{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T22:02:15Z","timestamp":1779919335329,"version":"3.53.1"},"reference-count":28,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,12,28]],"date-time":"2024-12-28T00:00:00Z","timestamp":1735344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Open Access Publication Fund of Bielefeld University and the Deutsche Forschungsgemeinschaft (DFG)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>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 (\u226450 years) (OR: 1.73; 95% CI: 1.30\u20132.14) and males (OR: 1.46; 95% CI: 1.23\u20131.72). Distant metastases showed no significant association (OR: 0.96; 95% CI: 0.81\u20131.13). 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.<\/jats:p>","DOI":"10.3390\/cancers17010056","type":"journal-article","created":{"date-parts":[[2024,12,31]],"date-time":"2024-12-31T14:21:12Z","timestamp":1735654872000},"page":"56","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Discharge Against Medical Advice in Cancer Patients: Insights from a Multicenter Study in Germany"],"prefix":"10.3390","volume":"17","author":[{"given":"Sarah","family":"Krieg","sequence":"first","affiliation":[{"name":"Department of Inclusive Medicine, University Hospital Ostwestfalen-Lippe, Bielefeld University, 33617 Bielefeld, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2799-2287","authenticated-orcid":false,"given":"Sven H.","family":"Loosen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Roderburg","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2496-1079","authenticated-orcid":false,"given":"Andreas","family":"Krieg","sequence":"additional","affiliation":[{"name":"Department of General and Visceral Surgery, Thoracic Surgery and Proctology, University Hospital Herford, Medical Campus OWL, Ruhr University Bochum, 32049 Herford, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2124-7227","authenticated-orcid":false,"given":"Karel","family":"Kostev","sequence":"additional","affiliation":[{"name":"Epidemiology, IQVIA, 60549 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1056\/NEJMp078046","article-title":"Leaving against medical advice","volume":"357","author":"Taqueti","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"255","DOI":"10.4065\/84.3.255","article-title":"\u201cI\u2019m going home\u201d: Discharges against medical advice","volume":"84","author":"Alfandre","year":"2009","journal-title":"Mayo Clin. Proc."},{"key":"ref_3","first-page":"417","article-title":"What happens to patients who leave hospital against medical advice?","volume":"168","author":"Hwang","year":"2003","journal-title":"CMAJ Can. Med. Assoc. J. = J. L\u2019association Medicale Can."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1016\/j.amjmed.2007.08.024","article-title":"Hospital discharge against advice after myocardial infarction: Deaths and readmissions","volume":"120","author":"Fiscella","year":"2007","journal-title":"Am. J. Med."},{"key":"ref_5","unstructured":"Beauchamp, T.L., and Childress, J.F. (2001). Principles of Biomedical Ethics, Oxford University Press. [5th ed.]."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1007\/s00264-023-05836-4","article-title":"Discharge against medical advice: Cross-sectional survey from a regional orthopaedic hospital in sub-Saharan Africa","volume":"47","author":"Toluse","year":"2023","journal-title":"Int. Orthop."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Abuzeyad, F.H., Farooq, M., Alam, S.F., Ibrahim, M.I., Bashmi, L., Aljawder, S.S., Ellouze, N., Almusalam, A., Hsu, S., and Das, P. (2021). Discharge against medical advice from the emergency department in a university hospital. BMC Emerg. Med., 21.","DOI":"10.1186\/s12873-021-00422-6"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1056\/NEJMp1914671","article-title":"Against Medical Advice","volume":"382","author":"Sievert","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.amjms.2023.04.007","article-title":"The risk factors, consequences, and interventions of discharge against medical advice\u2014A narrative review","volume":"366","author":"Foster","year":"2023","journal-title":"Am. J. Med. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1176\/ps.2006.57.8.1192","article-title":"Discharge against medical advice from inpatient psychiatric treatment: A literature review","volume":"57","author":"Brook","year":"2006","journal-title":"Psychiatr. Serv."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"61","author":"Altman","year":"2008","journal-title":"J. Clin. Epidemiol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Kostev, K., Krieg, S., Krieg, A., Luedde, T., Loosen, S.H., and Roderburg, C. (2024). In-Hospital Mortality and Associated Factors among Colorectal Cancer Patients in Germany. Cancers, 16.","DOI":"10.3390\/cancers16061219"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Kostev, K., Michalowsky, B., and Bohlken, J. (2024). In-Hospital Mortality in Patients with and without Dementia across Age Groups, Clinical Departments, and Primary Admission Diagnoses. Brain Sci., 14.","DOI":"10.3390\/brainsci14050455"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/j.amjsurg.2007.07.005","article-title":"Defining social support systems for women with breast cancer","volume":"194","author":"Gass","year":"2007","journal-title":"Am. J. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Choi, M., Kim, H., Qian, H., and Palepu, A. (2011). Readmission rates of patients discharged against medical advice: A matched cohort study. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0024459"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e000902","DOI":"10.1136\/bmjopen-2012-000902","article-title":"A qualitative study to identify reasons for discharges against medical advice in the cardiovascular setting","volume":"2","author":"Onukwugha","year":"2012","journal-title":"BMJ Open"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1080\/08897077.2019.1671942","article-title":"Understanding why patients with substance use disorders leave the hospital against medical advice: A qualitative study","volume":"41","author":"Simon","year":"2020","journal-title":"Subst. Abus."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1111\/dar.13311","article-title":"Predictors of and reasons for early discharge from inpatient withdrawal management settings: A scoping review","volume":"41","author":"Ling","year":"2022","journal-title":"Drug Alcohol Rev."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Kraut, A., Fransoo, R., Olafson, K., Ramsey, C.D., Yogendran, M., and Garland, A. (2013). A population-based analysis of leaving the hospital against medical advice: Incidence and associated variables. BMC Health Serv. Res., 13.","DOI":"10.1186\/1472-6963-13-415"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1056\/NEJMsa0802381","article-title":"Growth in the care of older patients by hospitalists in the United States","volume":"360","author":"Kuo","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Hern\u00e1ndez-Morales, A., Gonz\u00e1lez-L\u00f3pez, B.S., Scougall-Vilchis, R.J., Bermeo-Escalona, J.R., Vel\u00e1zquez-Enr\u00edquez, U., Islas-Zaraz\u00faa, R., M\u00e1rquez-Rodr\u00edguez, S., Sosa-Velasco, T.A., Medina-Sol\u00eds, C.E., and Maupom\u00e9, G. (2023). Lip and Oral Cavity Cancer Incidence and Mortality Rates Associated with Smoking and Chewing Tobacco Use and the Human Development Index in 172 Countries Worldwide: An Ecological Study 2019\u20132020. Healthcare, 11.","DOI":"10.3390\/healthcare11081063"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1007\/s10552-024-01867-3","article-title":"Persistent poverty disparities in incidence and outcomes among oral and pharynx cancer patients","volume":"35","author":"Karanth","year":"2024","journal-title":"Cancer Causes Control CCC"},{"key":"ref_23","first-page":"420","article-title":"Reasons for discharges against medical advice: A qualitative study","volume":"19","author":"Onukwugha","year":"2010","journal-title":"Qual. Saf. Health Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1017\/S1352465822000431","article-title":"The evolution of motivational interviewing","volume":"51","author":"Miller","year":"2023","journal-title":"Behav. Cogn. Psychother."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Bonafede, M., d\u2019Errico, A., Rugarli, S., Mensi, C., Miligi, L., Calisti, R., Della Gatta, R., Piro, S., Melis, P., and Vasselli, D. (2024). The psychological impact of diagnosis of sinonasal, nasopharyngeal, and laryngeal cancers: A systematic review. Front. Psychol., 15.","DOI":"10.3389\/fpsyg.2024.1355186"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1111\/inr.12919","article-title":"Clinical nurse specialists in nutrition: A systematic review of roles and clinical experiences","volume":"71","author":"Mancin","year":"2024","journal-title":"Int. Nurs. Rev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.12968\/bjon.2019.28.20.1308","article-title":"The similarities and differences between advanced nurse practitioners and clinical nurse specialists","volume":"28","author":"Cooper","year":"2019","journal-title":"Br. J. Nurs."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Kilpatrick, K., Savard, I., Audet, L.A., Costanzo, G., Khan, M., Atallah, R., Jabbour, M., Zhou, W., Wheeler, K., and Ladd, E. (2024). A global perspective of advanced practice nursing research: A review of systematic reviews. 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