Krieg Sarah, Loosen Sven H, Roderburg Christoph, Krieg Andreas, Kostev Karel
Department of Inclusive Medicine, University Hospital Ostwestfalen-Lippe, Bielefeld University, 33617 Bielefeld, Germany.
Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany.
Cancers (Basel). 2024 Dec 28;17(1):56. doi: 10.3390/cancers17010056.
Discharge against medical advice (DAMA) disrupts continuity of care and is associated with increased readmission rates, morbidity, and mortality. While extensively studied in general hospital populations, its prevalence and associated factors in cancer patients, where treatment adherence is critical for outcomes, remain underexplored.
This multicenter, cross-sectional study analyzed anonymized data from the IQVIA hospital database, including cancer patients hospitalized in 36 German hospitals between January 2019 and December 2023. Multivariate logistic regression assessed associations between DAMA and factors such as age, sex, cancer type, metastases, and comorbidities.
Among 51,505 cancer patients, DAMA occurred in 0.9% of hospitalizations. The highest rates were observed in cancers of the lip, oral cavity, and pharynx (2.1%), larynx (2.0%), and liver (1.8%). DAMA was more frequent in younger patients (≤50 years) (OR: 1.73; 95% CI: 1.30-2.14) and males (OR: 1.46; 95% CI: 1.23-1.72). Distant metastases showed no significant association (OR: 0.96; 95% CI: 0.81-1.13).
The findings suggest that DAMA in cancer patients is more strongly associated with demographic and social factors than with disease severity. These results provide a basis for exploring strategies that address underlying psychosocial and economic challenges during hospitalization, particularly in younger and male patients. Further research is needed to better understand these associations and their implications for clinical practice.
违反医嘱出院（DAMA）会破坏医疗连续性，并与再入院率、发病率和死亡率的增加相关。虽然在综合医院人群中已进行了广泛研究，但其在癌症患者中的患病率及相关因素（治疗依从性对治疗结果至关重要）仍未得到充分探索。
这项多中心横断面研究分析了IQVIA医院数据库中的匿名数据，包括2019年1月至2023年12月期间在36家德国医院住院的癌症患者。多变量逻辑回归评估了DAMA与年龄、性别、癌症类型、转移情况和合并症等因素之间的关联。
在51505名癌症患者中，0.9%的住院患者出现了违反医嘱出院的情况。唇部、口腔和咽部癌症（2.1%）、喉癌（2.0%）和肝癌（1.8%）的发生率最高。违反医嘱出院在年轻患者（≤50岁）中更常见（比值比：1.73；95%置信区间：1.30 - 2.14），在男性中也更常见（比值比：1.46；95%置信区间：1.23 - 1.72）。远处转移未显示出显著关联（比值比：0.96；95%置信区间：0.81 - 1.13）。
研究结果表明，癌症患者的违反医嘱出院与人口统计学和社会因素的关联比与疾病严重程度的关联更强。这些结果为探索应对住院期间潜在心理社会和经济挑战的策略提供了依据，特别是针对年轻和男性患者。需要进一步研究以更好地理解这些关联及其对临床实践的影响。
