요법

2014.9 암환자 공동 진료비(의사 5인 기준 환자부담금 7,000원), 집중영양치료비(대학병원