PDF(Pubmed)
Abstract：
Background and Objectives: The discharge destination of patients with advanced cancer correlates with their quality of life. Patients with bone metastases often undergo lifestyle changes owing to pain and activity limitations. However, there are few reports on factors related to the discharge destination of patients with bone metastases. This study aimed to elucidate the factors associated with the discharge destination of patients with bone metastases. Methods: This study included 278 patients diagnosed with bone metastases who were admitted to the University of Tsukuba Hospital between April 2015 and March 2020. This study examined discharge destination, occurrence of skeletal-related events (SREs), primary lesions, locations of bone metastases, functional ambulation categories (FAC), age, and length of hospital stay. A binomial logistic regression analysis was conducted to compare the home and non-home discharge groups. Results: Of the 278 patients, 142 were discharged to home, 89 were discharged to somewhere other than home (non-home), and 47 died. The discharge destination was associated with spinal cord compression (SCC) (odds ratio [OR] 3.37, 95% confidence interval [CI] 1.35-8.43), hypercalcemia (OR 6.84, 95% CI 1.09-42.76), and FAC at admission (OR 0.45, 95% CI 0.35-0.58). The admission FAC cut-off value for discharge to home was determined to be 1.5 (area under the curve [AUC] 0.79, sensitivity 77.5%, specificity 68.5%). Conclusions: Factors associated with discharge destination were identified. The walking ability required for discharge to home was FAC 1.5, meaning that the patient needed one person to assist in preventing falls when walking on level ground. A cut-off value for FAC on admission for predicting outcomes was identified, suggesting the importance of gait ability assessment on admission.
摘要：
背景和目的：晚期癌症患者的出院目的地与他们的生活质量相关。骨转移患者通常由于疼痛和活动限制而改变生活方式。然而,关于骨转移患者出院目的地相关因素的报道很少。本研究旨在阐明与骨转移患者出院目的地相关的因素。方法：这项研究包括2015年4月至2020年3月在筑波大学医院住院的278例诊断为骨转移的患者。这项研究检查了出院目的地，骨骼相关事件（SRE）的发生，原发性病变,骨转移的位置，功能行走类别(FAC)，年龄,和住院时间。进行了二项逻辑回归分析，以比较家庭和非家庭出院组。结果:278例患者中,142人出院回家，89人被出院到家庭以外的地方(非家庭)，47人死亡出院目的地与脊髓压迫（SCC）相关（比值比[OR]3.37，95％置信区间[CI]1.35-8.43），高钙血症（OR6.84，95%CI1.09-42.76），和入院时的FAC（OR0.45，95%CI0.35-0.58）。确定出院到家的入院FAC临界值为1.5（曲线下面积[AUC]0.79，灵敏度77.5％，特异性68.5%）。结论：确定了与出院目的地相关的因素。出院回家所需的步行能力为FAC1.5，这意味着患者在水平地面上行走时需要一个人来帮助防止跌倒。确定了FAC入院时预测结果的截止值，提示步态能力评估对入院的重要性。
