Background: 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. Methods: 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. Results: 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). Conclusions: 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.
背景：违背医疗建议出院（DAMA）会中断治疗的连续性，并与再入院率、发病率和死亡率的增加相关。尽管在普通住院人群中已有广泛研究，但在癌症患者中，治疗依从性对预后至关重要，其DAMA的发生率及相关因素仍未得到充分探讨。方法：这项多中心横断面研究分析了来自IQVIA医院数据库的匿名数据，包括2019年1月至2023年12月期间在德国36家医院住院的癌症患者。采用多变量逻辑回归分析评估DAMA与年龄、性别、癌症类型、转移及合并症等因素之间的关联。结果：在51,505名癌症患者中，DAMA发生率为住院人次的0.9%。发生率最高的癌症类型为唇、口腔和咽部癌（2.1%）、喉癌（2.0%）和肝癌（1.8%）。DAMA在年轻患者（≤50岁）（OR：1.73；95% CI：1.30–2.14）和男性患者（OR：1.46；95% CI：1.23–1.72）中更为常见。远处转移未显示出显著关联（OR：0.96；95% CI：0.81–1.13）。结论：研究结果表明，癌症患者的DAMA与人口统计学和社会因素的相关性强于疾病严重程度。这些结果为探索在住院期间解决潜在心理社会和经济挑战的策略提供了依据，尤其是在年轻和男性患者中。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。
Discharge Against Medical Advice in Cancer Patients: Insights from a Multicenter Study in Germany
肿瘤(癌症)患者之家