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支持性护理诊所收治患者的临床特征与管理及非计划再次入院的 predisposing 因素:单中心经验。 (注:“predisposing”此处可能是“诱发、易患相关的”意思,但需结合更多语境准确理解,这里按原文直接翻译)

Clinical Characteristics and Management of Patients Admitted to the Supportive Care Clinic and Predisposing Factors of Unplanned Hospital Readmission: Single-Center Experience.

作者信息

Baş Onur, Tokatlı Mert, Güdük Naciye, Erdoğan Dilara, Boyraz Nur Evşan, Çengelci Çağla, Guven Deniz Can, Dizdar Ömer, Türker Fatma Alev, Aksoy Sercan

机构信息

Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Sihhiye, 06100 Ankara, Turkey.

Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Sihhiye, 06100 Ankara, Turkey.

出版信息

J Clin Med. 2025 Apr 14;14(8):2679. doi: 10.3390/jcm14082679.

Abstract

It is well known that supportive care clinics are vital in medical oncology practice. This study aims to present a portrait of the supportive care clinic of a tertiary cancer center in a low-middle-income country. This study included patients admitted to our supportive care clinic between January 2019 and December 2023. This study included patients who attended the supportive care clinic. For patients who were readmitted more than once throughout the study period, only the first readmission was included in the analysis. The primary outcome of this study was a better understanding of the risk factors associated with hospital readmissions in cancer patients, which could lead to improved patient outcomes. In addition, the secondary objective was to identify the characteristics of patients and clinical decisions regarding follow-ups as inpatients or outpatients referred to the supportive care clinic. This study included 477 patients; 300 (62.9%) were directed to oncology inpatient care, while 177 (37.1%) were treated as outpatients. The most common diagnoses were lung cancer (20.5%), colorectal cancer (13.6%), and breast cancer (8.4%). Most patients (71.5%) were evaluated for symptom palliation. In multivariate analysis, metastatic disease (OR: 2.52 95% CI 1.48-4.29 = 0.001), Eastern Cooperative Oncology Group (ECOG) performance status (OR: 1.58 95% CI 1.04-2.42 = 0.034), and a decrease in albumin levels (OR: 0.42 95% CI 0.29-0.61 < 0.001) were significantly related to hospitalization. In univariate analyses, albumin level ( < 0.001), disease stage ( = 0.007), and ECOG performance status ( = 0.025) were statistically associated with unplanned hospital readmission. Among these factors, a decrease in albumin levels was significantly associated with the outcome, with an odds ratio of 0.54 (95% CI 0.39-0.75, < 0.001), indicating a protective effect of higher albumin levels. In univariate analyses, sex ( = 0.016), cancer treatment type ( = 0.010), albumin level ( < 0.001), disease stage ( < 0.001), unplanned hospital readmission ( < 0.001), ECOG performance status ( < 0.001), and hemoglobin ( = 0.008) were statistically related to overall survival. Among these factors, sex (HR: 1.28 95% CI 1.03-1.59 = 0.025), a decrease in albumin levels (HR: 0.67 95% CI 0.56-0.82 < 0.001), disease stage (HR: 1.52 95% CI 1.11-2.09 = 0.008), unplanned hospital readmission (HR: 1.30 95% CI 1.03-1.63 = 0.027), and ECOG performance status (HR: 3.45 95% CI 2.68-4.45 < 0.001) remained significant in the multivariate analysis. This study shows that supportive care clinics are a key element of patient care. Early evaluation of patients in supportive care clinics may aid clinicians in identifying high-risk patients who may require closer follow-up or inpatient care. Several factors were identified as predisposing to hospitalization, unplanned hospital readmission, and overall survival. Further prospective studies are needed to determine the risk factors associated with hospitalization, readmission, and overall survival.

摘要

众所周知,支持性护理诊所在医学肿瘤学实践中至关重要。本研究旨在描绘一个中低收入国家三级癌症中心支持性护理诊所的情况。本研究纳入了2019年1月至2023年12月期间入住我们支持性护理诊所的患者。本研究纳入了就诊于支持性护理诊所的患者。对于在整个研究期间多次重新入院的患者,分析中仅包括首次重新入院情况。本研究的主要结果是更好地了解癌症患者再次入院的相关风险因素,这可能会改善患者的治疗结果。此外,次要目标是确定转诊至支持性护理诊所的患者的特征以及关于住院或门诊随访的临床决策。本研究包括477名患者;300名(62.9%)被安排接受肿瘤住院治疗,而177名(37.1%)接受门诊治疗。最常见的诊断是肺癌(20.5%)、结直肠癌(13.6%)和乳腺癌(8.4%)。大多数患者(71.5%)接受了症状缓解评估。在多变量分析中,转移性疾病(OR:2.52,95%CI 1.48 - 4.29,P = 0.001)、东部肿瘤协作组(ECOG)体能状态(OR:1.58,95%CI 1.04 - 2.42,P = 0.034)以及白蛋白水平降低(OR:0.42,95%CI 0.29 - 0.61,P < 0.001)与住院显著相关。在单变量分析中,白蛋白水平(P < 0.001)、疾病分期(P = 0.007)和ECOG体能状态(P = 0.025)与非计划再次入院在统计学上相关。在这些因素中,白蛋白水平降低与结果显著相关,优势比为0.54(95%CI 0.39 - 0.75,P < 0.001),表明较高的白蛋白水平具有保护作用。在单变量分析中,性别(P = 0.016)、癌症治疗类型(P = 0.010)、白蛋白水平(P < 0.001)、疾病分期(P < 0.001)、非计划再次入院(P < 0.001)、ECOG体能状态(P < 0.001)和血红蛋白(P = 0.008)与总生存期在统计学上相关。在这些因素中,性别(HR:1.28,95%CI 1.03 - 1.59,P = 0.025)、白蛋白水平降低(HR:0.67,95%CI 0.56 - 0.82,P < 0.001)、疾病分期(HR:1.52,95%CI 1.11 - 2.09,P = 0.008)、非计划再次入院(HR:1.30,95%CI 1.03 - 1.63,P = 0.027)和ECOG体能状态(HR:3.45,95%CI 2.68 - 4.45,P < 0.001)在多变量分析中仍然显著。本研究表明,支持性护理诊所是患者护理的关键要素。在支持性护理诊所对患者进行早期评估可能有助于临床医生识别可能需要更密切随访或住院治疗的高危患者。确定了几个易导致住院、非计划再次入院和总生存期的因素。需要进一步的前瞻性研究来确定与住院、再次入院和总生存期相关的风险因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bdb5/12028016/cf9e87efcb76/jcm-14-02679-g001.jpg

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