TY - JOUR
T1 - Factors Associated With Attrition in a Multicenter Longitudinal Observational Study of Patients With Advanced Cancer
AU - Perez-Cruz, Pedro E.
AU - Shamieh, Omar
AU - Paiva, Carlos Eduardo
AU - Kwon, Jung Hye
AU - Muckaden, Mary Ann
AU - Bruera, Eduardo
AU - Hui, David
N1 - Funding Information:
Pedro Perez-Cruz is supported in part by funds awarded by the National Commission for Scientific and Technological Research, Santiago, Chile (FONDECYT INICIO 11130533; REDES1440024). David Hu is supported in part by National Institutes of Health grants ( 1R01CA214960-01A1 , R21NR016736 ), an American Cancer Society Mentored Research Scholar Grant in Applied and Clinical Research ( MRSG-14-1418-01-CCE ), and the Andrew Sabin Family Fellowship Award.
Funding Information:
Pedro Perez-Cruz is supported in part by funds awarded by the National Commission for Scientific and Technological Research, Santiago, Chile (FONDECYT INICIO 11130533; REDES1440024). David Hu is supported in part by National Institutes of Health grants (1R01CA214960-01A1, R21NR016736), an American Cancer Society Mentored Research Scholar Grant in Applied and Clinical Research (MRSG-14-1418-01-CCE), and the Andrew Sabin Family Fellowship Award.
Publisher Copyright:
© 2017 American Academy of Hospice and Palliative Medicine
PY - 2018/3
Y1 - 2018/3
N2 - Context: Attrition is common in longitudinal observational studies in palliative care. Few studies have examined predictors of attrition. Objectives: To identify patient characteristics at enrollment associated with attrition in palliative oncology outpatient setting. Methods: In this longitudinal observational study, advanced cancer patients enrolled in an outpatient multicenter study were assessed at baseline and two to five weeks later. We compared baseline characteristics between patients who returned for follow-up and those who dropped out. Results: Seven hundred forty-four patients were enrolled from Jordan, Brazil, Chile, Korea, and India. Attrition rate was 33%, with variation among countries (22%–39%; P = 0.023). In univariate analysis, baseline predictors for attrition were cognitive failure (odds ratio [OR] 1.23 per point in Memorial Delirium Assessment Scale; P < 0.01), functional status (OR 1.55 per 10-point decrease in Karnofsky Performance Status; P < 0.01), Edmonton Symptom Assessment Scale [ESAS] physical score (OR 1.03 per point; P < 0.01), ESAS emotional score (OR 1.05 per point; P < 0.01), and shorter duration between cancer diagnosis and palliative care referral in months (OR 0.89 per log; P = 0.028). In multivariate analysis, cognitive failure (OR 1.12 per point; P = 0.007), ESAS physical score (OR 1.18 per point; P = 0.027), functional status (OR 1.35 per 10-point decrease; P < 0.001), and shorter duration from cancer diagnosis (OR 0.86 per log; P = 0.01) remained independent predictors of attrition. Conclusion: Advanced cancer patients with cognitive failure, increased physical symptoms, poorer performance status, and shorter duration from cancer diagnosis were more likely to dropout. These results have implications for research design, patient selection, and data interpretation in longitudinal observational studies.
AB - Context: Attrition is common in longitudinal observational studies in palliative care. Few studies have examined predictors of attrition. Objectives: To identify patient characteristics at enrollment associated with attrition in palliative oncology outpatient setting. Methods: In this longitudinal observational study, advanced cancer patients enrolled in an outpatient multicenter study were assessed at baseline and two to five weeks later. We compared baseline characteristics between patients who returned for follow-up and those who dropped out. Results: Seven hundred forty-four patients were enrolled from Jordan, Brazil, Chile, Korea, and India. Attrition rate was 33%, with variation among countries (22%–39%; P = 0.023). In univariate analysis, baseline predictors for attrition were cognitive failure (odds ratio [OR] 1.23 per point in Memorial Delirium Assessment Scale; P < 0.01), functional status (OR 1.55 per 10-point decrease in Karnofsky Performance Status; P < 0.01), Edmonton Symptom Assessment Scale [ESAS] physical score (OR 1.03 per point; P < 0.01), ESAS emotional score (OR 1.05 per point; P < 0.01), and shorter duration between cancer diagnosis and palliative care referral in months (OR 0.89 per log; P = 0.028). In multivariate analysis, cognitive failure (OR 1.12 per point; P = 0.007), ESAS physical score (OR 1.18 per point; P = 0.027), functional status (OR 1.35 per 10-point decrease; P < 0.001), and shorter duration from cancer diagnosis (OR 0.86 per log; P = 0.01) remained independent predictors of attrition. Conclusion: Advanced cancer patients with cognitive failure, increased physical symptoms, poorer performance status, and shorter duration from cancer diagnosis were more likely to dropout. These results have implications for research design, patient selection, and data interpretation in longitudinal observational studies.
KW - Palliative care
KW - attrition
KW - longitudinal study
KW - oncology
KW - outpatient
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U2 - 10.1016/j.jpainsymman.2017.11.009
DO - 10.1016/j.jpainsymman.2017.11.009
M3 - Article
C2 - 29155290
AN - SCOPUS:85041571239
SN - 0885-3924
VL - 55
SP - 938
EP - 945
JO - Journal of pain and symptom management
JF - Journal of pain and symptom management
IS - 3
ER -