Ponzetti Agostino, Lista Patrizia, Pagano Eva, Demichelis Maria Maddalena, Ciuffreda Libero, Ciccone Giovannino
Tumori. 2014 Jan-Feb;100(1):91-6. doi: 10.1700/1430.15822.
The study analyzed the value of physical and psychosocial frailty assessment in predicting the need for supportive care and the risk of short-term failures after discharge in hospitalized cancer patients.
Frailty was assessed in 350 consecutive patients using a multidimensional tool. Patients were followed for 4 months after discharge to record the occurrence of chemotherapy interruption, urgent hospital readmission or death. The association between patient characteristics and the outcomes were analyzed with either logistic or Cox multivariable models.
About 40% of patients were classified as frail, with a higher prevalence of clinical frailty (alone or together with psychosocial frailty). Psychosocial frailty was positively associated with the need for supportive care at discharge (adjusted OR, 3.46; 95% CI, 1.55-7.76) but did not predict a worse prognosis when other important clinical factors were considered. However, the need for supportive care at discharge, in addition to advanced disease and reduced performance status, was a strong predictor of short-term hospital readmission or death (HR 7.50; 95% CI, 3.12-18.02).
A more comprehensive assessment of frailty in cancer patients can aid in the timely identification of the need for supportive care after hospital discharge and improves the prediction of the short-term risk of hospital readmission or death.
本研究分析了身体和心理社会衰弱评估在预测住院癌症患者出院后支持性护理需求及短期预后不良风险方面的价值。
使用多维工具对350例连续患者进行衰弱评估。患者出院后随访4个月，记录化疗中断、紧急住院再入院或死亡的发生情况。采用逻辑回归或Cox多变量模型分析患者特征与结局之间的关联。
约40%的患者被归类为衰弱，临床衰弱（单独或与心理社会衰弱一起）的患病率更高。心理社会衰弱与出院时支持性护理需求呈正相关（校正比值比，3.46；95%可信区间，1.55 - 7.76），但在考虑其他重要临床因素时不能预测更差的预后。然而，出院时支持性护理需求，除了疾病进展和体能状态下降外，是短期住院再入院或死亡的有力预测因素（风险比7.50；95%可信区间，3.12 - 18.02）。
对癌症患者衰弱进行更全面的评估有助于及时识别出院后支持性护理需求，并改善对住院再入院或死亡短期风险的预测。
