Department of Internal Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Department of Palliative Care, King Hussein Cancer Center, Amman, Jordan.
J Pain Symptom Manage. 2018 Mar;55(3):938-945. doi: 10.1016/j.jpainsymman.2017.11.009. Epub 2017 Nov 16.
Attrition is common in longitudinal observational studies in palliative care. Few studies have examined predictors of attrition.
To identify patient characteristics at enrollment associated with attrition in palliative oncology outpatient setting.
In this longitudinal observational study, advanced cancer patients enrolled in an outpatient multicenter study were assessed at baseline and two to five weeks later. We compared baseline characteristics between patients who returned for follow-up and those who dropped out.
Seven hundred forty-four patients were enrolled from Jordan, Brazil, Chile, Korea, and India. Attrition rate was 33%, with variation among countries (22%-39%; P = 0.023). In univariate analysis, baseline predictors for attrition were cognitive failure (odds ratio [OR] 1.23 per point in Memorial Delirium Assessment Scale; P < 0.01), functional status (OR 1.55 per 10-point decrease in Karnofsky Performance Status; P < 0.01), Edmonton Symptom Assessment Scale [ESAS] physical score (OR 1.03 per point; P < 0.01), ESAS emotional score (OR 1.05 per point; P < 0.01), and shorter duration between cancer diagnosis and palliative care referral in months (OR 0.89 per log; P = 0.028). In multivariate analysis, cognitive failure (OR 1.12 per point; P = 0.007), ESAS physical score (OR 1.18 per point; P = 0.027), functional status (OR 1.35 per 10-point decrease; P < 0.001), and shorter duration from cancer diagnosis (OR 0.86 per log; P = 0.01) remained independent predictors of attrition.
Advanced cancer patients with cognitive failure, increased physical symptoms, poorer performance status, and shorter duration from cancer diagnosis were more likely to dropout. These results have implications for research design, patient selection, and data interpretation in longitudinal observational studies.
在姑息治疗的纵向观察性研究中，失访很常见。很少有研究探讨失访的预测因素。
确定姑息肿瘤门诊环境中与失访相关的入组时患者特征。
在这项纵向观察性研究中，招募了来自约旦、巴西、智利、韩国和印度的晚期癌症患者，在基线和 2 至 5 周后进行评估。我们比较了返回随访和失访患者的基线特征。
从约旦、巴西、智利、韩国和印度招募了 744 名患者。失访率为 33%，各国之间存在差异（22%-39%；P=0.023）。在单因素分析中，失访的基线预测因素包括认知失败（在 Memorial 谵妄评估量表中每增加 1 分，比值比 [OR] 为 1.23；P<0.01）、功能状态（Karnofsky 表现状态每降低 10 分，OR 为 1.55；P<0.01）、埃德蒙顿症状评估量表[ESAS]身体评分（每增加 1 分，OR 为 1.03；P<0.01）、ESAS 情绪评分（每增加 1 分，OR 为 1.05；P<0.01）和癌症诊断与姑息治疗转介之间的时间（以月为单位，OR 为 0.89/对数；P=0.028）。多因素分析中，认知失败（OR 为 1.12/分；P=0.007）、ESAS 身体评分（OR 为 1.18/分；P=0.027）、功能状态（OR 为每降低 10 分，1.35；P<0.001）和癌症诊断时间（OR 为 0.86/对数；P=0.01）仍然是失访的独立预测因素。
认知失败、身体症状增加、功能状态较差和癌症诊断后时间较短的晚期癌症患者更有可能失访。这些结果对纵向观察性研究的研究设计、患者选择和数据解释具有启示意义。
