Tam-McDevitt Jennifer
Geriatric Oncology Consortium, Baltimore, Maryland, USA.
Oncology (Williston Park). 2008 Aug;22(9):1052-5, discussion 1055, 1058, 1060.
The plethora of medications taken by older patients with cancer increases the risk for adverse drug reactions, drug-drug interactions, and nonadherence for this age group. Although polypharmacy can be an issue in any age group, it can especially be a problem for the elderly, who consume more medications than any other patient group. Factors such as the presence of multiple comorbid conditions, advances in pharmacotherapy, and increased availability of over-the-counter and herbal supplements for self-treatment can all contribute to polypharmacy in this population. Physiologic changes associated with aging may alter the pharmacokinetic and pharmacodynamics of drug metabolism, which, in turn, affects potential drug toxicities. The incorporation of preventive methods--such as patient and physician education, and regular medication list review and monitoring--prior to its occurrence is key to preventing polypharmacy. Clinical trials designed to better reflect the "typical" general elderly population as well as to consider the implications of cost, drug interactions/metabolism, and adherence are needed to substantiate our clinical practice when dealing with the largest subset of our cancer population.
老年癌症患者服用的药物过多，增加了该年龄组发生药物不良反应、药物相互作用和用药依从性差的风险。尽管多重用药在任何年龄组都可能是个问题，但对老年人来说尤其成问题，因为他们服用的药物比其他任何患者群体都多。多种合并症的存在、药物治疗的进展以及非处方和草药补充剂用于自我治疗的可得性增加等因素，都可能导致该人群出现多重用药情况。与衰老相关的生理变化可能会改变药物代谢的药代动力学和药效学，进而影响潜在的药物毒性。在多重用药情况发生之前采用预防方法，如对患者和医生进行教育，定期审查和监测用药清单，是预防多重用药的关键。需要开展临床试验，以更好地反映“典型”的一般老年人群，并考虑成本、药物相互作用/代谢以及依从性方面的影响，以便在应对癌症患者这一最大亚群时充实我们的临床实践。
