Lisa DiMartino, Vincent Merrill, Celette Sugg Skinner, Ramona Rhodes, Timothy P Hogan, Winnie S Wang, Navid Sadeghi, Arthur S Hong
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引用次数: 0
Abstract
Context: Frailty is common among patients with advanced cancer and increases risk for poorer outcomes. Frail patients may benefit from palliative care (PC) services. Limited data examine how frailty relates to PC delivery within safety-net systems.
Objectives: To examine association between frailty and setting of PC initiation (inpatient consultation vs. outpatient clinic referral) among patients with advanced cancer. Secondarily, we examined whether frailty was associated with PC exposure exclusively in the inpatient setting vs. only outpatient referral.
Methods: Patients with advanced-stage solid tumor exposed to PC from January 2018 to July 2023 at Parkland Health were identified via electronic health record. Multivariate logistic regression examined associations between frailty level, using a modified electronic frailty index, and 1) initial PC exposure as inpatient consultation (vs. outpatient referral) and 2) inpatient consultation-only (vs. outpatient referral-only). Models adjusted for key covariates.
Results: Among 1053 patients (44.3% female, 75% non-White, mean age: 57.7), 46.2% were mildly frail and 23.6% were moderately/severely frail. In multivariate regression, frailty was associated with greater odds of initiating PC as an inpatient consultation (v fit; moderate/severe frailty: adjusted Odds Ratio (aOR), 3.50 [95% Confidence Interval [CI] 1.71-7.18]; mild frailty: aOR, 2.37 [95% CI 1.34-4.19]) and inpatient consultation-only (v fit; moderate/severe frailty: aOR 4.48, [95% CI 2.67-7.53]; mild frailty: (aOR 2.72, [95% CI 1.74-4.24]).
Conclusion: Higher frailty was associated with inpatient PC initiation among patients with advanced cancer exposed to PC. These findings reflect the complex interplay of increased disease burden and access challenges faced by vulnerable cancer patients.
背景：虚弱在晚期癌症患者中很常见，并增加了不良预后的风险。体弱病人可能受益于姑息治疗（PC）服务。有限的数据检验了脆弱性与安全网络系统内个人电脑交付的关系。目的：研究晚期癌症患者虚弱与PC起始（住院咨询与门诊转诊）之间的关系。其次，我们检查了虚弱是否与PC暴露相关，仅在住院环境中或仅在门诊转诊中。方法：通过电子健康记录对2018年1月至2023年7月在帕克兰健康中心暴露于PC的晚期实体瘤患者进行鉴定。多变量逻辑回归检验了虚弱水平（使用改进的电子虚弱指数）与1)住院会诊（与门诊转诊相比）和2)仅住院会诊（与仅门诊转诊相比）的初始PC暴露之间的关联。根据关键协变量调整的模型。结果：1053例患者（女性44.3%，非白人75%，平均年龄57.7岁）中，46.2%为轻度虚弱，23.6%为中/重度虚弱。在多变量回归中，虚弱与在住院会诊时启动PC的几率较大相关(v fit；中度/重度虚弱：调整优势比（aOR）， 3.50 [95% CI 1.71至7.18]；轻度虚弱：aOR， 2.37 [95% CI 1.34至4.19])和仅住院会诊（v拟合；中度/重度虚弱：aOR 4.48, [95% CI 2.67至7.53]；轻度虚弱：aOR 2.72, [95% CI 1.74至4.24]）。结论：在暴露于PC的晚期癌症患者中，较高的脆弱性与住院PC的发生有关。这些发现反映了脆弱癌症患者面临的疾病负担增加和获取挑战之间复杂的相互作用。
期刊介绍：
The Journal of Pain and Symptom Management is an internationally respected, peer-reviewed journal and serves an interdisciplinary audience of professionals by providing a forum for the publication of the latest clinical research and best practices related to the relief of illness burden among patients afflicted with serious or life-threatening illness.
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