암보험약관상 ‘암치료를 직접목적으로 하여’ 또는 ‘암의 직접치료를 목적으로’의 의미에 관한 소고

김은경 한국기업법학회 2019 企業法硏究 Vol.33 No.2

최초의 암보험은 1980년 12월에 출시된 후, 1988년에는 생명보험사들이 암보험을 보장성상품으로 공동개발하여 판매한 후 지금에 이르렀다. 지난 40여년 간 암보험은 다양한 수요와 사회적 현상을 고려하여 현재의 상품구성을 하게 되었고, 초고령사회라는 특징을 가진 새로운 시장 앞에 있다. 그런데 최근 암보험약관의 해석과 관련하여 논란이 계속되고 있다. 2000년도 A회사가 판매한 암보험의 약관에 보험금의 지급사유 중 ‘여성특정암, 상피내암 또는 부인과질환으로 진단확정되고 그 치료를 직접목적으로 하여 4일 이상 계속하여 입원하였을 때’에서 ‘그 치료를 직접목적으로 하여’ 중 ‘직접’의 의미를 놓고 분쟁이 발생했다. 암보험 출시 당시에는 암보험약관 규정상 ‘암의 치료를 목적으로 하는’ 으로 시작되었던 것이 ‘암치료를 직접목적으로 하여’ 로 그 문구가 수정되기까지 몇 번의 개정을 거쳐 보험금지급사유를 ‘암의 직접치료’로 변경하게 되었다. 이러한 표기로 암보험약관의 해석에 혼란이 가중되었다. 이 문제는 약관의 해석문제를 넘어 암이라는 병의 치료방법에 대하여 소비자가 구체적인 인지를 필요로 한다는 것으로까지 확대되는 듯하다. 현재로서는 약관에서 보험금지급기준인 암의 직접치료는 무엇을 의미하는 지에 대하여 그 의미가 매우 모호하다. ‘암치료를 직접목적으로 하여’ 또는 ‘암의 직접치료를 목적으로’에서 직접이라는 단어가 치료를 지시하는 것인지 또는 목적을 지시하는 것인지에 따라 암보험약관에 포함된 의미는 달라질 수 있다. 그러나 문제는 직접이라는 의미를 정하는 세부적인 기준을 가지고 있지 않은 보험자가 사업자의 입장에서 이에 대하여 자의적인 해석을 함으로써 소비자가 가진 암보험 가입에 대한 기대에 현격히 반하는 보험금지급기준을 제시한다는 것이다. 보험약관에서 암의 치료는 암이라는 질병을 치료한다는 취지의 것이지 암을 치료하는 것에 특정한 방법을 요구하는 것은 아니므로 치료의 목적이 암을 치료하는 것에 있는 경우라면 암을 치료하기 위해 임상적으로 허용된 모든 방법과 내용이 인정되는 것이고, 심지어 치료에 효과가 있었는지 여부도 불문하여야 한다. 결론적으로 암의 치료를 직접목적으로 한의 의미는 암의 치료에 최종목적이 있고 의사의 치료나 수술이 암을 낫게 하려는 것을 지향한다는 취지의 것이라고 이해하여야 한다. 그러므로 암치료의 직접목적성이나 암을 직접치료한다는 것은 소위 구체적인 의학적인 행태를 의미하는 것이므로 치료를 직접하였거나 암의 치료를 직접목적으로 한다는 것을 문언적으로 해석할 것이 아니라 해당 치료가 암을 치료함에 있어서 불가피한 것인지, 즉 필요한 것인지 지 여부로 판단하는 치료의 불가피성 내지 필요성을 기준으로 보는 것이 합리적일 것이라고 본다. 암보험에서 ‘암치료를 직접목적으로 하는’에서 직접목적 내지 직접치료가 보험계약에서 설명의 대상인지도 역시 매우 중요한 사안이다. 암의 치료를 직접목적으로 하는 입원이나 치료가 무엇인지에 대하여는 보험계약자가 별도의 설명없이도 충분히 예상할 수 있는 사항이 아니므로 계약체결과정에서 암보험에 내재된 보험금지급사유를 제한하고자 하는 보험자의 취지가 인식될 수 있도록 보험자는 보험계약자 측에 암보험약관에 대한 설명의무를 이행하여야 한다. The first cancer insurance was introduced in December 1980, and in 1988, life insurance companies jointly developed and sold term insurance for cancer. Over the past 40 years, current cancer insurance products, reflecting social changes and diverse customer needs, have faced new markets characterized by super-aged society. Recently, there has been controversy over the interpretation of the general terms and conditions for cancer insurance. A company has encountered dispute with consumers caused the interpretation of meaning of the reasons for the insurance claim under the cancer insurance sold in 2000. One of the reasons for claim is when the insured person has been diagnosed as a female specific cancer, intra-epithelial cancer or gynecological disease, and the patient has been admitted for more than 4 days for the purpose of treatment. There was a dispute with consumers regarding the meaning of ‘direct’ for direct purpose. At the time of the launch of the product, the general terms and condition of the product were defined as ‘for the purpose of cancer treatment’, but the phrase was changed to sequentially ‘direct treatment of cancer’ and ‘direct treatment of cancer’. These kinds of the wording added to the confusion of interpreting the terms and conditions under the cancer insurance to the customer. This seems to extend beyond the problem of interpreting the terms of the contract, and the consumer should be aware of the specific treatment of the disease. At present, the meaning of direct treatment of cancer, which is the standard for payment of insurance benefits, is very ambiguous. The meaning of the general terms and conditions under the cancer insurance can be interpreted differently depending on whether the word ‘direct’ in the direct aim of cancer treatment or direct treatment of cancer directs the treatment or indicates the purpose. However, the problem is that the insurer does not define a detailed meaning of direct, but merely interprets it from the viewpoint of themselves and suggests the policyholder (or insured person) with a standard of insurance payment that can not be met at the time of joining. Treatment of cancer under the insurance contract is intended to treat a cancer, not a specific way of treating cancer. All methods and contents that are clinically acceptable for the treatment of cancer are recognized, unless the purpose of treatment is not only a cure from cancer. It may or may not even have been effective in the treatment. In conclusion, ‘direct aim of cancer treatment’ is to understand that the ultimate goal of cancer treatment is to have a doctor's treatment or surgery to treat cancer. Therefore, direct treatment of cancer treatment or treatment of cancer directly refers to the so-called specific medical behavior, so it is not a literal interpretation that treatment is directed, or the treatment of cancer is directed. It is reasonable to base the necessity or necessity of whether the treatment is inevitable or necessary for cancer treatment. In the cancer insurance, it is very important whether the ‘direct purpose’ or ‘direct treatment’ in the ‘direct aim of cancer treatment’ is the matter that the insurer must fulfill the explanation obligation to the policyholder. The policyholder cannot fully anticipate or understand what admission or treatment for the purpose is of treating cancer directly without the detailed explanation by the insurer. Therefore, the insurer must fulfill the obligation to explain the general terms and conditions of the insurance to the policyholder so that the intent of the insurer to limit the reasons for insurance claims inherent in the cancer insurance can be recognized during the contracting process.

간편고지보험 고지항목별 무사고기간에 따른 암 발생 및 치료 상대위험도 예측

전희주 ( Heuiju Chun ),인태교 ( Taekyo Leen ) 한국보험학회 2024 保險學會誌 Vol.138 No.-

본 연구는 표본코호트2.0DB를 활용하여 2002∼2019년도에 건강보험 자격을 유지하고 있는 사람을 대상으로 2017년 초 시점을 기준으로 연령군 및 중대질병1∼9, 입원, 수술, 계속투약, 계속치료 무사고기간을 1년 단위로 측정한 설명변수에 기반하여 로지스틱회귀모형을 이용하여 성별 암 발생 및 암 치료 여부를 예측하고자 한다. 무사고기간 증가에 따른 암 발생 상대위험도를 산출한 결과, 남성의 경우 협심증, 간경화증, 고혈압, 당뇨, 입원, 수술, 계속투약, 계속치료 무사고기간이 증가함에 따라, 여성의 경우에는 간경화증, 고혈압, 당뇨, 계속투약, 계속치료 무사고기간이 증가함에 따라 상대위험도가 감소하는 것으로 나타났다. 무사고기간 증가에 따른 암 치료 상대위험도를 산출한 결과, 남성의 경우 간경화증, 고혈압, 당뇨, 계속투약, 계속치료 무사고기간이 증가함에 따라, 여성의 경우 간경화증, 고혈압, 당뇨, 수술, 계속투약, 계속 치료 무사고기간이 1년 증가함에 따라 상대위험도가 감소하는 것으로 나타났다. 본 연구를 통해 전체 고지항목 조합의 경우의 수를 포괄하는 일반화된 모형을 수립했다는 점에 의의가 있다. 또한 암 발생 및 암 치료에 유의한 영향을 끼치는 각 고지항목의 무사고기간을 식별할 수 있고, 각 고지항목의 무사고기간이 1년 변화함에 따라 나타나는 상대위험도 변화량을 실증적으로 산출하여 제시하였다. This study calculated the relative risks of cancer incidence and cancer treatment according to the duration of accident-free periods for various SI (simplified issue) notification items. Using the National Health Insurance Service National Sample Cohort (NHIS-NSC) data, individuals maintaining health insurance eligibility from 2002 to 2019 were selected. The study measured accident-free periods according to age group, major diseases 1-9, hospitalization, surgery, continuous medication, and continuous treatment, based on the starting point in early 2017, using one-year intervals as explanatory variables. Logistic regression models were employed to predict gender-specific cancer incidence and cancer treatment. Results of the calculated relative risks for cancer incidence with increasing accident-free periods indicated that, for males, the risk for cancer incidence decreased with an increase in accident-free periods related to angina, liver cirrhosis, hypertension, diabetes, hospitalization, surgery, continuous medication, and continuous treatment. For females, the risk for cancer incidence decreased with an increase in accident-free periods related to liver cirrhosis, hypertension, diabetes, continuous medication, and continuous treatment. Regarding the relative risks of cancer treatment with increasing accident-free periods, for males, the risk of cancer treatment decreased with an increase in accident-free periods related to liver cirrhosis, hypertension, diabetes, continuous medication, and continuous treatment. For females, the risk of cancer treatment decreased with an increase in accident-free periods related to liver cirrhosis, hypertension, diabetes, surgery, continuous medication, and continuous treatment. This study is significant in that it established a generalized model that encompasses the number of cases of combinations of all notification items. In addition, this study identified the effect of accident-free periods for each SI notification item on cancer incidence and cancer treatment. It empirically showed that the changes in relative risks associated with a one-year increase in accident-free periods for each notification item can be calculated.

암보험 약관의 개선 방안에 관한 연구

이성남 서강대학교 법학연구소 2019 법과기업연구 Vol.9 No.1

It appears that the coverage of cancer claims is ultimately the need for hospitalization for the treatment of cancer, and that it is concluded whether by the hospitalization in the course of cancer treatment or after the treatment is closed, and the gravity of the patient’s condition, as shown in the Accepted and rejected cases. In conclusion, there seems to be no inherent difference between the phrase “for the purpose of treating cancer” and the phrase “for the direct purpose of treating cancer,” which eventually modifies the hospitalization. The need for hospitalization should be considered as a risk requirement for cancer treatment and as a requirement for cancer treatment. The treatment of cancer is treated through administration of anti-cancer drugs, radiation treatment, surgery, etc. In addition, the treatment of side effects associated with the treatment of cancer, or adverse events occurring in the cancer itself, can be considered to be included in direct cancer treatment. Hospitalization means that a patient enters and stays in a hospital for a certain period of time to cure a disease, and the need for hospitalization is considered as a separate requirement in the sense of hospitalization for the direct purpose of treating cancer. The need for hospitalization is required to be considered as a separate requirement in the sense of direct purpose hospitalization. However, when determining the requirements for hospitalization, it is necessary to broadly recognize the requirements for hospitalization by considering symptoms, difficulties in treatment or patient condition, depending on the broad-ranging criteria. If hospitalization is interpreted as essential to receive anti-cancer medication, there is room to unfairly reduce the scope of hospital admission. 암입원비 보험금의 지급 대상 여부는 결국 암의 치료를 위한 입원 필요성이고, 그 필요성 여부는 인용사례와 기각사례에서 알 수 있듯이 암 치료 과정상의 입원인지 치료가종결된 후에 이루어진 입원인지 여부, 환자 상태의 중대성 등에 의하여 결론이 나는 것으로 보인다. 결론적으로 ‘암의 치료를 목적으로 한’의 문구와 ‘암의 치료를 직접 목적으로 한’이라는 문구의 본질적인 차이는 없는 것으로 보이고, 이러한 문구는 결국 입원을수식하는 어구이다. ‘암의 치료를 직접 목적으로 한 입원’ 여부는 목적성 요건으로서 암의 치료와 필요성요건으로 입원의 필요성 여부가 검토되어야 한다. 암의 치료는 항암제 투여, 방사선 치료, 수술 등을 통하여 치료하게 되는데 이러한 것 외에도 암의 치료와 관련하여 나타나는 부작용 또는 암질병 자체에서 나타나는 이상반응의 치료도 직접적인 암치료에 포함되는 것으로 볼 수 있다. 입원이란 환자가 병을 고치기 위하여 일정한 기간 동안 병원에 들어가 머무는 것이 보통의 의미인데 암의 치료를 직접 목적으로 한 입원의 의미에서 입원의 필요성이 별도의 요건으로 검토될 것이 필요하다. 그러나 입원의 필요성 요건을 판단할 경우에는 완화된 기준에 따라 증상이나 처치의 곤란, 환자의 상태 등을 고려하여 필요성 요건을 넓게 인정할 필요가 있다. 자칫하면 입원이 항암약물치료를 받기위해 필수불가결한 것이어야 하는 것으로 해석할 경우 입원의 인정 범위를 부당하게 축소할 여지도 있다. 따라서 필수불가결성을 판단기준으로 삼을 필요는 없을 것으로 생각된다. 암보험약관에서 입원은 의사 등 전문가에 의한 치료 필요성과 자택에서 치료 곤란성을 제시하고 있는 바, 전문가에 의한 치료 필요성은 다른 말로 의료행위의 필요성을 뜻한다고 볼 수 있다. 그런데 의료행위라 함은 의학적 전문지식을 기초로 하는 경험과 기능으로 진료, 검안, 처방, 투약 또는 외과적 시술을 시행하여 하는 질병의 예방 또는 치료행위 및 그 밖에 의료인이 행하지 아니하면 보건위생상 위해가 생길 우려가 있는 행위를 의미하고, 이러한 의료행위의 광범성으로 인하여 치료의 필요성은 쉽게 인정될 여지가 있다. 또한 자택에서 치료 곤란성이란 통상의 가정의 여건과 환경 속에서 암의 치료가 곤란하여 암의 치료에 필요한 의료장비를 갖춘 의료기관에서 암의 치료가 필요한 경우나 암으로 인한 병적 증상의 우발적인 발현에 대한 즉각적인 의료적 대처가수시로 발생하는 경우 등이 이에 해당될 수 있을 것이다. 암보험은 암의 발견에서 치료과정 및 종료에 이르는 일련의 과정에서 나타나는 사실을 기초로 암진단, 암수술, 암입원, 암통원, 암요양, 연명치료 등의 사실이 발생할 경우를 보험금 지급사유로 설정하여 소정의 보험금을 지급하고 있다. 입원이란 환자가 병을고치기 위하여 일정한 기간 동안 병원에 들어가 머무는 것을 말하고 요양이란 휴양하면서 조리하여 병을 치료하는 것을 말한다. 요양은 장소적 제한은 없다. 또한 의료시설로서 호스피스 병원이 있고, 앞으로 의료 휴양의료시설의 출현도 예상해 볼 수 있는 바, 병원, 요양병원, 호스피스 병원 등의 각종의 시설에 입원 및 이용에 대해 보험으로 어떻게 합리적인 급부를 설계할 것인지 고민할 필요가 있다. 또한 현행 보험상품에서는 일반입원비 보험과 암입원비 보험금이 지급요건을 다르게 설정하고 다 ...

암환자의 진단-치료 소요기간에 따른 생존분석과 지역사회별 격차 및 시계열적 추이

김우림 ( Woorim Kim ),한규태 ( Kyu-tae Han ) 한국보건행정학회 2021 보건행정학회지 Vol.31 No.1

Background: The Korean government introduced National Cancer Control Program and strengthening national health insurance coverage for cancer patients. Although many positive effects have been observed, there are also many concerns about cancer management such as patient concentration or time-to-treatment. Thus, we investigated the association between the time-to-treatment and survival of cancer patients, and compared regional differences by time trend. Methods: The data used in this study were national health insurance claims data that included patients diagnosed with lung cancer and received surgical treatment between 2005 and 2015. We conducted survival analysis with Cox proportional hazard model for the association between time-to-treatment and survival in lung cancer. Additionally, we compared the regional differences for time-to-treatment by time trend. Results: A total of 842 lung cancer patients were included, and 52.3% of lung cancer patients received surgical treatment within 30 days. Patients who received surgical treatment after 31 days had higher 5-year or 1-year mortality compared to treatment within 30 days (5-year: hazard ratio [HR], 1.566; 1-year: HR, 1.555; p<0.05). There were some regional differences for time-to-treatment, but it was generally reduced after 2010. Conclusion: Delayed surgical treatment after diagnosis can negatively affect patient outcomes in cancer treatment. To improve cancer control strategies, there are needed to analyze the healthcare delivery system for cancer care considering the severity and types of cancer.

Effect of gynecological cancer and its treatment on bone mineral density and the risk of osteoporosis and osteoporotic fracture

( Jeong Eun Lee ),( Che Yon Park ),( Eunhyun Lee ),( Yong Il Ji¸ ) 대한산부인과학회 2020 Obstetrics & Gynecology Science Vol.63 No.4

Objective The purpose of this study was to evaluate the risk of osteopenia and osteoporosis by examining the bone mineral density (BMD) of the lumbar spine and femur in patients with gynecological cancer without bone metastasis and to evaluate the impact of treatment for different cancers on BMD. Methods This study retrospectively reviewed the medical records of 243 women with gynecological cancer and 240 controls between March 2010 and December 2016. Patients with cervical cancer (n=105), endometrial cancer (n=63), and ovarian cancer (n=75) were treated with total hysterectomy including bilateral salpingo-oophorectomy and/or chemotherapy and/or radiotherapy. For the control group, healthy post-menopausal women without gynecologic cancer were selected. Results Before anticancer treatment, the BMD of patients with cervical cancer and ovarian cancer was significantly lower than that of the controls, and the BMD of patients with endometrial cancer was not significantly different from that of the controls. However, the BMD of endometrial cancer significantly decreased after treatment. According to the treatment methods, there were significant differences in the BMD of L3, L4, and the femur neck. Changes in the BMD were lowest in patients who underwent surgical treatment only, and the highest bone loss was found in patients who underwent postoperative concurrent chemoradiotherapy. Conclusion Patients with cervical and ovarian cancer had lower BMD than those in the control group before treatment, and patients with endometrial cancer had decreased bone density after treatment. Therefore, during the treatment of gynecological cancer, strategies should be implemented to mitigate these risks.

암 환자의 처우개선에 관한 법·제도적 연구

宣恩㶼,(Seon, Eun-Ae) 한국토지공법학회 2021 土地公法硏究 Vol.95 No.-

2020년 12월 24일 발표된 2017년 국가암등록통계 보건복지부·중앙암등록본부, “암 진단 후 5년 초과 생존자 100만 명 넘었다”, 2019, 12, 24일자 보도자료. 에 따르면 암 유병자 187만 명(전 국민의 3.6%)이며, 암발생률은 인구 10만 명 당 연령표준화발생률(이하 발생률)은 282.8명으로 전년 대비 6.6명(2.3%) 감소하였다. 이러한 암 발생률은 1999년 이후 2011년까지 연평균 3.7%씩 증가하다가, 2011년 이후 매년 약 2.6%씩 감소하고 있다. 우리나라 국민들이 기대수명(83세)까지 생존할 경우 암에 걸릴 확률은 37.4%였으며 남자(80세)는 5명 중 2명(39.8%), 여자(86세)는 3명 중 1명(34.2%)에서 암이 발생할 것으로 추정되고 있다. 국가암정보센터(https://www.cancer.go.kr/)- 암 발생율(검색일자: 2021. 7. 14.) 이러한 추세를 본다면 암은 결코 개인의 문제가 아닌 사회적인 문제로 인식되어야 하며 국가와 지방자치단체의 발 빠른 대처가 필요하다고 할 것이다. 이에 대해 국가에서는 「암관리법」을 규정하여 국가가 암의 예방과 진료 및 연구 등에 관한 정책을 종합적으로 수립ㆍ시행하고 있고 「호스피스ㆍ완화의료 및 임종과정에 있는 환자의 연명의료결정에 관한 법률」에 있어서 호스피스 완화의료 및 임종과정에 있는 환자의 대상자 중 암 환자를 대상으로 함으로서 암 환자의 연명의료결절에 있어서의 권리를 규정하고 있으나 실질적으로 암 환자의 처우를 개선하기 위한 입법적 도입이나 효율성 있는 정책은 한계점이 있다. 향후 암 환자의 증가가 명백히 예상되는 바, 처우를 개선하기 위한 국가 및 지방자치단체의 관리가 더욱 필요하다고 할 수 있다. 따라서 암 환자를 우리 사회에서 더욱 보호해야 될 대상인 사회적 약자로 인식하고, 암 환자의 처우개선을 위한 법적 근거를 바탕으로 국가 및 지방자치단체의 책무를 명시하고 암 환자 처우에 있어서 「암관리법」의 법률 정비를 통해 암 환자의 권리를 명시하여 처우개선에 있어서 근거 법률을 규정하여야 하며 현재 「암환자에 대한 의료비 지원기준 등에 관한 고시」의 암 환자의 재정적 지원에 관한 규정을 법률로서 명시하고 암환자를 사회적 약자로 규정하여 그에 대한 생계지원도 함께 이루어져야 한다. 또한, 암 환자 상담 및 관리를 위한 국가 및 지방자치단체에서 전문인력의 확충을 통해 다양한 복지처우를 제공하여야 하며 암 환자의 심리 치료 지원을 적극적으로 지원함으로서 암 환자의 처우 개선이 증대되며 향후 증가하는 암 환자를 관리함으로서 생존율을 높여 암 환자의 삶의 질 향상을 가져오게 될 것이다. According to the National Cancer Registration Statistics for 2017 of having been announced on December 24, 2020, the patients with the presence of cancer stood at 1,870,000 people(3.6% of the whole nation). In terms of the cancer incidence rate, the age-standardized incidence rate per 100,000 people came to 282.8 people, thereby having been down by 6.6 people(2.3%) year on year. This cancer incidence rate grew by 3.7% until 2011 following 1999 and then is reducing by about 2.6% every year after 2011. If our people would survive to life expectancy(83 years old), the probability of getting cancer amounted to 37.4%. Cancer is being estimated to occur in 2 people(39.8%) out of 5 people as for a male(80 years old) and in 1 person(34.2%) among 3 people as to a female(86 years old). Seeing this trend, cancer need to be recognized as a social issue, not an individual matter, and will be able to be considered to require the quick response from the state and local governments. With regard to this, the country stipulated 「Cancer Control Act」 and then is comprehensively establishing and implementing a policy pertinent to the prevention, treatment and research of cancer. In 「Hospice, Palliative Care, and Life-Sustaining Treatment Decision-Making Act」, it is targeting cancer patients among the patient subjects in the hospice palliative care and end-of-life process, thereby prescribing a right in the cancer patients’ life-sustaining treatment decision. But there is a limitation in legislative introduction or effective policy for substantially upgrading cancer patients’ treatment. A rise in cancer patients is definitely expected henceforth. Thus, the management of national and local governments to improve treatment can be mentioned to be more needed. Accordingly, there is a need to enact the responsibilities of the state and local governments based on the legal basis for enhancing the treatment of cancer patients while regarding cancer patients as the socially disadvantaged who will need to be further protected in our society. Hence, concerning the treatment of cancer patients, there is a need to make it a grounded law in the treatment improvement by specifying the rights of cancer patients through the maintenance of the law in 「Cancer Control Act」. In the current 「Notice of the medical expenses support standard, etc. for cancer patients」, there is a need to clearly state the regulations on a financial support for cancer patients in a law and to define cancer patients as the socially disadvantaged, thereby being necessarily made even the livelihood support for it together. Additionally for the cancer patient counseling and management, the state and local governments should provide a variety of the welfare treatments through the expansion of the professional workforce. A positive support for psychotherapy of cancer patients leads to increasing the treatment improvement in cancer patients. Managing cancer patients who grow down the road leads to a rise in survival rate, thereby likely coming to bring about improving the quality of life in cancer patients.

The Impacts of Exercise-Intervention on the Prevention and Treatment of Some Types of Cancer

( Han Kyo Seo ) 한국운동생리학회(구 한국운동과학회) 2021 운동과학 Vol.30 No.1

Cancer is a disease affecting millions of people and one of the primary causes of death worldwide like cardiovascular diseases. Nonpharmacological and nonoperative methods such as proper exercise-intervention, nutrition, maintaining the activity of daily living (ADL), psychological methods can also improve the physical function, cancer progression, and health-related quality of life (HRQOL). However it is extremely important, little light shed on the impacts of exercise-intervention on cancer prevention and treatments. Therefore, the purpose of this study was to analyze the impacts of nonpharmaceutical approaches such as diverse exercise-intervention on cancer prevention and treatments with psychological and physiological health for cancer patients. Moreover, this paper wants to combine knowledge regarding the many experimental papers and systemic reviews of cancer researches and exercise intervention liter-ature. A meta-analysis and systemic reviews of the impacts of an exercise intervention on cancer prevention and treatments were conducted to the PRISMA guidelines. 20 research articles were selected for final inclusion and extraction. And electronic analysis such as PubMed, Google scholar was carried for this study up to May 2020. The search keyword was ‘exercise-intervention and cancer’. We can suggest that physical exercise-intervention might be a suitable combination partner to exercise-related immune therapy in the prevention, delay, and treatment of cancer patients. Moreover, physical exercise-intervention directly enhances the QOL, ADL, healthy life, and even resilience of cancer patients. Therefore, these exercise interventions can be effective at reducing cancer symptoms, and enhancing cancer treatments for diverse and many cancer patients. Reversing low muscle mass can enhance cancer therapy outcomes and mortality. Nutrition strategies also might be helpful. A Follow-up study about specific high-quality tailoring exercise-intervention program on counteracting cancer symptoms, cancer prevention and treatment, physiological and psychological health and HRQOL is urgently needed in this area.

중 하부 직장암의 수술적 치료에 대한 종양학적 고찰

김남규(Nam Kyu Kim) 대한종양외과학회 2012 Korean Journal of Clinical Oncology Vol.8 No.1

Updates and Debate issues form the surgical treatment of middle or low rectal cancer The main goals for the surgical treatment of rectal cancer were the complete removal of the rectal cancer with surrounding lymphatic draining area, which subsequently result in decreasing the rate of local recurrence as well as prolong patient survival. If the tumor located at the near the anal canal, concerning issues will be whether anal sphincter can be preserved or not and furthermore autonomic pelvic nervous system could be saved or not. Multidisciplinary approach for rectal cancer has been more popular and treatment strategy rapidly changing based on more accurate preoperative local staging finding and minimal invasive surgical techniques become popular too. One of the advance technology is the development of transanal local excision techniques such Transanal endoscopic microsurgery technique such as TEM(transendoscopic microsurgery), TEO(transendoscopic operation) and TAMIS (transanal minimal invasive surgery). Those techniques make us be able to excise early rectal cancer with full thickness as well as unfragmented state, also can be approached to the upper rectum, which can not approach with previous conventional transanal approach method. Local excision for early T1 rectal cancer has been regards as good treatment option because patient can avoid complication related to the radial proctotectomy such as anastomoitc leakage, postoperative sexual and voiding dysfunction and dysregulated bowel movements. Neoadjuvant chemoradiation therapy has been recommended for patient with cT3N0 or cT3 N+ rectal cancer because some clinical trials showed us preoperative chemoradiation therapy showed better local control rate and less toxicities than postoperative chemoradiation treatment. Recent clinical trial both retrospective and prospective showed us a promising results about local excision after neoadjuvant chemoradiation selectively in patients with low rectal cancer. Neoadjuvant chemoradiation therapy for cT2N0 followed by local excision reported excellent oncologic outcomes quite comparable to the radical surgery group. In addition to that, there has been some reports which showed clinical complete remission after neoadjuvant chemoradiation therapy could be wait and see. A couple of observational studies showed wait and see can be possible option of treatment in selective patients. Radial surgery for middle and low rectal cancer still remains a cornerstone of surgical treatment Ultralow anterior resection with or without intersphincteric resection became a more standard surgical method for low rectal cancer. Oncologic and functional outcomes has been reported as safe even functional outcomes study was rare. Furthermore, Abdominoperineal resection has been famous for high intraoperative tumor perforation and positive circumferential resection margin, those factors have been contributed to the high rate of local recurrence and poor survival rate compared with sphincter saving procedures for rectal cancer. Recently, there have been great efforts for reducing theses problem and total levator excision or extended abdominoperineal resection concepts emerged. Surgeons who advocated this concept recommended perineal dissection under the Jack-knife position. Surgical management for low rectal cancer should be directed for radically and preserving function based on multimodality approach. We need more high level of evidence based on prospective clinical trials for tailored treatment of rectal cancer patients

대장암 진단 및 치료의 발전 방향

박인자 대한의사협회 2022 대한의사협회지 Vol.65 No.9

Background: Cancer is a major public health problem and the leading cause of death in Korea since 2000. Colorectal cancer is the third leading cause of cancer-related death. Therefore, early detection through screening, surgical techniques improvement, anticancer drugs, adjuvant treatment, and medical resources advancement is important to reduce colorectal cancer-related mortality. Current Concepts: In Korea, the 5-year relative survival rate of patients with colorectal cancer is approximately mid-70%, which is superior to other developed countries, such as the United States, United Kingdom, and Japan, with 60% to 68% because of the well performed screening program and technical improvement. Efforts are underway to conduct active endoscopic treatment for early colorectal cancer and identify cases requiring surgery. Minimally invasive surgery has evolved beyond conventional applications into disease-specific methods, and the robotic system has an important role for evolvement. Performing metastatic colorectal cancer efforts is necessary to improve the survival rate through active surgical treatment and gene therapy. Discussion and Conclusion: Eventually, the role of the patient’s genetic information in diagnosing and treating colorectal cancer is expected to increase. In some cases, diagnosing colorectal cancer using a non-invasive method is already realized. Active surgical treatment based on personal characteristics contributes in improving the treatment outcomes for difficult-to-treat metastatic colorectal cancer. After the period of overall colorectal cancer treatment results improvement, we will undertake the precision treatment era.

난소절제술이 약관상 ‘치유’ 목적에 해당되는지 여부 - 대법원 2021. 9. 9. 선고 2021다234368 판결을 중심으로 -

전한덕 (사)한국보험법학회 2022 보험법연구 Vol.16 No.1

The number of cancer patients is continuously increasing in Korea. Cancer accounts for the highest percentage of deaths in Koreans. As a result, the number of people who join cancer insurance products is steadily increasing to prepare for cancer. Those who have contracted a cancer insurance expect to be able to be fully funded through their insurance products. However, although people have joined cancer insurance, they have not been able to receive the insurance money properly and related disputes are increasing. The clause of cancer insurance and conditions of this case stipulate that if the disability payment rate is more than 50% due to the same cause other than the same disaster or disaster, the premium payment is exempted. The subject judgment was that the plaintiff who was diagnosed with Atypical Combined Endometriosis performed ovarian resection, and the loss of both ovaries was subject to the exemption of premium payment under the insurance clause. However, the term ‘treatment’ was used in the subject judgment, and most of the other clauses of cancer insurance use the expression of ‘direct treatment purpose of cancer'. Therefore, it is not desirable to interpret the object judgment as the same standard with other cases. Therefore, even if the treatment purpose and preventive purpose are exist in any medical treatment for the treatment of cancer, the medical treatment should be centered on the therapeutic purpose in order to be a ‘direct treatment of cancer’ under the clause of cancer insurance. 우리나라에서 암 환자 수는 지속적으로 증가하고 있다. 암은 한국인의 사망원인 중 가장 높은 비중을 차지하고 있다. 이에 따라 암에 대비하기 위하여 암보험상품에 가입하는 사람들 또한 꾸준히 늘고 있다. 이처럼 암보험에 가입한 사람들은 자신의 보험상품을 통해 암 치료비 재원을 충분히 마련할 수 있기를 기대한다. 그러나 많은 사람들이 암보험에 가입하고도 보험금을 제대로 지급받지 못하여 분쟁이 지속적으로 증가하고 있다. 이 사건 암보험약관에서는‘동일한 재해 또는 재해 이외의 동일한 원인으로 장해지급률 50% 이상 장해상태’가 되었을 경우 보험료 납입이 면제되는 것으로 규정하고 있다. 대상판결은 비정형 복합 자궁내막증식증 진단을 받은 원고가 난소절제술을 시행하였고, 이로 인한 양쪽 난소의 상실이 약관상 보험료 납입면제 요건에 해당된다고 판시하였다. 대상판결은 의사가 환자의 질병을 치료함에 있어서는 치료적인 목적과 예방적인 목적이 병존할 수 있음을 전제하고, 양자가 병존할 경우에는 보험소비자에게 유리한 방향으로 해석하였다. 이는 기존 암보험 약관상 ‘직접적인 치료’의 해석에 있어서도 중요한 참고자료가 될 수 있을 것으로 보인다. 그러나 대상판결에서 문제된 약관에서는 ‘치유’라는 용어를 사용하고 있고, 다른 암보험 약관에서는 대부분 ‘암의 직접적 치료목적’으로 라는 표현을 사용하고 있기 때문에 대상판결과 동일한 기준으로 해석하는 것은 바람직하지 않다. 따라서 암을 치료하기 위한 어떠한 의료행위에 해당 암을 직접적으로 치료하기 위한 목적과 예방목적이 병존하는 경우에도 암보험 약관상 암의 ‘직접적인 치료’에 해당되기 위해서는 해당 의료행위가 치료목적을 중심으로 이루어져야 하고, 예방목적은 단지 이에 부수하는 차원에 머물러야 할 것이다.